Help Please

[DebbieSil]

I've been suffering with a bad flare up since the middle of April (pains on my right side and my intestines feel inflammed, lower back pain). I don't generally have a problem with my BM, very occassionally). I suffer these symptoms every day and feel totally drained and don't know what to to get this under control. I'm on peppermint capsules and omeprazole but this don't seem to be doing anything. I have a cry almost every day now and just try to get through each day. Can anyone help me please, with some advice?

[FRreedman]

We have to realise that pain is like an alarm, (it hurts because it is trying to tell us something is wrong) and should be dealt with as soon as possible, so contact your GP/GI/Gastroenterologist and ask for an early appointment. In the meantime, you can help by taking paracetamol or any other non-NSAID (non-steroidal anti-inflammatory drug) to relieve the pain. Try to eat things like toast and soups, to aid the pain, but make sure you drink at least 2 litres of water per day. It may be an idea to curl up in bed with a pillow stuffed between your belly and legs while laying in the foetal position. I would only emphasise do not take Ibuprofen or any of its sister drugs as they can damage your stomach lining. Good luck, take care and stay safe.

[DebbieSil in reply to FRreedman]

I've had blood tests, results were good. Just waiting on results from stool tests.

[FRreedman in reply to DebbieSil]

What pain relief has your doctor offered or prescribed? Remember the stronger the painkiller the more likely to result in constipation.

[DebbieSil in reply to FRreedman]

Just paracetamol

[FRreedman in reply to DebbieSil]

Does that help with the pain?

[Carlettejaque]

Peppermint oil, despite what some people say, is not good for IBS and can make it worse. Omeprazole and other meds of a similar name are also really bad. I was on Omeprazole and it got to the point that my stomach lain was worse than Labour pains. It also took away my sense of taste. I came off them and within days I felt so much better and eventually got my taste back.

In my experience I would not take peppermint at all. Try cutting out the Omeprazole for a while and see what difference it makes and while recuperating stick to s low Fodmaps diet. Let me know how you get on.

[DebbieSil in reply to Carlettejaque]

Thank you for this. I've spoken to my Doctor this morning who advised me to stop taking both meds. 😊

[xjrs]

In terms of pain, you may be suffering from visceral hypersensitivity (functional abdominal pain) - there is info about it here:

iffgd.org/lower-gi-disorder...

It is where the brain interprets the normal activity of the bowel as pain - this is due to a wearing down of neurons in pain control centres of the brain which can be caused by PTSD, neglect or abuse in childhood, extreme stressful events etc. The first line treatment is nerve pain agents such as low dose amitriptyline. There is a theory that being on something like amitriptyline for 6-12 months can help the pain control centre neurons to regenerate. Note that amitriptyline can cause constipation, but this can be helpful in people who are diarrhea dominant. Unfortunately I couldn't tolerate these. Linaclotide (for IBS-C only) & a good probiotic (Alflorex) have helped me with this intestinal pain.

I used to experience IBS pain from my mid to lower back (usually at night anywhere from 2am onwards when my bowel from preparing for a BM in the morning). The doctors kept insisting I had acid reflux and kept giving me PPIs. However if it were acid reflux I would experience the pain in my back higher up between the shoulder blades. It took some time (including a colonoscopy since my stool inflammation markers were high) to get the diagnosis of visceral hypersensitivity plus IBS-C (constipation dominant IBS).

Here is some further info about IBS some of which you might find useful:

IBS can be due to a number or combination of factors - these can be stress (including stress from early life experiences) which impacts the communication between the brain and the digestive system. There are lots of free webinars online at the moment regarding mindfulness meditation which might help. Plus you can ask to be referred for CBT or something similar to reduce your anxiety - I would have thought online appointments are available. Exercise can play a major role in IBS in terms of reducing stress, helping your gut microbiome and regulating bowel movements.

There is also not absorbing certain types of carbohydrates called FODMAPs very well, the residue ending up in the colon and bacteria feeding off them causing symptoms. Ordinarily feeding gut bacteria is a really good thing - when you feed good gut bacteria these produce by-products that have great health effects in the gut and throughout the body. However, in some people with IBS bad bugs might have the upper hand over good - these bad bugs may cause symptoms such as pain or disordered bowel movements (in some people). There is an interesting infographic on this here:

gutmicrobiotaforhealth.com/....

This is why it’s worth trying probiotics such as Alflorex (which has been scientifically studied for IBS) or Symprove to crowd out the bad bugs and make their numbers die down. If that doesn't work you can try the FODMAP elimination and reintroduction diet. This is normally under the guidance of a nutritionist via GP referral - this may not be possible at the moment so you can read about it online. If you download the Monash University FODMAP app it will tell you which foods contain FODMAPs and in what quantities. You can eliminate all FODMAPs for 2 weeks and then introduce each type of FODMAP one at a time starting in small quantities, increasing over a 3 day period and wait up to 4 days for symptoms. I go much slower than this - only introducing a small amount (1/4 to 1/3 of a normal portion size) of the same food for 3 days and then increase if tolerable or no symptoms and cut back to the previous amount if symptoms for longer and then try to increment again . I've read your microbiome can adapt to handling a new food if introduced very slowly and your bad bugs are under control with a good probiotic. Ideally you want to eat as many FODMAPs as you can since they are good for your health. Many people with IBS don't have diverse gut bacteria - it has been found that people who lack a diverse microbiome are more prone to diseases in general. In the long run, if you can get your symptoms under control, the ideal situation is to have a very varied diet - lots of different coloured fruits and vegetables, a variety of protein and carbohydrate sources including cereal fibres. This may seem a long way off, but with the right treatment all of this is possible. Last year all I could consume to control my IBS was white rice, protein and limited low fodmap veg. Using the approach above (particularly introducing Alflorex) I am now able to consume far more foods - more than I've ever dreamed of including wholewheat bread which is unheard of for me.

You may also find assistance with anti-spasmodic medication such as mebeverine (Colofac), though these might slow down your BMs if these are currently normal.

You can find some info on self management here:

theibsnetwork.org/the-self-...

[DebbieSil in reply to xjrs]

Thank you for your helpful comments. I've been so stressed since March.

[xjrs in reply to DebbieSil]

That's hardly surprising with what is going on in the world at the moment and you may have your own life stressors on top of that. I hope you find some answers soon. Take care.

[DebbieSil in reply to xjrs]

Thank you so much. Yes, I just need to calm down

[Iesgobdafydd]

As you're aware of being stressed during this period, there's a good chance your symptoms are stress-related and in addition to the other suggestions people have made, if you're not already doing this, you could try things like meditation, yoga, hot baths, mindfulness, anything that helps you relax at a deep level. There's a big difference between sitting down and relaxing the big obvious muscles, and deep relaxaton.

However, pains, fatigue and bowel movements not that different to normal is reminiscent of my own IBS symptoms, and since in my case I believe they were caused by the less common underlying problem of temporo-mandibular joint disorder, I thought it may be worth mentioning to you. TMJD typically is caused by dental surgery or injury, and causes pains in the jaw or shoulder area. In my case it had gone on a long time and built up to where it was affecting connective tissue all round my body, including some going through my gut and back area which were causing the pains there. I've spent a lot of time over the last couple of years lying down relaxing, practising my inner awareness of bodily sensations to figure out where the tight areas are and then working nearby muscles to gently stretch and free them. My digestive problems largely cleared up after a few months of this, but I still have a lot of trouble with fatigue, and pains in a variety of places. But it's great to have something I can do that feels like it's making progress, and at least shifts the pain so it's not stuck in one place, and often clears it up. I hope eventually doing this will fix it. There are medical treatments available for TMJD - physiotherapy, and also I've been told that medications can be prescribed by a rheumatologist, but they do have side effects. Craniosacral therapy is also said to help.

[DebbieSil in reply to Iesgobdafydd]

Thanks for your response. I was thinking if yoga and 'proper' relaxation. Wishing you all the best.