"8 A.M: I have a normal BM.”
Everyone poops—so says the classic kids' book. But for many women, it's hardly that simple, often involving drama like cramping, straining, or diarrhea. Sometimes the culprits are seesawing hormones (as in: PMS) or suspicious grub. More often, though, it's irritable bowel syndrome (IBS), a catchall diagnosis for chronic gut malfunctions that happen at least three days every month.
Of the one in five adults who has IBS, a full 60 percent are women.
There's no cure for IBS, but experts say the best way to manage (or even eradicate) symptoms is to track your day-to-day behaviors and flag stomach-disrupting triggers. We had three patients—for whom OTC meds don't cut it—do just that for WH. Then we presented their cases to top docs. This pro advice can help you make peace with your own bowel disturbances, IBS or otherwise
For the past three years, Meg has struggled with dull, period-cramp-type aches in her stomach and sharp pangs throughout her abdomen, sometimes several times a day.
Her stools often contain bright red blood.
Following an endoscopy and colonoscopy, Meg was diagnosed with IBS and proctitis, a rectal-lining inflammation that can cause bloody BMs. Her M.D. prescribed an anti-inflammatory; it didn't help much. Meg tracked her mood, diet, and symptoms for one week:
"I started a new job six months ago, and I'm struggling to get the hang of it. I'm constantly stressed. I feel like I'm always falling behind, and I even cried in front of my boss this week—so embarrassing!"
The Expert Take:
The brain and the gut are intimately connected by a network of nerves and neurotransmitters. A troubled mind can leave your gut in turmoil, whether or not you have IBS, says Satish Rao, M.D., Ph.D., chief of gastroenterology and hepatology and director of the Digestive Health Center, Augusta University. When you're tense, the body directs blood to your vital organs, away from your digestive system, which can provoke abrupt bowel-muscle contractions, he adds.
"Following a traditionally healthy diet doesn't make things better for me. A green smoothie might tear through me the way spicy fajitas do for someone else, so I'm working on finding a different kind of healthy through trial and error. Breakfast is often coffee, oatmeal with berries, and a multivitamin, while lunch and dinner tend to be soup, sandwiches, or salads."
The Expert Take:
IBS sufferers often have to experiment with which nutrient-packed foods sit well with them, since every patient is different, says Jennifer Inra, M.D., gastroenterologist, Brigham and Women's Hospital; instructor of medicine, Harvard Medical School.
Plus, multivitamins with synthetic iron can irritate the digestive tract, says Lisa Ganjhu, D.O., clinical associate professor, division of gastroenterology and liver diseases, NYU Langone Medical Center. Getting the recommended 18 milligrams a day through meats or iron-fortified milk or cereal is friendlier to a sensitive gut.
Certain compounds in java speed up digestion, which can worsen diarrhea, Ganhju adds. She recommends switching to black or green tea.
As for salad, though healthy, cruciferous greens tend to hang out in the gut, where they can produce gas while being digested, she says. Taking an enzyme tablet like Beano before meals may help.
"I had a few bouts of bloating, and every day I experienced nausea and sharp stomach pains, sometimes after eating, other times not until hours later. My flare-ups usually last at least an hour, but a few times this week I had quick, five-minute bouts. On days I didn't have a bowel movement, I had diarrhea the next day."
The Expert Take
If you swallow too much air (by eating quickly or chewing gum), gas can get trapped in the small intestine, causing bloating, says Ganjhu. Taking a few deep breaths may help release it.
Post-meal pangs can come from a gas bubble that formed shortly after eating, or much later, from a colon that's inflamed by a stuck piece of poop, says Rao. A fast-moving gas bubble can press on oversensitive nerves and cause short bursts of pain.
Stress is likely exacerbating Meg's IBS. Because of that close gut-brain connection, meditation and deep breathing can quiet both mental stress and bowel disruptions.
If they don't, she might want to try the FODMAP diet; it temporarily cuts out foods high in certain poorly absorbed carbs, then reintroduces them slowly to suss out which ones cause symptoms.
A study found 50 percent of IBS patients who followed FODMAP for six weeks saw an improvement in pain.
Seven years ago, Cheryl's issues appeared out of the blue. She has daily pain that cycles between dull and stabbing, accompanied by bloating, gas, and bouts of constipation and diarrhea, sometimes one after the other. She logged three typical days.
"8 A.M: I have a normal BM (easy to pass, soft blobs) before breakfast. 12 P.M. I have another normal BM. 3 P.M. I take a two-mile walk. 6 P.M. I have my third normal BM of the day. 8 P.M. I eat dinner with a glass of flavored seltzer."
The Expert Take
There's no "normal" pooping frequency, says Inra. How often you go may depend on your diet and exercise habits. But tell your M.D. about any major change to your usual amount.
Exercising for 20 to 30 minutes, three to five times a week, can curb symptoms, possibly by helping move gas bubbles along or by reducing stress, Rao adds. Steer clear of carbonated drinks; the bubbles can add to bloating and gas.
"9 A.M. I wake up having slept horribly—my mind wouldn't shut off. My stomach is crampy and feels like it's churning. 10 A.M. I still feel sick, but I eat fruit and a danish, since avoiding food sometimes makes me feel awful. 3 P.M. I eat a sandwich, and immediately, my stomachache worsens. Also, annoyingly, I get the hiccups. 4 P.M. I had two normal BMs this morning, but now I have diarrhea and lower-abdominal cramps that last for several hours."
The Expert Take
Lack of sleep can make you less able to manage stress, which can contribute to symptoms, says David Rubin, M.D., chief of gastroenterology, hepatology and nutrition, University of Chicago.
While the acid and bile in an empty stomach can make gut pain worse, the added sugars in that danish could cause gas and bloating, says Ganjhu.
Hiccups happen when a distended stomach aggravates the nerve that makes the diaphragm contract, Ganjhu adds. Drink cold water to stop the irritation.
"12 P.M. I try not to miss breakfast, but I don't manage to eat until lunch. I microwave a frozen turkey dinner with gravy and stuffing. 2 P.M. I get crampy, lower-abdominal pain that continues throughout the day. A few times I feel like I urgently need to go to the bathroom but don't have a BM. 7 P.M. I eat a big dish of pasta with a slice of bread. I haven't pooped all day and am feeling constipated."
The Expert Take
Skipping meals can also lead you to overstimulate the gut with a big meal later, says Ganjhu. Eat small, spaced out meals five to six times a day. However, rich, fatty foods take longer to break down, which can leave you with gastric distress. You don't have to nix them, but again, try smaller portions, she adds.
That false sensation of feeling like you need to go #2 can happen when poop takes longer to pass through the colon, says Rubin.
Fiber powder supplements can help you pass stool if you're feeling really plugged, says Inra. OTC laxatives are okay on occasion, but if you're relying on them too much, see a doc.
Prioritizing a solid night's rest through better sleep hygiene or mind-calming therapies like progressive muscle relaxation (clench and release muscle groups one by one, starting at the feet) would lessen symptoms and put Cheryl in a better mental position to battle her frequent bloating and diarrhea.
She should also try eliminating trigger foods (like carbonated beverages and high-fat eats) and incorporate more fiber into her diet, especially when she's constipated. If dietary and lifestyle changes don't cut it, she may want to speak to her doctor to see if she's a candidate for a prescription antispasmodic medication such as dicyclomine, which she'd take 30 to 60 minutes before a meal.
For the past three years, Carly has ping-ponged daily between constipation and diarrhea. Her pain fluctuates too, from piercing abdominal cramps to feeling like she's been punched in the stomach. Prescription antispasmodics, antibiotics, and antidepressants didn't relieve her symptoms. At her family doctor's suggestion, she followed the FODMAP diet for eight weeks, but it only helped a little. She kept track of what a good, average, and bad day look like.
"I'm on vacation in San Francisco with my husband; we spend the entire day walking all over the city. Our best find: a bakery that sells amazing macaroon cookies! Around 5 p.m., I have a glass of wine and then a cocktail with dinner. I don't have a BM all day, but I don't feel too bloated."
The Expert Take
Those macaroons may have contributed to Carly's happy gut.There's some evidence that coconut may reduce inflammation and help with constipation, says Rubin.
But alcohol is a gut irritant, says Gahjhu. If you're going to imbibe, stick to one glass of wine or beer—they are better tolerated than some liquors. And sip while snacking on food.
"We spend most of the day in the car, driving back home to Portland. I'm bloated and I don't eat much all day because I'm so constipated. At 9 p.m., I have my first bowel movement. It starts out soft and then turns into diarrhea. I feel some relief but still have the urge to go."
The Expert Take
Being stationary can keep gas from moving around and exiting, says Rao. Try stopping the car and taking a short walk during long trips.
As far as that sneaky bout of diarrhea, consistency can change mid-poop, says Inra. When food shuttles too quickly through an irritated gut, you're left with diarrhea. But any food that moved through before spasms started can come out as hard stool.
"I'm up at 6:30 a.m. and sit on the toilet for 45 minutes attempting to have a BM, which finally comes out as diarrhea. After lunch (a salad), I start having cramps and bloating that last several hours. I'm able to get in a four-mile run before dinner, which is spaghetti with garlic and onions. Immediately after, I'm bloated and it feels like I need to go to the bathroom but can't. It feels as if there's a rock in my stomach. I can't move."
The Expert Take
First of all, if after 10 minutes you haven't been able to poop, get up, says Rao. Excessive pushing sets the stage for hemorrhoids or a weak pelvic floor, which will make constipation even worse.
Onions and garlic contain hard-to-digest fructans, which can lead to gastric distress, says Ganjhu That "rock" could be trapped gas that's sitting in her intestine, or she may still have a hard, stuck piece of poop in the colon, she adds.
Diet tweaks and prescription meds help most IBS patients. Neither has worked for Carly, so she should seek a second opinion from a GI doc to confirm her diagnosis, then consider seeing a therapist.
Research shows that replacing negative thoughts (I'll never feel better) with more positive ones (This pain is just temporary) can help patients curb the anxiety that can worsen a flare-up.
Similarly, biofeedback therapy—an electrical device monitors stress response so patients know when to intervene with relaxation therapies—has proven effective in reducing symptoms and severity.
*Names have been changed.