IBS trigger is stress. Life contains stress. What do?

February 16, 2023 11:25 AM

I have long had IBS and just accept that as a part of my life, bad things happening (breakups, work drama, difficult tasks) will cause my guts to act up. Now it's turned into diverticulosis and what was annoying is now potentially life threatening. What should I do?

I was recently hospitalized for what I thought was "just another flare up" with agonizing abdominal pain and so forth, but luckily was taken to a hospital where they discovered I had a perforation, abscesses, and partial obstruction. 5 days in hospital on heavy antibiotics and now I'm resting at home, to return in a week for more scans and discussions of surgical options.

Unlike the typical IBS, which usually has dietary triggers, mine seems to be entirely triggered by stress and anxiety; I've no trouble with lactose or gluten or anything else, but stress and anxiety will tie me in knots of actual physical agony. (As in I literally cannot walk without help)

I take antidepressants and they work well for me, and for the occasional anxiety flare I take Valium, which helps at the time, but I can't live on the stuff. Cannabis helps a bit but again, not sure I should live on it. And I certainly can't arrange things so that nothing bad or upsetting happens to me, ever.

I've already cut out social media and following the news; I meditate and that helps but I can't be constantly taking the time off to lie flat and force myself calm. I've had both a therapist and a psychologist and both have helped my overall anxiety, but bad news still will broadside me. And once the flare starts, I have to rest it for 2-4 days; bed, meditation, clear liquid diet, because if I try to 'push through it' it gets much worse, fast, due to the stress of the pain and anxiety now adding to the shame of being sick with something embarrassing and invisible from the outside.

I'm female, 50, little overweight, otherwise good health, single and fairly stable in my living situation. I love my job but I can't do it if having a flare, and while my boss has been understanding, I know there's limits to how often I can just call out sick.

Any advice?

posted by anonymous to Health & Fitness (7 answers total)

I've mentioned it in other comments, but you might consider trying LDN (typical dose is usually around 4.5mg, taken at night). I've taken it for between half a year and a year now (see here), and it's had a huge positive impact on my chronic pain and my sleep, and some positive impact on my mood. My IBS has also improved a lot. I can't directly link it to the LDN, as there have been a few other changes in my life, but I suspect that the LDN is the main factor. There is clinical evidence that many have improvements in their IBS through taking LDN (see, for instance, this article). I got it prescribed by a doctor online, and pay $35 per month for the prescription and the medication both. Feel free to message me if you have questions. No bad side effects and might be worth a shot!
posted by ClaireBear at 11:45 AM on February 16, 2023 [4 favorites]

I don't have the same chronic health issue that you do, but for mine I essentially have to try and stay in front of it. Sort of like how people training for a marathon will taper their training down a week or two in advance of a known race, I will give myself extra rest and other supports in advance of times I know could be stressful. If there is nothing on the horizon I'll still try to do a rest cycle every 2 months or so.

Obviously not all stress is planned for, but it helps me to think of it as "training" instead of "managing a disability".

For your job, look into FMLA, it will give you 12 weeks off/year (unpaid except in special states). It isn't ideal but will keep you from getting fired and can be taken intermittently. It sorta sucked to tell HR and my boss I had a disability and would need to set up intermittent leave, but it took a lot of the pressure off myself to perform and not take breaks. It was better for my job performance to take that time off and come back in better health than to cling on for weeks doing the bare minimum while managing pain.
posted by Narrow Harbor at 12:02 PM on February 16, 2023 [2 favorites]

I'm so sorry. This sounds really terrible, both painful and incredibly disruptive to life. Do you trust and respect that your medical providers have investigated all possible causes and that's it is in fact IBS and not anything else? I ask in part because I know that doctors don't always treat women and our pain as worthy of real concern and investigation.

Next, yes, please do the paperwork for FMLA. You can use it intermittently, as needed, and it'll help protect your job.
posted by bluedaisy at 12:16 PM on February 16, 2023 [1 favorite]

I was like you, previously, with Valium (it helps but you don't want to take it too often). The game-changer recently for me has been Buspar, which can be taken more frequently and is milder on your system than a benzo (at a low dose it almost feels like a placebo, no drowsiness, and the only noticeable effect is less GI upset and better thoughts). Buspar taken on an as-needed basis has saved me from IBS flare-ups during some of the usual triggers during the past year.
posted by knotty knots at 12:28 PM on February 16, 2023 [1 favorite]

Is this your first diverticulitis flare? And you’ve got a perforation, abscess and obstruction? I’d wager that you’ve had more than just IBS going on for a while… I hope you have a referral to a new gastroenterologist for followup…

I can’t pretend to know even a little about the gut/brain connection, I’m reading around it because my SO is also in the middle of a DV flare (simple case thankfully, but his 6th in five years). But it’s certainly complicated. And often bidirectional… could it be the other way around? That you’ve been having flares and then experiencing anxiety as a result? Or that stress is prompting flares which then aggravate stress?

Gabapentin can be used off label for anxiety (though it can aggravate depression in some). Cannabis, ok, works for some, go for low THC products, high CBD and CBG.

Reddit’s communities have a lot of great advice from other patients, check out r/diverticulitis and r/gastritis. For example, the first is where I learned that medical grade ($$$) probiotics can help rebuild the mucosal barrier inside the intestines. The two brands most recommended were VSL#3 and Visbiome. Lots of experience there.

Best of luck, I know this is scary.
posted by cotton dress sock at 5:34 PM on February 16, 2023 [2 favorites]

You might want to look into Vaso Vagal theory, which is the study of how the vagus nerve (which is activated by stress) affects our digestive system. It's a complex nerve and is tied into many different bodily systems, but there are a number of therapies and techniques that can be used to down-regulate an overactive vagus nerve, which can mitigate or completely resolve IBS symptoms, among many other positive effects.

Ive started incorporating these techniques into my daily routine and I can definitely say I have had way fewer flare ups than I used to.

This is certainly not a cure all, and I hope you get in to see a good gastroenterologist soon, but it may help make things easier for you while you get a more comprehensive treatment plan.
posted by ananci at 7:21 PM on February 16, 2023 [6 favorites]

Have you tried the Nerva hypnosis app for IBS? It sounds a little kooky, but there are papers in the literature showing hypnosis (or what they call hypnosis, anyway) is as effective as a low-FODMAP diet for IBS.

As someone whose IBS has a strong neurological/stress component, I've used it and found it helpful and not creepy. And also... it's an app. So way less investment of money and risk to try it than a new med, in my opinion. If it works to reduce or eliminate your flares? Amazing!!! If not? Oh well, you're out $60 for the fee, unsubscribe and move on.
posted by cnidaria at 4:56 PM on February 17, 2023