Irritable Bowel Syndrome (IBS): So my doctor thinks I have it, and I have several months until I get to see a specialist. What do I do now?

October 27, 2005 9:07 PM

Irritable Bowel Syndrome (IBS): So my doctor thinks I have it, and I have several months until I get to see a specialist. What do I do now?

On my followup appointment after taking an insane amount of blood and stool tests, my doctor's thinking that I probably have IBS, though she's referring me to a specialist who normally has a 'several month backlog' to make sure it's not anything else that's more serious. What do I do now?

What I've done so far:
Food/symptom journal for 3 weeks
Experimented with a few days of insoluble fiber supplements (ow)
Experimented with a week of soluble (Citrucel) fiber supplements (not exactly ow, but increased amounts of symptom #2 below)

Symptoms (very food dependant, but almost always present to some degree):
1. Painful bloating and gas, sometimes to the extent that I can't sleep
2. Soft stool/occasional diarrhea accompanied by that not-quite-finished feeling.

posted by anonymoose to health & fitness (33 answers total)

Try giving soluble fiber a few weeks. It is not for everyone but it has helped me (I have colitis, inherited from my father (thanks Dad)). But it takes a while for your system to get used to it. For me it resolved after a few weeks, and then regular supplement improved things overall. Might not be effective for you, but it is worth taking the experiment a little longer. Be very regular (sorry) in your habits, take the supplement at the suggested level and at about the same time daily. Try not to miss any doses.
posted by nanojath at 9:14 PM on October 27, 2005

I'm also of the opinion that the colon is very suceptible to emotional issues, so be mindful of what's going on there. I did a lot of work addressing lifelong depression and anxiety and at the end of it all, I just have a lot less frequent and severe symptoms. Proof of nothing, of course, but suggestive.
posted by nanojath at 9:17 PM on October 27, 2005

I've heard mixed things about Citrucel as a source of soluble fiber, but I can't seem to find anything else. Is Citrucel fine as these things go?
posted by anonymoose at 9:20 PM on October 27, 2005

I use the Metamucil capsules (or their Target-brand equivalent) for fiber. Doing that, plus giving up coffee (and, as nanojath said, working on emotional issues -- in my case, a very significant one in particular via yoga and therapy) pretty much cured about 95% of my IBS symptoms within a few months. FWIW, I know at least 2 other people who were really helped by giving up coffee as well.
posted by scody at 9:26 PM on October 27, 2005

Oh, and make sure you accompany an increase in fiber (whether through food or supplements) with plenty of water.
posted by scody at 9:27 PM on October 27, 2005

I tried the metamucil cap equivalents and felt simply *terrible* - made all of my symptoms 2x worse. Switching from insoluble to soluble fiber brought my symptoms closer to normal..
posted by anonymoose at 9:40 PM on October 27, 2005

i've had crohn's disease (very similar to ibs) for about 20 years now.
go check out http://www.ccfa.org . knock off coffee and black tea and spicy foods. supplement your diet with ensure. clear liquids to minimize gut stress.


why so long before you get to a specialist?
posted by NickPeters at 9:45 PM on October 27, 2005

I just finished 3 weeks of strict removal of irritant foods (for me that's eggs, soy, & nuts) out of my diet & all my symptoms (same as yours, frequently alternating with constipation) went away except for two days, one of which I ate at a restaurant and didn't think to ask for ingredients... I've since reintroduced everything & while the symptoms haven't been as bad, they're definitely noticably back.

I can't live at halloween without some chocolate stuff (which invariably seems to involve nuts) & thanksgiving with pumpkin pie (egg), (soy just seems to be in everything) but I'm thinking come the new year, I'm going to do it for two months solid & then reintroduce more slowly to see if that improves things any...
posted by susanbeeswax at 9:54 PM on October 27, 2005

i've had crohn's disease (very similar to ibs)

Just fyi, Crohn's Disease and Ulcerative Colitis are very different from IBS. These two diseases are known as inflammatory bowel diseases (IBD), which are often confused with irritable bowel syndrome (IBS).

IBS does now have some diagnostic criteria, which was news to me. I generally thought of it as a diagnosis of exclusion, and your doctor may, too.

I'd second/third/fourth the fiber.
posted by gramcracker at 10:19 PM on October 27, 2005

You say your symptoms are very food dependant, but how do you know? Did your food/symptom journal make you suspect any ingredients in particular? Or is it more of a hunch?

Have you ruled out gluten intolerance? For a long time my wife suffered similar symptoms and was told by various (lousy in retrospect) doctors that she had IBS (a catch-all diagnosis). She eventually found out she had Celiac disease, and switching to a gluten free diet changed her life for the better.

Anyway, good luck!
posted by gooddoggy at 10:47 PM on October 27, 2005

Lactose? I used to eat cereal (with milk) all the time. Then I started having similar problems, went to the doctor for samples and whatnot. The doctor's tests didn't find anything. Turns out, it was the milk from the cereal. That, and some psychosomatic things, I think. Every time I try to drink milk now, I end up regretting it--usually much later in the day.

Beer also causes me some problems. I haven't given up beer, though, nor will I ever. EVER.

Anyhow, I'd check out your lactose and stress intake. If you're drinking milk daily, consider not doing so for a week or so.
posted by dsword at 10:49 PM on October 27, 2005

Thanks for the input so far!

I can't see a specialist quickly because that department is totally backlogged and I'm stuck with Kaiser's GI department.

I tend to react to foods within an hour (sometimes within 5 minutes). So far, evenings have sucked more than mornings, but that may well be because I eat problem food at night. Seems like I'm not lactose intolerant, but beyond that I have no idea; seems like I have problems with so many vastly different types of food that eliminating problem foods seems like just too big of a task.

Journal results:

OK (95% sure):
Yoghurt, Banana, Cereal, Oatmeal, Eggs

OK (75% sure):
Veggie burgers
Fried mozzerella sticks
Mussels
Soy turkey (I'm vegetarian + fish)
Cookies, cake
Halibut

Definitely mixed results:
Tuna sandwich

Terrible (75% sure)
European Cucumber (in California rolls)
Honey Mustard Fake Chicken Strips
Pasta w/ Alfredo sauce
Potato Salad
Crab Cakes
Tortilla Chips

Terrible (95% sure)
Evil pain night of death at El Torito (Chips, Cheese Enchilada, Lots of corn stuff)
Evil pain night of death at Chinese food place (Garlic shrimp w/ white rice)
posted by anonymoose at 12:33 AM on October 28, 2005

I back up what scody says as well. I was diagnosed with IBS at one point as well. Turns out the real culprit was several stressful/depressing life situations. I don't suffer at all any more and forgot about the diagnosis.
posted by BigBrownBear at 1:03 AM on October 28, 2005

I'm in the same boat as BigBrownBear... was only given anti-depressants. That was about 5 years ago. Depression has pretty much lifted and no IBS anymore.

I'm looking after my sister at the mo and she has similar issues, caused, I suspect, by the stress of her GCSE's (school exams).

Everyone is different though. I still guzzle down the coffee with no real side effects (just the sweats and jitters if I OD, no cramps)
posted by twistedonion at 1:34 AM on October 28, 2005

I know people with IBS report reactions to certain types of food, but I've had attacks after a glass of water on an empty stomach. I just don't see any patterns in my particular case. I agree with those who say stress is a big culprit. What are your stress levels like?

In general, lots of fibre is good. Linseed (flax) is supposed to be good for the bowels too -- take the oil or sprinkle some seeds on cereal and in soups. Avoid beans, which can be hard to digest.

For bloating and trapped wind, take a low-level activated charcoal supplement. You could also try ginger as a general preventative, especially at night. Empty a ginger capsule into boiling water. You can get it in capsule form, which I like to empty into boiling water for a spicy tea. This from the Wikipedia entry for ginger: "The gingerols have analgesic, sedative, antipyretic, antibacterial, and GI tract motility effects."
posted by londonmark at 2:05 AM on October 28, 2005

Some people have good luck with fiber, but there are others with IBS who find that their symptoms are helped only by reducing it. Like me.

I spent last November through January in crippling pain from a very bad flare up of IBS. I had blood tests and a full abdominal ultrasound and X-rays and a sigmoidoscopy. All they came up with was that my intestines were a little "stiff" and there was no physical reason why it felt like I had a spear in my right side.

After trying the high fiber solutions and an intestinal relaxing medication, I found a book by Heather Van Vorous. Called Eating for IBS, ISBN 1569246009. She has the best advice for dealing with it, both immediatetly and in the long term.

(I am not a doctor or nutritionist, just a fellow sufferer) For right now you might try eating low residue foods, like saltines, white rice, white bread -- until the problems subside. After that, go easy on the meat, stay away from uncooked vegetables, and slowly increase your fiber intake. I lived for a month on sourdough toast and Ensure, until I was finally better. Now the only things that I have to stay away from are the cruciforous vegetables.

I hope that you feel better soon. If you haven't already, you might want to use a hot water bottle or heating pad for the gas pains at night.
posted by monopas at 2:38 AM on October 28, 2005

you may also try probiotic supplements (any drugstore/GNC). they're essentially the miscellaneous bacteria and yeast that makes your colon happy.
posted by kcm at 4:47 AM on October 28, 2005

I think a lot of it is experimentation -- seeing what triggers and what doesn't. Sometimes eating something will be fine, and another time it won't be.

Fiber has helped my husband a great deal because he didn't really have fiber in his diet otherwise, but it hasn't been a cure-all. For him I think it is eating fatty foods (esp. fast food, which used to be fine) and sometimes eating at a restaurant (that maybe cooks in butter?). I think he's also had trouble with the glass of water on an empty stomach, too.

So trial and error, my friend. On triggers and what helps (going to look up some of these recommendations too).
posted by evening at 5:07 AM on October 28, 2005

In high school I was diagnosed with IBS, and there seemed to be no pattern with foods causing it. The doctor suggested that my problem was that I was internalizing stress. I was definitely under a lot of it. He said I needed to find a way to work off the stress instead of letting it attack my innards.

As it turned out, the advice worked. I took up a form of exercise that I really enjoyed, and with that, I was able to keep the IBS under control. I go years without a flare up, and when it does flare up again, I know I need to go scream and yell and run around and just basically do physical stuff to get rid of it. It still works. YMMV.
posted by litlnemo at 5:21 AM on October 28, 2005

(By "go scream and yell and run around and just basically do physical stuff" I don't mean "just do that for 5 minutes and the attack goes away." I mean I need to just make myself more active in my daily life for a while and really make an effort to de-stress that way.)

Even when I had constant flare-ups they never seemed food-related... but they did happen like clockwork on my way to school each morning, which was the first hint that it was stress. (I was hating school at that point, and especially the first period class.)
posted by litlnemo at 5:26 AM on October 28, 2005

Diet and exercise seems to do it for me-- lots of vegetable fiber and a running regimen keeps my stools relatively firm and my gas almost tolerable. In fact, I even get constipated once in a blue moon now, which certainly didn't happen when I was younger.

You're going to have occasional symptoms. I still have diarrhea two or three times a week and there's nothing I can do about it. One parrt of dealing with it is accepting that it never goes away completely.
posted by Mayor Curley at 6:22 AM on October 28, 2005

This website (not so much its forums, but YMMV there) and the book that spawned it were tremendous help for me.
posted by mendel at 6:36 AM on October 28, 2005

My family has bad digestive troubles but I have never had trouble. Recently though I have been under huge amounts of stress and was drinking A LOT of coffee. I then got a sinus infection and my whole digestive track broke down. Basically A LOT of gas started coming out each end and the symptoms you describe as well. I was just told to start eating more yohgurt because the flora of my gut is apparently wrecked.
posted by Napierzaza at 7:04 AM on October 28, 2005

A lot of good advice so far. I don't think anyone has mentioned sleep. I know that with my own problems, the amount of sleep I get makes a difference on how I tolerate certain foods.
posted by Atreides at 8:19 AM on October 28, 2005

Sorry for the late reply, but I think I can help answer this question, as I've been suffering from IBS for awhile. I just returned from a specialist yesterday, and this is what he reccommended to minimize it:

A high-fibre diet along with 1-2 tablespoons of the orange flavoured Metamucil, mix with 9 oz of water or juice and 1-2 tablespoons of Lactulose in the same glass.

Lactulose can be picked up at any pharmacy without a prescription, you just have to ask the pharmacist for it.

Continue this regimin for a few weeks, my specialist swears by it. I'm on day two.
posted by carabiner at 8:47 AM on October 28, 2005

Caraway tea is the greatest thing ever for IBS. It tastes like dirty sock...however...it helps with the pain like no other. Take a tablespoon of caraway seeds and place them in a tea ball. Let them steep in hot water for about 3-5 minutes, then drink. it's always helped me.
posted by Nenna at 9:43 AM on October 28, 2005

It is great that you are keeping a log! That is the surefire way to figure out what is going on. I would weed out some of the big players and then slowly introduce them when you are feeling better, so you know what you can have. Big players like ALL dairy, gluten grains (including oatmeal), bananas and other high fiber fruits, etc.

Read Heather Van Vorous' books. She has two good ones that I know of, IBS: Your first year and Eating for IBS.

Sleep and EXERCISE! Go for a walk, jog, gym, whatever you are comfortable with.. but get the body moving. A moving body is moving bowels. :P

Fiber is key. If you don't do well with suppliments, try increasing your intake of veggies -- salad a day, smoothie made from fresh fruit, bowl of fruit in the morning.

Increase your intake of RAW foods. In fact, since you are veggie now (I have been for 10 years and this is the place that I am at) you might want to consider a raw food/living food diet. Basically, since raw/living food still has enzymes intact, the food does a lot of the breakdown work for you, thus easing the amount of energy and stress the body has to do. Plus it is so vitamin/nutrient rich, your body is getting what it needs. Send me a PM for more info/questions. I can tell you that adding raw foods into my diet this way has started to remove IBS completely.. and I feel great!
posted by dhammala at 10:26 AM on October 28, 2005

Thanks all; very helpful!

Interestingly, if you do a search for 'enteric caraway' on google, there are a bunch of doubleblind studies with ridiculously impressive numbers on the effectiveness of enteric coated caraway + peppermint oils on IBS. I can't seem to find a source for such pills except this kinda fishy http://www.regimint.com/ website...
posted by sirion at 11:05 AM on October 28, 2005

Since no one else has mentioned it:

People with IBS frequently can't use Allegra. IBS is flipping back and forth between diarrhea and constipation. I took a survey of IBS folk, most of them get constipated on Allegra D. One of them was Crohn's, she can't either. One of the IBS people reported she can't digest the second half of the pill and it kills her. I didn't ask her for details. Apparently, I was the last one in the country to try Allegra and figure this out.

I have IBS, and I just get up and pound black coffee until I get sick and run out of ammo, get well, and then go to work. I always feel like I know what to expect once the gut is empty. If I put the wrong thing in there, my gut just grinds to a halt and about 3 days later, it'll dump everything, probably in the middle of the night to the accompaniment of a lot of pain.

Disclaimer: I'm old, and this is just what works for me at 60. I lived with it for a long time when I was young, but it was more intermittent then. The things that threw it into a mess when I was younger were MSG, meat tenderizer (papaya enzymes) and garlic. I found there were certain triggers, but they changed as I got older. (At that time, they didn't know about IBS. It tends to be more a female disease, and back then whatever you had, you were on your own. You had to figure out what made it worse and stop that. I don't mean to sound bitter, I'm not, but it's the truth that if you were female, you were pretty much on your own.)

Good luck!
posted by deep_cover at 11:25 AM on October 28, 2005

Forget diet, forget pills, forget any means of alleviating IBS except alleviating what is causing you to stress. I had IBS very bad for years, and the day my wife left me and I (instantaneously) realized I should quit my job and go to art school, IBS disappeared. That day. That was 17 years ago. Metamucil and every other friggin' brand did nothing for years. IBS is stress related. HOWEVER, you (like me) may be totally unaware of the source of your stress. Tricky, foxy, coyote. Once and a while it creeps back in, usually work related. But look into your head, not your bowels to find relief.
posted by johngumbo at 11:11 PM on October 28, 2005

I've had IBS for about 13 years (and am also vegetarian and lactose intolerant). I totally agree about stress-reduction as a solution. Before flights, long road trips or meetings with my thesis advisor I usually have to take lots of deep breaths and drink lots of water and relax.

I find that not thinking about things over which one has no control also relieves many stresses that could cause a flare up.
posted by vkxmai at 4:40 PM on October 29, 2005

I don't know how you feel about pharmaceutical medications, but I found that Zelnorm is a miracle for me!

I've always had a regular schedule with daily vigorous exercise and lots of walking, and I couldn't seem to find a pattern with my diet (ate lots of fruits and veggies, or didn't; ate whole grains, or didn't; ate protein, or didn't); I sucked down ginger tea, tried Pau d'Arco, which is supposed to aid digestion.

None of it made a lick of difference, so I finally caved and went for medication. I hate the notion of being shackled to a pill, and was reluctant to begin, but I actually feel normal again. No bloating, little gas (some is to be expected given my vegetable-rich diet), regularized intestinal activity. I find that it's worth it.
posted by tentacle at 8:37 AM on November 3, 2005

I will add a delayed comment here about stress and IBS. Remember that even good stress is still stress. You go on vacation, get a new girl/boyfriend, start school at a school you love -- it's still stressful, even if you are happy. So to control IBS you need to become more aware of when your body is having a reaction to stress -- any stress -- and you need to then understand what you can do to alleviate that stress response.
posted by litlnemo at 5:39 PM on November 7, 2005