IBS Problems

[PinkDragonfly]

Hi everyone. I've just been diagnosed with IBS pending blood tests. Had it on and off for years but it's come on with a vengeance this year. Doc sent me for a FIT test which came back negative and a calprotectin which was negative too which is great news!

This past 10 days I've had terrible watery diarrhoea which leaves me feeling weak after and almost as if I want to pass out. Always happens after breakfast and throughout the morning, usually easing as the day goes by. The doc has given me some Citalopram and some Mebervine 135 tablets.

I hope you lovely people don't mind me asking but I have a couple of questions.

1. Is it ok to crush the Mebervine? The tablet is too big for me to swallow

2. The diarrhoea scares me at times, the force and the awful feelings of weakness I get with it. Is this normal?

3. I feel very nauseous with the diarrhoea, was even retching this morning with it. Is this normal too?

Everything seems very scary at the moment!

[xjrs]

Probably best to phone your GP surgery to ask about the Mebervine. It depends on whether it has a required gastro resistant coating that needs to stay intact. They may offer you an alternative if that is the case.

Diarrhea can be pretty unpleasant and can affect you mentally. Nausea can be due to a build up of gas or if you are getting very anxious about it all, which is understandable.

The next thing is to try some things to gain control of your IBS so that you don't have these episodes. Here is some information about IBS that I have shared with others in this group in case any of these tips are of interest to you:

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 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 excess gas, pain or disordered bowel movements. 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 and Kings College fodmap apps, they 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.

If you are also suffering from 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) & Alflorex have helped me with this intestinal pain.

You may also find assistance with enteric coated peppermint.

You can find some info on self management here:

theibsnetwork.org/the-self-...

If all of the usual IBS remedies fail and you are experiencing diarrhea, it is worth getting tested for BAM (Bile Acid Malabsorption), which can cause constant diarrhea - there is a separate test and treatment for that. Good luck.

[PinkDragonfly in reply to xjrs]

Thank you so much for your really helpful reply xjrs . Yes my GP has mentioned FODMAP, I definitely think it's the way to go. Personally I can't eat cauliflower, broccoli, fruit, wholemeal bread - all the good stuff I really like and would love to reintroduce at least some of it back into my diet.

I had a chat with my GP via telephone earlier and he said I can crush the Mebeverine and put in some jam to swallow so that's helpful. He also said the Citalopram may be making my IBS worse! I guess from now in it's all trial and error. So glad to hear you're on the right path, there's hope for me yet!