How Stress Affects The Gut
Irritable Bowel Syndrome
Imagine a full auditorium in a theater with at least 200 people. 20 out of the audience will definitely know what it means to have irritable bowel syndrome, a problem that affects an average of 10% of the world’s population. Stress aggravates the dangerous symptoms, the stomach suffers.
Signs of IBS
- Abdominal pain associated with changes in abdominal output (pain when diarrhea and / or constipation start)
- Variable bowel movements (one period is constipation, then begins a period of diarrhea). If there are complaints only of abdominal pain, but it is not accompanied by altered bowel movements, it is likely that it will not be IBS, but rather a functional type of abdominal pain
- Timing: Complaints should be present at least once a week for the last three months and symptoms last for at least six months
Although Professor Anatoliy Danilān has repeatedly said that no one dies from functional disorders of the digestive tract and it does not endanger health in the future, this complaint can damage the quality of life.
This is also the case with Irritable Bowel Syndrome (IBS), in which case the abdomen from time to time behaves like insane – it hurts, bloats, diarrhea, constipation again.
The person has been fully examined, but when receiving the results, the doctor does not understand what is happening, saying – healthy, nothing is wrong with you!
Unfortunately, for a person with IBS, this response is neither relieved nor pleasurable as the symptoms persist. They have shown it that patients with disabilities tend to have an even worse quality of life than those with other more serious diseases, which have an effective treatment that allows symptoms to be corrected.
Patients with IBS are very anxious and think of the worst-case scenario, although the worst thing that could happen to them is that the doctor says “you don’t mind” because it causes confusion.
It is therefore important to explain to patients that this syndrome is indeed very disturbing, but it does not pose a threat to surgery, disability or life expectancy.
How to diagnose IBS
The criteria for diagnosing IBS seem specific, but the path to it is difficult. Because it will never be the case that the patient comes and tells the doctor – I have pain once a week and we relate it to a change in bowel movements.
Often we come to the diagnosis only after 2-3 consultations. On the first visit, we get acquainted, understand the situation, find out what medications the patient is already taking, discuss what to change in the diet, take analyzes.
At the second visit, the results of the tests are usually expected, then the picture of the disease becomes clearer. Honestly, IBS is a rather complicated diagnosis, the mechanisms of this problem are complex and perhaps everything is still unclear.
Describing Your Stools…
There are patients with predominant diarrhea in IBS, some predominantly constipated, while others have mixed disorders.
This is a delicate issue, and it can be difficult for a patient to describe what type of bowel movement he or she has in the doctor’s office.
The doctor should then have a Bristol scale on hand, in which we visualize all seven abdominal outlets. All you have to do is point to the image that best describes the situation.
This helps to determine which subtype of IBS this patient has and to arrive at the most appropriate treatment.
Bristol Stool Scale
1: Individual solid pieces resembling nuts
2: Sausage-like, uniform consistency
3: Sausage-like shape, but the surface is divided, cracked
4: The shape resembles a soft, smooth sausage or snake
5: Several soft pieces with specific contours
6: Soft stools consisting of several pieces with unclear contours
7: Watery stools without solid structures
You should have type 3, 4 or 5 for a healthy stomach.
Find out the IBS subtype
Knowing the subtype of IBS is important because it determines what treatment we might recommend the patient. Because the development of IBS is determined by many factors that interact with each other, there is no single drug that can help all patients.
In most cases, doctors are guided by the type of disorder when prescribing treatment. Patients feel better when arranging bowel movements, whether liquid bowel movements or constipation need to be corrected. Not all IBS patients are treated equally.
IBS-C (dominates constipation)
Stool is most often characterized by variations 1 and 2 of the Bristol scale
IBS-D (dominates diarrhea)
Stool characterizes the 6th and 7th variation of the Bristol scale
Stool sometimes corresponds to variations 1 and 2 of the Bristol scale, sometimes variation 6 or 7
Stool can’t be designated into any variations
Be sure to check the thyroid gland
Irritable bowel syndrome is given as a clinical diagnosis because it has known criteria (Roman criteria) by which the diagnosis can be made to the exclusion of other possible organic diseases.
We must perform basic examinations –
- both physical examination and collection of medical history
- exclusion of obese symptoms
- careful examination of patients
- blood and faecal examinations
If the complaints are about unexplained weight loss, blood in the stools, palpable abdominal formations, enlarged lymph nodes, and the patient is over 45 years of age, they should also perform colonoscopy, which is the gold standard in the colon’s diagnosis.
I also recommend that patients with abdominal problems have a thyroid examination, because with slowed thyroid function (hypothyroidism) – frequent diarrhea.
The brain regulates intestinal function
It closely relates intestinal and brain function. Emotions affect bowel movements, can cause pain. It is also known that one of the most studied neurotransmitters, serotonin, is released in both brain cells and intestinal neuroendocrine cells.
Therefore, in patients with psychosomatic illnesses, anxiety and depression, IBS is also more pronounced. These symptoms often overlap.
One trigger of IBS may be psycho-emotional trauma, acute gastroenteritis, especially at an early age, the use of antibiotics, and the important role of serotonin metabolism, which is one neurotransmitter of depression.
There are also cells in the intestinal tract that release serotonin, a hormone of happiness. If it impairs serotonin secretion, severe intestinal symptoms may also occur.
For this reason, psychotherapy and antidepressants often help in the treatment of IBS. For example, if a patient has a subtype of IBS where diarrhea predominates, we may prescribe him or her medication to slow down stools but also reduce depressive symptoms, regulate hormonal balance in the abdomen, and neurotransmitters in the gut.
I also recommend thinking about how to reduce the workload, find more time to rest and go to bed.
1. Change Your Diet
If the symptoms are not very pronounced and excruciating.
Talk to your doctor about which products to give up and which can be used safely. It is advisable to set up a nutrition diary before the upcoming consultation and to write down honestly everything that is eaten for 1-2 weeks.
Following these notes will make it easier for your doctor to see the “slippery” places in your eating habits.
They have also shown it that the symptoms of IBS are most often provoked by stress, as well as these three products: onions (35%), milk (32%) and wheat (30%).
If, by excluding them from the diet, you can achieve an excellent result with dietary adjustments and the complaints disappear – ideally, it can continue!
2. With the help of the FODMAP diet
If it is not clear which products are causing the complaint
Following this diet will help you understand which products are causing the complaints. FODMAP is the most popular and most studied diet recommended for IBS.
Abbreviation FODMAP refers to simple fermentable carbohydrate products that are poorly absorbed from the gastrointestinal tract but, when entering the colon, produce gases and cause gastrointestinal symptoms.
Proteins (meat, fish, eggs) and fats (oil, lard) do not contain FODMAP substances. It follows this diet for 2-4 weeks. If you feel well, after this time you can return to your menu one by one from the list of banned products.
Include one product and observe your well-being for 2-3 days – if you feel good, add the next product to the menu. As soon as you manage to catch the culprit, to which the gastrointestinal tract is uncomfortable, continue to exclude this product.
This narrows the list of banned products. In case of IBS we also recommend it to use gluten-free or low-gluten diets, less refined, white flour, lactose-containing products.
These can be eaten safely (Low FODMAP content).
- green beans
- canned chickpeas
- Products without wheat
- Lactose-free milk
- lactose-free yogurt
- hard cheeses
- plant based milk
These are excluded and reintroduced one at a time after 2-4 weeks
- dried fruits
- canned fruit
- Brussels sprouts
- broccoli courgettes
- Wheat and rice in large quantities
- Milk (cow, goat, sheep)
- soft and fresh cheeses
- cottage cheese
- ice cream
- high fructose corn syrup
You can download Low FODMAP Diet App for smartphone to keep track.
3. With Medication
If the symptoms are bothersome and the diet alone does not seem to improve health
Approaches to treat IBS can be varied – you can start with a diet and then add medication, but there may be situations where the medication is prescribed immediately.
The patient is taking medication that relieves symptoms, but at the same time continues to follow a diet. Medications can regulate intestinal motility, act on pain syndrome, reduce diarrhea, regulate constipation, probiotics help stabilize the intestinal microflora.
- Antispasmodics are recommended for pain. A very good natural antispasmodic is peppermint oil.
- For constipation, your doctor will prescribe fiber-based medications. Care should be taken to get more natural fiber in your diet.
- Tricyclic antidepressants, which can cause constipation as a side effect, can sometimes help with diarrhea. However, IBS patients feel better because of this side effect, because not only the mood stabilizes, but also the bowel movement is regulated.
- Against gases prescribes probiotics, dietary adjustments and special antibiotics, which are usually given as a course in the case of dysbacteriosis. If you have a bloated stomach, you should also refrain from using sweet fruits, smoothies, carbonated drinks, chewing gum.
- Because patients with IBS tend to have altered intestinal microflora, probiotics are one of the cornerstones of IBS therapy. A particular probiotic may be prescribed to a particular person to help reduce symptoms. Probiotics have the power to reduce both the feeling of pain and to regulate bowel movements.
4. With psychotherapy
If the gastroenterologist has done everything, but the symptoms do not decrease due to prolonged stress
All chronic diseases usually get worse when we live in long-term stress.
However, it is clear that when receiving complaints about abdominal disorders in the gastroenterologist’s office, not every patient dares to discover that, for example, they have recently divorced or are experiencing other psycho-emotional problems, which may also contribute to the manifestations of IBS.
These patients need to be treated with a method of psychodynamic psychotherapy, theories of which believe that certain symptoms reflect a person’s internal conflicts, which may be conscious, unconscious or partially conscious, and these symptoms have a metaphorical meaning.
Like a symptom of frequent urination, it is the equivalent of mental fear. Because this symptom is prevalent in the IBS patient, we should seek a cause for fear.
When working with these patients, you also have to hear negative revelations, such as who turns out to have witnessed domestic violence, even murder, others have had an aggressive father in the family, some have been physically abused in the past, or one of the parents has worked at-risk, so children have been exposed to a constant feeling of fear.
Very often, the fears that lead to an exacerbation of IBS are experienced in childhood, ones that are no longer remembered by the mind, but this feeling that accompanies a person from childhood to adulthood turns into bodily sensations at some point. Then the doctor’s job is to understand why the fear has become active.
It is most often associated with an inner sense of shame. We must look for an internal conflict that may be rooted in the past and create a sense of shame.
For example, a woman from a strict Catholic family is pregnant but not married, so she feels ashamed. Or a person who has reached an age at which, according to the norms accepted in society, he should want to get married, but he does not have such a desire …
This feeling of shame can metaphorically manifest itself as bloating.
Metaphorically, it is difficult for a person to rely on others, to reveal himself, to make close emotional contact. They are hiding something; they are very careful.
Working with these patients should help develop the ability to build closer relationships, trust.
Of course, working with a patient is not always as easy as it sounds, but based on the dominant body reaction, we can work and help to get to the real point of the problem, because these symptoms are a chemical reaction based on a psycho-emotional difficulty.
Some patients are very psychologically minded and are able to find connections faster.
Others have a harder time because they sometimes push painful memories out, they do not want to be remembered, because the psyche is a delicate structure and unpleasant childhood memories are hidden in the deeper layers of memory, not in operative memory.
However, psychotherapists are proud of the effectiveness of psychotherapy in helping patients with bowel syndrome who are suffering from bloating, constipation, diarrhea or abdominal pain.
What should be in the first aid kit
If you know that IBS is your problem, you should also have some of the over-the-counter medications in your home pharmacy:
- For diarrhea – diosmectitis, silica
- Bloating – simethicone
- Constipation – “Macrogol 4000”