I spend part of each day thinking about my bowels. I know that sounds strange, but for me it has become a normal part of living with irritable bowel syndrome (IBS).
Let me take you through an ordinary day when my IBS symptoms are flaring up. Upon waking up, I immediately have to rush to the bathroom, then again as I’m on my way out the door. At the office, I feel mildly nauseated throughout the day and don’t eat much, so my energy levels are low.
During a meeting, my stomach feels like it’s full of angry hornets, and I’m faced with a decision: hold the gas in and suffer the cramps or stink up the conference room. I make bathroom runs throughout the day, interrupting my workflow and making me self-conscious of looking like a bad employee for not being at my desk.
At home, I can finally indulge in real food without caring how it will affect my stomach. I can sit on the toilet for as long as I want until my rectal cramps pass (yes, that’s a thing) without fretting about not getting work done.
But then I have to do it all again the next day, and the next, not just at work but when I’m spending time with friends, on dates or attending events in crowded spaces where I can’t always escape to the bathroom on a moment’s notice. I typically forgo alcohol while out with friends and have to be selective about what food I eat. Everything I consume comes with a risk-versus-benefit analysis.
Though IBS can be irritating, plus embarrassing and exhausting, the good news is that, while there is no cure for it, it is treatable.
Why bowels get irritated
Though I spent years trying to hide my symptoms and felt like I was the only person who had IBS, I now know better: There are an estimated 40 million people in the United States — more than 1 in 10 — who have IBS, and many of us are young women. IBS is the most commonly diagnosed gastrointestinal problem.
IBS is a functional gastrointestinal syndrome, which means there is no visible damage to the bowels. This makes IBS different from inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, where the bowels are visibly enflamed.
“In IBS, we think there’s a brain-gut dysregulation so that the brain is misinterpreting the signals it gets from the bowel. There’s an alarm bell going on in the brain even without any injury or irritation. Even the normal digestive process creates sensations of bloating, pain and discomfort,” says Shoba Krishnamurthy, M.D., a gastroenterologist at UW Medicine’s Eastside Specialty Center who treats people with IBS.
In times of actual crisis, this process is helpful. If you’re trying to run away from a threat, for example, you don’t want your brain to send blood to your bowels so they can digest food; that energy is best diverted elsewhere. But for people with IBS, our brains and guts somehow think that danger is a constant.
Living with IBS
Though IBS isn’t dangerous, it can significantly interfere with someone’s life. Research shows that people with IBS often feel embarrassed by it, avoid activities where dealing with IBS would be difficult and feel that the condition limits them.
IBS is commonly defined by the stomach pain it causes, plus the constipation and diarrhea. And all of those things definitely occur. But, for me at least, the worst things are the ones that aren’t talked about, like how embarrassing it is to constantly have to fart while out with friends and how distracting it is to be highly tuned in to every little pain or gurgle in my gut.
A lot of people with IBS are extra sensitive to the goings-on of their bowels. That’s probably due to the brain-gut dysregulation, Krishnamurthy says. This heightened awareness to bodily functions is often called visceral hypersensitivity.