IBS rant (and advice seeking)

Hi all,

I'm a former frequent poster over on the Crohn's board but think this board is probably a better place for my current issues (and I no longer even know if I have Crohn's, thanks to a doctor two years ago doubting my original diagnosis due to the lack of scarring in the intestines....but that's a story for another day).

Regardless of if I have Crohn's, UC, or neither, I certainly have some form of anxiety-related IBS. And it's not just conscious anxiety, but really any change from my daily routine. For example, I'm a college instructor, in my second semester teaching, and every day, without fail, I experience bouts of diarrhea before I teach. My diet is very consistent and controlled (no red meat, no cream-based foods, no fried foods, etc), so I know it's not because of something I ate (and because the diarrhea itself is very consistent, showing up every Tuesday and Thursday morning without fail). Even as my own anxiety about teaching has decreased and my confidence has increased, this has had no impact on the occurrence of diarrhea on teaching days.

I experience similar symptoms every time I travel (and I travel a lot). Whether it's a 30-minute car ride to somewhere I haven't been before (or to somewhere I have been before to do something new) or the same flight I've take nearly every month for the last two years, I will feel nauseous and have diarrhea (usually 6-12 BMs) for anywhere between 1-3 hours before leaving, and sometimes well into the trip. I get very anxious before going out to eat at a restaurant, partly because I have little control over the ingredients that go into my food (extra butter or oil, for example) that could set me off and because I had some really embarrassing experiences at restaurants in the months before my Crohn's diagnosis in 2006. Because of this, I rarely go out to eat, and if I do, I drive separately (in case I have to leave) and always take meds like Immodium beforehand.

I've tried changing my diet by removing anything even close to suspicious in the days before these events. I've tried taking Immodium first thing when I wake up on teaching days (rather than following a loose BM). I have been prescribed hyoscyamine and take that on teaching mornings as well. They appear to have little impact (two Immodiums plus the hyoscyamine tend to slow me down, but it's usually after 4-6 BMs).

This is having a negative impact on my life and I want to do anything in my power to stop it. I should note that I also take 100mg of Trazodone at night, originally prescribed 2.5 years ago for insomnia and mild depression, and 1mg of Klonopin a day to treat my anxiety (prescribed two months ago). While I think the Klonopin has had a small positive impact on my anxiety generally, it has not had the hoped-for impact on the IBS.

I am writing this post for two main reasons. One, to get this struggle off my chest to a group of people who can sympathize and empathize with what I'm going through, and two, to hopefully get some suggestions regarding alternative approaches to ending or at least better controlling my IBS. Yes, foods set me off sometimes, but that's almost always because I'm eating something I know I shouldn't be eating. I try to do everything in my power to avoid the IBS (making sure I'm prepared to teach/travel well in advance, repeating mantras to myself at night that I'm going to feel good in the morning and do a great job, etc) and nothing seems to work.

Thank you for reading (if you made it this far!) and if you have any advice or suggestions, I would love to hear them.

Hi kazbern,

I have tried talk therapy at two different points in the past four years and have not had any success with it. I haven't learned formal relaxation techniques but go through a routine to relax at night before going to bed (mainly by reading a book for pleasure and shutting down my otherwise active brain). I am in a very stable relationship and am very happy with that. I also exercise five days a week, partially as a way to combat stress. My life is very stressful, but there's no avoiding that at without changing careers. I'm in the final year of my PhD and work 65-70 hours a week. In general, I feel that I have always handled stress well, and rarely feel stressed out to the point where it raises my anxiety.

The most frustrating component of this is that I don't really feel anxious when these things happen. When I wake up in the morning on a day that I'm teaching, it is just like any other day. I'm not physically anxious and not (consciously) psychologically anxious. And I still get these symptoms. There are situations when my diarrhea is directly linked to anxiety (when I am going out to eat, for example), but traveling and teaching are examples of situations when I just don't feel that anxious. I wouldn't be surprised if there is underlying unconscious anxiety at play, but most days I feel just fine mentally.

Maybe it could be something other than anxiety causing this problem, but I don't know what else it could be. I should also note that when my anxiety has been especially bad (I had a string of panic attacks during 2009 and 2010, one of which landed me in the ER), my heightened anxiety during those times was generally not linked to gastrointestinal problems.

Hi there, I share your anguish. My gut is anything but normal (meaning those lucky ones who can eat anything they want and then have 1 bm per day, w/o difficulty). I am fortunate since I don't have to travel but when I have done so, nearly every trip I take I find myself in a bathroom having dumping episodes, just sitting there, flushing the toilet every 5 minutes or so. Waiting for that clean out episode to be over with. I've taken about 7 or 8 short trips in the past 2 or so years (have a daughter in college), and all but one trip these episodes have happened. Most of the time I have warning, my gut starts to do it's heave thing and the rumbling begins. If I am able to, I find a bathroom somewhere and hole up. My favorite was at my daughter's campus' new student center - 5 floors, each with restrooms and each women's restroom has 20, yes that's right, 20, stalls. I finally just told her, please let me have 2 hours and I'll hopefully be cleaned out by then. I just took the very last stall near the wall and sat. And sat. This certainly isn't a normal way to live. So I feel for you so much!

Now on two of those trips, I had salads from the Ruby Tuesday's salad bar. Until someone told they spray their lettuce with preservatives. Now I avoid RT's, just an observation I wanted to make.

I wish I could give you an easy answer. My problem is from having my sigmoid and then a foot and a half removed above that, due to rectal cancer 12 years ago. Complicating things is having my gall bladder removed as well.

6 weeks ago I tried cholestyramine out of desperation and saw an improvement for 1 week. Then the side effects freaked me out so I went off of it. Now I've missed that one good week out of 12 years. I'm back on it but haven't noticed the formed stool yet (wonder why). I'm still stuck in what I call the putty stage.

If I had to give you any advice regarding travel is to pretend in your mind you are not traveling (silly advice but it works for me, I close my eyes in those foreign bathrooms and pretend I'm home with my dog in my favorite bathroom), and possibly to pack your own food if you can (ie, avoid Ruby Tuesday's, which is a shame because they have one of the best salad bars around).