Calming IBS Diarrhea Urgency

Don't Try to Empty!

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The urgency of diarrhea episodes can be one of the most disruptive and debilitating aspects of IBS. It has been my experience that many people who suffer from diarrhea-predominant IBS (IBS-D) try to deal with this urgency through efforts to “empty” their bowels before leaving the house. The thinking is that “if there is nothing left” then one’s bowels should be quiet. In my opinion, this approach to managing IBS-D is a mistake.

I always advise my patients to focus on calming, not emptying. My rationale for this is not based on any hard science, but rather my general knowledge of how the intestinal system works.

The Problem

There are several problems with the “make sure I’m empty approach.” The first is that the worry about how empty you are is going to produce anxiety. Anxiety has the unfortunate result of creating the very symptoms you are trying to avoid, because it stimulates our body’s stress response.

The next issue is that there is no such thing as an empty bowel. The bowel is continually making stool. People who are stranded without food will continue to have bowel movements for several days. When you encourage your body to continue emptying itself of food, you will be passing looser stool material – material that hasn’t had the time to rid itself of extra moisture. With each successive bowel movement, the stool will be looser and more watery.

This loose, watery stool is harder for your rectum to hold on to, thus increasing your risk for continued intestinal cramping and perhaps some fecal soiling.

The Solution

It is helpful to focus on how your intestines are supposed to work as you try to manage your IBS. Although there are no set rules as to how often a healthy body has a bowel movement (it's highly variable depending on the person), a typical routine is for a person to have one or two bowel movements at a time, with a prolonged period of quiet afterward.

During this quiet time, stool material in the colon is being firmed up as water is absorbed back into the body. Thus, after your second bowel movement, your body is really as empty as it needs to be, and you can now focus on using delay to encourage your bowels to quiet down.

The successful use of delay involves not running to the toilet in response to urges, but rather requires that you sit quiet and use some relaxation techniques to actively encourage your system to quiet down. If the urges continue to become stronger and more intense, then by all means walk slowly to the toilet and let the bowel movement happen. However, with practice you may find that you become better able to facilitate a quieting of your bowels so that you can leave your house with a feeling of confidence, not trepidation.

For more tips on dealing with IBS urgency, see:

Relaxation How Tos

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