Fibromyalgia
and
Irritable Bowel Syndrome
Home The Fictions Articles The Facts Life Stories Poems etc. Herbs etc. Links
Please note: all links on this page, are off site references, save where noted

As many as 70% of fibromyalgia sufferers, have IBS. We are very familiar with it. The making a bee line to the bathroom, especially after eating, to the point where eating, becomes something we are almost afraid of doing. Which is stressful and therefore not helping, but it can be hard to avoid feeling that way, if nearly every time you put food in your mouth, you pay a price in pain and aggravation.

Eating causes contractions of the colon, which is perfectly normal, it's supposed to do that. But in our case, it often goes way over board and what should happen a few hours from now, often happens right now ! Or, the alternate, where it doesn't happen at all. Where we don't see the inside of the bathroom for a week or more, other than to brush our teeth etc, bloated out like beach ball, due to constipation. A few factoids to know, if you are one of the 70%. See the page bottom for, things you can do on your own, that might help. :)


Causes of Irritable Bowel Syndrome

The exact causes IBS are still unknown, at least none they all can agree on, which is pretty typical of both doctors and researchers; however, recent research does show that IBS may be caused by a problem with neurotransmitters in the brain. IBS is often thought of as being caused by psychological problems, as in your stressed out. This is a myth, new studies show that psychological factors are not the cause. You can be perfectly calm, and still have IBS problems.

"IBS is thought to result from an interplay of abnormal gastrointestinal (GI) tract movements, increased awareness of normal bodily functions, and a change in the nervous system communication between the brain and the GI tract.

Abnormal movements of the colon, too fast or too slow, are seen in some, but not all, people who have IBS. It has been suggested that IBS is caused by dietary allergies or food sensitivities, but this has never been proven. Symptoms of irritable bowel syndrome may worsen during periods of stress or during the menses, but these factors are unlikely to be the cause that leads to development of IBS."

As others have said and I agree. It's sort of odd and more than a bit ironic really, that for years, we were told, that IBS was "all in the head", well, seems they were right, but for entirely the wrong reasons.


Neurological Dysfunction and Brain-Gut Interaction

"A major development in the study of IBS and other gastrointestinal diseases in recent years has been the growing knowledge of the importance of the nervous system in the gut. The intestines are now known to have the highest concentration of nerve cells in the body, besides the brain. There is constant back and forth communication between the brain and gut, particularly through nerve cells using serotonin, a neurotransmitter that is also very important in the brain in the regulation of mood, (sleep and pain regulation). "

You didn't know your gut could talk to the brain did you ? Well, it can, it gives a whole new meaning to the phase, having a "gut feeling" doesn't it. :)

Numerous studies have shown that serotonin exerts a wide range of effects on the intestines, most notably:

  • Mediating intestinal motility ( meaning regulation of how things move )
  • Mediating intestinal secretion in the GI tract ( how much or how little mucous the gut creates )
  • Modulating perception in the bowels. ( how much you notice them )

Irritable bowel, affects each person differently

First sign, is abdominal discomfort or pain. The following are also common:

  • Abdominal cramping and pain that is relieved after bowel movements
  • Alternating periods of diarrhea and constipation ( or, both at once ... see below )
  • Change in the stool frequency or consistency
  • Gassiness (flatulence)
  • Passing mucus from the rectum
  • Bloating
  • Abdominal distention
  • Nausea
The following are not typically symptoms or characteristics of IBS:
  • Blood in stools or urine
  • Vomiting (rare, but does occur on occasion in IBS) It is not as rare as the medical establishment tends to think. 

  • Note: (This often due to straining and pressure back up... what typically happens in this case is you have constipation and diarrhea, at the same time. The body attempts to move matter past a blockage, by keeping it in a liquid state and forcing it past the block. This can be extremely painful, and you can find your abdomen involuntary clenched to the point of straining the muscles. The body will often repeat this action many times in order to finally clear the blockage and or move matter past it, but the pressure the body has created has to go somewhere. 
  • That somewhere is often back up the system, and your stomach gets filled with gas that has been forced up from the gut. The bodys natural reaction to this, is to void the air, so you explosively belch what is often foul gas and whatever happens to be in your stomach at the time, comes along with it and you vomit. ) In extreme cases of bowel blockage this can even be ... "fecal matter that has been drawn into the stomach from the intestine by spasmodic contractions of the gastric muscles". Link

  • Pain or diarrhea that interrupts sleep
  • Fever
  • Weight loss
A combination of history, physical examination, and various tests are used to help diagnose irritable bowel syndrome, (such as a CT scan or small intestinal x-rays), or a lower GI endoscopy (colonoscopy), sigmoidoscopy and the ever popular, Barium Enema. I won't even go into the details on some of these tests. Lets just say, you leave your dignity at the door and let it go at that !

"Current figures suggest that 10-20% of the population may suffer from the disease and it is the most common gastrointestinal illness diagnosed by doctors in the western world. Historically, IBS has not been thought to result from or lead to physical damage to the colon, like in Inflammatory Bowel Disease (IBD), or lead to development of other, possibly more serious diseases." Research in recent years however, has advanced the understanding of IBS greatly with the recognition that physical factors and damage to the lining of the bowel may indeed be involved. Research


Extra Sensitivity

"It is thought that people with IBS have an extra sensitivity to pain and contractions that occur in their gastrointestinal tract. This is very similar to people with fibromyalgia, who have an extreme sensitivity to pain in their muscles and skin. It has been theorized that both disorders are caused by problems with the brain's ability to process pain signals. The brain interprets pain signals as being much more intense than they would otherwise be in normal individuals, resulting in severe discomfort, and sometimes even disability.

Recent studies have shown that people who have both IBS and fibromyalgia suffer from symptoms that are 38% more severe than those who only have one illness. IBS tends to exacerbate fibromyalgia pain and fatigue, while fibromyalgia tends to increase the severity and frequency of IBS symptoms. Studies also show that people with both illnesses tend to have a worse quality of life than those with only one. This is because of the limitations that the disease can put on your daily lifestyle. As many as 70% of fibromyalgia sufferers, have IBS; similarly, 1 in 5 IBS sufferers, also have fibromyalgia."
Research


Medications- treatments:

"Antispasmodic medicines, such as dicyclomine (Bemote, Bentyl, Di-Spaz) and hyoscyamine (Levsin, Levbid, NuLev)". (As the name suggests, their job is to keep the gut from spasming out, and reduces the chance of spasms in the first place.)

"Antidiarrheal medicines, such as loperamide (Imodium), a kaolin/pectin preparation (Kaopectate), and diphenoxylate/atropine (Lomotil), are used when diarrhea is a major feature of IBS". (Most of us with IBS are well familiar with these OTC medicines, to the point where most of us carry them with us.)

"Antidepressants in smaller doses. Imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin) are some commonly used medicines that may alleviate irritable bowel symptoms for some. The likelihood of the most benefit, is when clinical depression and IBS, coexist. "

(Perhaps for those whose IBS is a direct result of major depression, these might be useful. However, since most FMers have been on tons of these kinds of medications, as they are the most commonly prescribed and we still have IBS. I think that pretty well trashes this theory myself and the tests tend to bear that out.)

"Tegaserod (Zelnorm) is used for the short-term treatment of women with irritable bowel syndrome when constipation is the main symptom. Tegaserod stimulates the digestive tract to maintain movement, decreasing the risk of developing constipation. The drug is taken twice daily 30 minutes before the morning and evening meal for 4-6 weeks. In individuals who respond, an additional 4-6 weeks of therapy may be considered. A doctor should be contacted immediately if new or sudden worsening of abdominal pain or diarrhea occurs. The safety and efficacy of tegaserod has not been sufficiently studied in men; therefore, the US Food and Drug Administration (FDA) has not approved the drug for treatment of IBS in men.

Alosetron (Lotronex) is approved only for short-term treatment of women with severe, chronic, diarrhea-predominant IBS who have failed to respond to conventional IBS therapy. Fewer than 5% of people with irritable bowel syndrome have the severe form, and only a fraction of people with severe IBS have the diarrhea-predominant type. Alosetron was removed from the United States market but was reintroduced with new restrictions approved by the FDA on June 7, 2002."

"The drug is being restricted because serious and unpredictable gastrointestinal side effects (including some that resulted in death) were reported in association with its use following its original approval in February 2000. As with tegaserod, the safety and efficacy of alosetron has not been sufficiently studied in men; therefore, the FDA has not approved the drug for treatment of IBS in men. "Mednet

Well, finally, a few meds just for women that don't have anything to do with our reproduction, trust me, this is rare :) pain and gender bias on site link

"Antibiotics and non-steroidal anti-inflammatory medicines ( Ibuprofen, Voltaren and others) make the symptoms worse and should be avoided." 

The anti bios are well known for causing both this effect, and yeast infections, but I find it interesting to note that the NSAIDS, the ones the doctors are so fond of handing out, should not be given to a person with IBS, without very good overriding reason. Somehow, I get the feeling that most doctors, are unaware of this, as they are the first thing they tend to want to give you for FM. ( This is despite the fact that they are useless for FM ) Research

FDA warning about NASAIDS a must read


Other Tests for IBS:

Blood Tests - A complete blood count looking for anemia, etc. Erythrocyte sedimentation rate (looking for tissue damage or inflammation) and a thyroid test. Stool Tests - For intestinal parasites or occult (hidden) blood in the stool, and tests for lactose intolerance

The Official 'Rome III' Diagnostic Criteria for IBS

At least 3 months, with onset at least 6 months previously, of recurrent abdominal pain or discomfort associated with 2 or more of the following features:

It is relieved with defecation, and/or
Onset is associated with a change in frequency of stool, and/or
Onset is associated with a change in form (appearance) of stool.

Other symptoms that are not essential, but support the diagnosis of IBS:

Abnormal stool frequency (greater than 3 bowel movements per day or less than 3 bowel movements per week)
Abnormal stool form (lumpy/hard or loose/watery stool)
Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation)
Passage of mucus
Bloating or feeling of abdominal distention.

Factors that may have a role in IBS include:

Neurological Dysfunction (Brain-Gut Interaction)
Stress
Leaky Gut Syndrome
Food Sensitivities/Intolerance's
Candida and Gut Dysbiosis (the disruption of normal intestinal flora )


Things you might try to help yourself:

Eliminate possible food allergies:

Keep a log:

Keep a food log for at least 30 days, what you eat, when you eat, what mood you were in, etc. At the end of the mt. scan it and look for related factors. If you find out that having bread, often sets it off. Then you just might have a gluten intolerance. Like wise, if you had heavy red meats, you might want to have the gall bladder function checked, etc. etc.. the log will help you pin point and track down anything you might be eating, that is having a direct effect. Just to rule out food allergies. If you find that a certain food is the problem, ( lucky you ) drop it off the menu and I hope that makes it go away for you.


Fiber, Fiber and more Fiber, but ... the right kind:

Soluble fibers, which becomes a gel in the gut, that breaks down and is absorbed into the blood stream.

And no I don't mean most veggies or bran muffins here, those are considered insoluble fibers. Soluble fibers are things like :

  • Oats
  • Dried beans and peas
  • Nuts
  • Barley
  • Flax seed
  • Potatoes
  • Broccoli
  • Fruits such as oranges, apples bananas, and berries
  • Carrots
  • Psyllium husks
Insoluble fibers, which basically make bulk are track cleaners, they attract water to themselves and scrub the system.
  • Whole grain foods
  • Bran ( here is your bran muffin you were thinking about )
  • Vegetables such as green beans, cauliflower, zucchini , and celery
  • The skins of some fruits, like tomatoes
Now, stands to reason that you need both and dependent on what is dominate in your IBS, will decide what you can try to eat more of. Some, like Psyllium husks or celery, are dual purpose. A little research into both kinds of fiber are well worth checking into. Make note of which fiber your eating more of and you may find you could need more of the other kind, to balance things out.

Probiotics:

There are bacteria that naturally live in the gut. I know, that sounds disgusting, but news, they are there and they have good reason to be there. Now, what can happen is these friendly and useful bacteria can get killed off, by a variety of things. Antibiotics, as mentioned above, are well known for it. Surgery of almost any kind, under general anesthetic, is almost of promise of killing off these needed tiny critters that call us home. Especially in the case of surgery on the gut itself.

Ok, things to try to restore the balance: Probiotic foods, which contain a live microbiological culture, typically fermented in some way.

  • Acidophilus milk
  • Yogurt
  • Artichokes
  • Honey
  • Goat’s milk
  • Miso soup
  • Soft cheeses
  • Sauerkraut
  • Brined Olives
  • Activia
There are many others, but it is definitely a good idea to add at least a few of them to the diet. Those with Pancreatitis, should avoid these.

Eat like your pregnant: Dissect your diet

As any woman can tell you, the bit of breaking up a days food into many small meals, is helpful for countering morning sickness ( who coined name that anyway ? Had to be a man, as any woman with half a brain can tell you it is not just mornings ! ) Anyway, break up the total food for the day into smaller amounts, consumed throughout the day. Some have found it helps them a great deal, as the system is never overloaded. For others, this is a not, as the more often you eat, the more the symptoms are kicked off ( I am one of those ) but it does work for some people, so it's worth a shot.


Herbs and alternative therapies:

Chamomile
Evening Primrose Oil ( for women whose IBS is worsened, during their menses )
Peppermint Oil

Diarrhea: Barberry, catnip, chickweed ( which is also laxative in larger amounts ) cloves, dill, garlic, marshmallow root, mullein, nettles, papaya, passionflower, pau de arco, cayenne, raspberry leaves, shepherds purse, sage, slippery elm, St. johns wort, thyme, willow.

Constipation: Aloe vera, cascara sagrada, chickweed, coffee, damaina, fenugreek, flax seed, kelp, licorice root, marshmallow, yerba mate, oatstraw, papaya, quassia, safflower oil, senna, slippery elm, sunflower seeds, yellow dock.

General uses: Alfalfa, apples, goldenseal, myrrh, bee pollen, peanuts, ginger.

You might notice that some are listed for both states, this is for good reason, as those that are listed on both, can do either, as if the gut needs water, it will provide it, if it has too much fluid, they will absorb it into a form the body can better handle.

To see more details, see, herbs, on site link.

Things like Yoga, massage, heat applications, in short, anything you can do from the outside that soothes the gut. It's a matter of, if it feels good ? Do it.


Emotional Stress reduction:

A word here, not all emotional stress is distress: A certain amount of stress is necessary and even positive. This is called eustress. Bad or negative emotional stress is called distress: the negative physiological and emotional response when stress( demand ) is unresolved and doesn't translate into action. What is stress ?  Coping with stress

So in point of fact, most of what we call "stress" is the body and minds reaction, to something that effects our emotions, that we cannot, or do not take action on.

Now, as noted, IBS is not caused by this kind of stress, but is made worse by bad emotional stress, so, it stands to reason, that anything you can do to de-stress yourself emotionally, is a plus. Mind, you are not going to be able to get rid of "all" stress, you will just stress yourself out more, to even attempt it. Ditto with internally harping at yourself to "relax" all the time, as your inner nag, is keeping you from doing just that. So, keep your goals reasonable and just tackle the worst things, the rest will tend to take care of itself. ( body or internal stress is another subject entirely, Body stress and FM, on site link)

Possible means.

  • Mediation
  • Aromatherapy
  • Time management, a biggie, it's a lot easier to stress out, if your always pushed for time.
  • Money management, yet another big one. You might not have all the money you want or even need, but having a spending plan helps.
  • Light exercise, like Tai Chi, with the emphasis on light, grabbing a bar bell is generally not relaxing, not to mention, if you have FM, not a good idea.
  • Music, drag out your CD's or albums and crank it up.
  • Hobbies, find some you like, and enjoy yourself, Get creative.
  • Avoid Push, Crash -on site link
  • Order your life's real priorities, get your act together and stop wasting energy on trivia.
  • Take time out as you need it, get up, walk, etc. Stretch out and move.
  • Get outside, sunlight, Vit D, all that good stuff.
  • Say No to those who want you engage in emotionally stressful activities and feel no guilt for doing saying so.
  • Get counseling for problem family interactions if needed.