Casestudy overflow diarrhea Positive Gut

Case Study: 25-year-old woman with overflow diarrhea and ‘accidents’

Today I would like to share a story about one of the clients I worked with recently. By telling you her story, I hope to give you more insight into possible solutions to reduce your IBS symptoms. The last time I shared a case study with you, I told you about Melissa, a 45-year-old woman with heartburn and abdominal pain. And today I’m telling you about Mandy, a 25-year-old woman with overflow diarrhea and “accidents.”

Casestudy overflow diarrhea PG

Who is Mandy? First meeting

For my case study, I refer to my client as Mandy, this is not her real name.

Mandy first contacted me in July 2020. The first corona lockdown was over and she came to my practice in Krommenie.
Mandy told me that she had been suffering for 10 years from constipation, bloating, and heavy cramps 1x a month, which made it feel like she was dying (her words).

The bloating mainly got worse after eating and was especially bad after pasta dishes, garlic, and onion.

As a result of constipation, it often happened that Mandy could not relieve stools for 2 days, after which she became nauseous and she developed overflow diarrhea. It had happened a few times that Mandy lost stools outside the home (including once on vacation). Because of these events, Mandy didn’t dare go out anymore and she got severe cramps when she had to leave. She had started using macrogol to ease defecation.

Mandy had 1 school-aged child, and wanted another child but was still using contraception. She had suffered from hemorrhoids since the pregnancy, and persistent constipation did not make it any better.
As a child, Mandy had not known a safe and peaceful home and she experienced heavy losses. Because she had always experienced a lot of stress, she found it difficult to identify stress in adulthood.

Mandy worked 5 mornings during the week and the rest of the day was focused on her son. Mandy didn’t exercise (she didn’t dare because of her symptoms), but her boyfriend did encourage her to go for a walk, even though Mandy preferred to stay safe on the couch.

During the day a lot of energy and attention went to her child who often did not listen to her at all and had a poor sleeping pattern. This caused a lot of frustration and sometimes feelings of panic for Mandy.

The food and symptoms diary

After we had extensively spoken about Mandy’s symptoms and lifestyle, it was time to review her food and synptoms diary. It soon became apparent that Mandy often skipped meals because she did not have the time or the inclination to eat.

Mandy ate insufficient fiber, virtually no fruit (although she did prepare this for her child), and few vegetables. She drank about 5 glasses of Coke Zero a day. She ate vegetarian and drank no alcohol. The symptoms were present every day.

The plan:

We have drawn up a plan based on Mandy’s symptoms and her food diary. This included the following points:
Start with an elimination of FODMAP oligosaccharides. Mandy noticed an additional increase in symptoms after the use of grain products, garlic, and onion. The constipation symptoms can be caused by oligosaccharides.
Start with yoga exercises against bloating. If gas is trapped in the gut, twists in yoga can help provide relief.
Attention to breathing. Before eating and during stressful moments (eg when Mandy had to leave the house) conscious breathing can help to reduce stress.
Increase the use of fiber. And especially the non-fermentable fibers that can provide volume in the intestines and promote intestinal motility.
Attention to stress. Mandy checks several times a day how she feels, and tries to identify the feeling of stress so that she can recognize it.
Avoiding carbonated drinks. With carbon dioxide, extra gas ends up in the stomach and intestines, which can also cause symptoms.

The second consultation

After 4 weeks Mandy came in for her second consultation. She indicated that she experiences less pain than before, but that she does find it difficult to change things.
Drinking less cola was especially difficult. But she does notice that she has much fewer stomach acid symptoms since she reduced her cola intake.

The symptoms have improved the most when she is at home, but when she has appointments, diarrhea and nausea come back. Also, she now has hard stools every other day.
At appointments in the waiting room, Mandy is currently doing breathing exercises and that seems to be helping!

Advice:
Use a toilet stool and bowel retraining to counteract constipation.
Keep practicing the breathing exercises.
Start your day with yoga and breathing exercises if you have appointments later in the day.

The third consultation

Mandy has continued with the advice and has found her way more and more. It is actually going very well, she still has symptoms when she has to go to appointments, but this is much less intense than before.

The stool is not softer yet. Mandy didn’t try the toilet stool. And doesn’t quite stick to the elimination of oligosaccharides (she does eat wheat). She has also been under stress lately and slept poorly. This can all prevent improvement.

In the past month, she has had one severe abdominal pain attack of 15 minutes. What could that be, she wonders?

Advice:
Keep track of whether the abdominal pain attacks coincide with hormonal changes.
Take Macrogol again for 2-3 days if you are really constipated, this can help to get the stool going again.
Start with bowel massage to keep the bowels moving.
Variation options were discussed to replace wheat at meals.

After the thrid consultation

After the third consultation, Mandy’s coaching schedule became a bit messier, due to pressure at work and several colds and corona tests. This came with a lot of stress, so that the intestines could not completely calm down.

In the meantime, Mandy did continue with all the advice. She had started with the intestinal massage and the symptoms were no longer as severe as in the beginning.

2 months later life calmed down and Mandy noticed this immediately in her intestines! She currently feels that she has almost complete control over her symptoms during out-of-home appointments and that she knows what to do if things do go wrong.

The stools are more regular and the symptoms no longer stand in the way of her daily life. For now, we decided that Mandy will message me if she has any questions, and we will not reschedule.

Do you also have an irritable bowel or are stomach complaints getting in the way of your daily life? Schedule a free IBS symptoms assessment and we’ll discuss how I can help.

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