Today’s topic is about the emotion scars associated with experiencing severe GI symptoms related to irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO). For some, a difficult experience with SIBO or severe IBS may result in post traumatic stress disorder (PTSD).
First, I will briefly share my personal experience with SIBO, followed by a general overview of PTSD and some great tips from two US-based expert GI psychologists.
Let’s start with my back story.
Twenty four years ago, I developed a strangulated intestine while 3 months pregnant that resulted in 6 feet of my small intestine being removed, including my entire ileum and ileo-cecal valve. I endured new onset food intolerance with GI symptoms post surgery, but for the most part, I was able to cope and manage them for about nine years successfully. Then, it was if a flip switched and my GI symptoms became unbearable and difficult to manage. I suffered with severe abdominal pain, had trouble eating as I became full the minute I ate a bite of food, lost weight, and ended each day with a distended abdomen that appeared like a 6 month pregnant belly. Visits to the doctor and gastroenterologist came up empty–I endured 2 CAT scans, a colonoscopy, every blood test known to mankind. All the testing alone, added stress and a level of fear to the situation. The CAT scan testing did show tremendous gas in my intestine. Of course, I found that unsurprising. I was miserable. My symptoms were impacting my beautiful family and my quality of life. My husband’s business trips were shortened as I could not care for my young children alone. Simply bending over to take laundry out of the dryer was painful. So, I, like many of you, became the google Queen. I was able to connect a few of my clinical factors (resected ileo-cecal valve, bloating, gas, abdominal pain, elevated folate level) to one diagnosis, small intestinal bacterial overgrowth.
I was treated successfully for SIBO–and felt like myself again. But, with the return of any signs of bloating or cramping in my belly, I would be sent back emotionally to that difficult time of trying to get a grip of my health. I feared that the SIBO was going to come back with the same vengeance that it did before. These feelings felt like post traumatic stress disorder (PTSD). And I know there are many of you out there that can relate.
The good news is that the more I began to trust my body and find a gastroenterologist that understood SIBO, I no longer experienced the fear of a SIBO relapse. The more I learned about what foods worked for my body and what foods didn’t, (fortunately, my list of foods that don’t agree for me is quite small these days), the more empowered I felt to make choices that would keep my belly pain-free. And please know, your tolerance to foods can improve and change overtime too.
Stress management and self-care: make them part of your treatment strategy.
Understanding the role of stress and your gut symptoms is important. The gut and brain are intimately connected by the gut-brain axis (GBA). The GBA is a bi-directional communication pathway. When you experience emotional stress, your gut may become stressed out too. And of course, your gut symptoms can add to the stress you feel emotionally. It’s easy to feel out of control when your body is in pain.
Diet strategies are often only part of the solution
Many people with severe IBS and SIBO try to control symptoms with diet alone. I can tell you from clinical experience, this rarely works. Attempts to manage symptoms with diet alone may make you feel like you are in the driver’s seat, but truthfully, for most people with SIBO and severe IBS, diet is just part of the treatment plan. From my clinical experience, many individuals that focus on diet alone to manage GI symptoms keep restricting more and more foods until then can no longer meet their nutritional needs. The strict diet strips them of their social life and hunger from not eating enough leads to irritability, fatigue and greater anxiety.
The amount of fear mongering around food in the media is at an all time high which adds another level of uncertainty for the individual struggling with GI distress. Gluten, grains, dairy, lectins, nightshades, nuts and more are touted as inflammatory and the cause of GI problems–yet we have little human studies that support these statements. The truth is nutritional science is the new kid on the block and food patterns vs. eating one type of food is likely much more relevant to overall health. Modern diet culture looks at food as fuel alone. But isn’t eating meant to also provide emotional pleasure too? Sharing a meal is a bonding experience with people you love and yet food has become a moral substance. It’s portrayed as either good or bad. Does eating a cookie make you a bad person? I certainly do not believe that! I hope you agree with me. I will delve more into this topic in my next post where I discuss intuitive eating and the role it plays in diet and GI symptom control.
What is Posttraumatic stress disorder (PTSD)?
PTSD is a psychiatric disorder that develops in some people who have experienced a traumatic, scary, or dangerous event. People with PTSD will experience disturbing thoughts and feelings related to their experience that continue on for a while after the traumatic event has ended.
One of the key features of PTSD include, “re-experiencing symptoms”, which may include: flashbacks–reliving the trauma you felt over and over, bad dreams or frightening thoughts.
If these feeling resonate with your experience, don’t go it alone.
Laurie Keefer, PhD, a GI Health Psychologist at Ichan School of Medicine at Mount Sinai notes, “It is common to continue to have emotional scars after having been treated for severe IBS with SIBO– many patients worry that they might accidentally eat something that triggers the reaction again, which makes it hard to re-introduce food and often leads to unnecessary avoidance. Working together with a GI psychologist to re-train your brain through cognitive-behavior therapy or gut-directed hypnotherapy, in conjunction with a dietitian, can help people transitioning back into wellness and a healthy relationship with food.”
YES, we all should transition back to wellness and have a healthy relationship with food!
Megan Riehl, PhD, a clinical health psychologist expert in the treatment of gastrointestinal and anxiety related disorders at University of Michigan, provides more, “Once people have achieved a certain level of stability in their symptoms, for some, the fear of a return of symptoms is very present. There can be a healthy level of anxiety that motivates people to continue with the things that have helped them feel better (e.g. staying away from trigger foods, improved stress management, regular practice of relaxation skills and exercise, etc); however, if the anxiety is not useful for motivating behavior change or stability, it should be assessed by a mental health provider. GI-specific anxiety can be driven by fear of having symptoms which can lead to avoidant or overly restrictive behaviors with catastrophic thoughts and excessive worry related to the possibility of symptoms. In more severe cases where the symptoms of SIBO or IBS were considered traumatic by the individual, that individual may develop symptoms of post-traumatic stress which can include physical and emotional symptoms of hyper arousal, hypervigilance, nightmares, re-experiencing of the trauma through intrusive and repetitive thoughts and avoidance of situations/things that remind the person of the trauma. Given the vast range of ways in which someone’s emotions can be related to their physical health, it is best to work with a mental health professional to ensure they receive proper treatment.”
I interviewed Dr. Riehl, on a previous post titled, The Role of a GI psychologist for IBS, read more here.
In this previous post, Dr, Riehl provides a nice overview of how a GI psychologist can help stress, anxiety and GI symptoms with use of diaphragmatic breathing techniques to gut directed hypnosis. Diaphragmatic breathing is a technique that can calm the gut and mind. Activating the diaphragm through diaphragmatic breathing allows for a gentle massage of the internal organs (stomach and intestines). “This can aid with abdominal pain, urgency, bloating and constipation,” Dr. Riehl explains.
Take a Mindful Minute
Dr. Riehl shares some tips she uses with patients that have experienced IBS or SIBO, “When patients are faced with memories of their past negative experiences with their SIBO or IBS symptoms, I first like to encourage people to take a “mindful minute”. During this minute, the individual is encouraged to think about what is true for them in that moment. Couple it with slowing their breathing and scanning their body for tension. By relaxing the body and mind they can take back control of worrisome thoughts and/or better manage a physical discomfort. They may even find that by slowing down for a moment, their physical symptom (which can trigger anxiety), will pass.
The Use of Worry Control Questions
Another way to help manage your worrisome thoughts notes Dr. Riehl, “I also like to encourage the use of worry control questions. As you notice that your current thoughts about a past negative experience with your diagnosis is not helpful to your current situation or that your anxiety is increasing, you can ask yourself some of the following questions to aid with decreasing the worry,
“Am I overestimating the likelihood that something bad will happen right now or in the near future?”
“How did I handle things the last time it was bad? What can I do to handle things right now?”
“Am I minimizing my ability to cope with unexpected situations?”
Benefit from our own great advice and care
“Another great technique is to remove yourself from your stressful situation and pretend that a friend or loved one is experiencing it. Ask yourself, ‘What would I tell my best friend if they were in this situation?’ We often give our loved ones our best, most thoughtful advice. We want to be helpful and aid in calming their worries. However, we often hold ourselves to different standards which gets in the way of allowing us to benefit from our own good advice.”, suggests Dr. Riehl.
Here’s an example that Dr. Riehl put together to illustrate how you can benefit from treating yourself like your own best friend or loved one:
You want to go on a vacation with your family but you fear that if you have symptoms you will be a bother and will ruin the trip. So therefore, you decide to have your family travel without you.
What advice would you likely give a loved one?
You would likely tell them: “If you were to have symptoms on your trip, your family would surely understand and be there to support you. You could make adjustment to your itinerary if necessary, but you don’t even know if you would need to because you are feeling well. Either way, who better to travel with than your loved ones who can be flexible and understanding?”
If you experience stress and anxiety about your IBS and SIBO symptoms that feels “bigger than you” or contributes to a level of fear that is minimizing your quality of life, please know you are not alone. But, there are great GI psychologists and GI dietitians that can provide support, tips and tools to help you transition back to overall wellness.