People with IBS often develop little rituals or habits that offer a sense of control. They usually start with good intentions. You’re trying to avoid pain, stay close to a toilet, or reduce the risk of bloating.
The problem is that while these habits can reduce anxiety in the a moment, they often reinforce worry and may even keep your symptoms going.
Planning ahead isn’t necessarily the problem, especially when you have erratic bowel movements or food intolerances. Most people with IBS or SIBO check where toilets are when travelling somewhere unfamiliar. The question is whether the behaviour helps you live your life, or whether it has become something you feel unable to cope without.
Could safety behaviours be keeping your IBS going?
In this post I’m looking at some common behaviours I see in my clients. Then I’ll explain why they’re unhelpful, and ways to loosen their grip. I’m Anna, a registered nutritional therapist, and have over a decade of experience working with people who have IBS or SIBO.
Example: George was really afraid of being sick, but found chewing gum helped him. So much so that he constantly chewed gum in between meals. He felt safer when he had the chewing gum in his pocket, and was never without it. His safety behaviour was the gum in his pocket and the minty feeling which distracted him from feeling nauseous.
Here’s a few other examples of things I’ve heard from clients that feel, on the surface, like they are helpful in managing IBS.
- Googling variants of ‘can tomatoes cause IBS’ to identify more and more foods to avoid
- Sitting on the toilet for an hour before you leave the house to force out a poo so you don’t need it when you’re out
- Returning to the toilet 4-5 times before you go out ‘just in case’
- Needing to know where the toilet will be at your destination before you’ll leave the house
- Taking the same probiotic for a year because it helped at first
- Skipping lunch ‘just in case’ because you have to go out in the afternoon.
These might not all apply to you, or you might see yourself in a few of these behaviours. It’s not really the act of doing them, but how they might be interfering with your life.
Safety behaviours in IBS
The main issue with a behaviour like this is that you never get the chance to see what life is like when you don’t spend an hour on the toilet before work each day. Or you stop taking that probiotic.
There is nothing inherently wrong with looking online for IBS information (that might be what landed you here!). Or there is nothing wrong with checking if you need the toilet before you set off for work.
But sometimes safety behaviours can get in the way of feeling better.
- You don’t get to test out what life is really like without the crutch – you expect things to be bad but never test whether the worst really does come true
- This increases your bias towards believing that the crutch is important.
- Keeping an elaborate regime (e.g. multiple toilet visits, just in case) draws more attention to the thing you’re trying to avoid.
George was scared that if didn’t have access to his chewing gum he would feel very sick. The anxious feeling about NOT having the gum actually caused him to feel nausea (the very thing he was trying to avoid), and he also never got the chance to test how he could cope in a day without frequently chewing gum.
IBS habits that don’t help you
- Overactive googling – Often continued searching can increase stress and confusion about what to eat, tests or supplements to take. Constant research can also pull you further away from everyday life because you feel you haven’t found the ‘perfect’ solution yet.
- Sitting on the toilet too long and over straining can actually make it harder to poo in the future. Spending too long in this position can irritate haemorrhoids, increase pressure on the pelvic floor and reinforce the belief that you can’t leave unless everything feels perfect. The bowel empties best when the pelvic floor muscles can relax, but sitting for long stretches on the toilet can leave muscles tense or overworked. Over time this can train your muscles to stay tense, which makes it harder to empty fully, which may lead to more straining, discomfort and more of that feeling of incomplete evacuation.
- Repeatedly returning to the toilet to check because ‘I still feel like I might need a poo’. Forcing a poo out is similar to above, it can damage your pelvic floor over time. It’s ok to have multiple bowel movements each morning, but are you checking even when you don’t have an urge?
- Constantly scanning for toilets when you’re out can keep the brain in a threat-focussed mode. This often heightens gut sensitivity and anxiety around symptoms.
- Taking the same probiotic for a year because it helped at first. If you feel like you can’t break up with your supplements they might be helping, or they might be like a crutch that you no longer need.
- Missing meals usually leads to low energy, reduced fibre, constipation or more bloating over time. This can actually make your digestive symptoms worse.
By chewing gum all the time George was constantly reminding himself that he could feel sick at any moment so keeping the threat alive. Also, conversely some people swallow more air during chewing gum which can lead to bloating which can trigger feelings like nausea.
Hypervigilance and IBS
Many people with IBS become highly tuned in to sensations coming from their digestive tract. Maybe you notice every rumble, gurgle, cramp or urge to go to the toilet. This is called hypervigilance.
The more attention we pay to bodily sensations, the bigger and more urgent they can feel. You could be having a normal day, but then you feel a little twinge in your gut, you think ‘am I feeling nauseous?’ and suddenly your thoughts spiral into a bad day.
Better in the short term
The thing is, in the moment you the safety behaviours may be reassuring or soothing, and may reduce physical symptoms. E.g. if you manage to push out a poo after 45 mins on the toilet you feel rewarded, and that this system does work ok.
But the more we focus on a symptom the more anxiety we may have about it, and therefore the worse it can become.
Is this IBS habit even a problem?
Some habits are fine, and you don’t need to unpick all your daily digestive routines!
But if they are interfering with you getting on with your life, or taking over all your headspace it could be time to make a change.
Here’s some questions you can ask yourself about your gut health habits:
- Does it feel like you can’t do without it (e.g. sitting on the toilet for 30 mins before you go to work)
- Does this require a lot of my time or attention to the detriment of other parts of my life (e.g. researching IBS diets)
- If I didn’t do this behaviour, what am I worried would happen? What evidence do I have for this potential outcome?
- Could this habit be inadvertently increasing the risk of what I’m hoping to avoid?
- Do I feel proud of doing this, or is it something that leaves me feeling incompetent or weak?
- Does it allow you to do things you wouldn’t otherwise do (socialise, eat certain foods)?
Creating IBS behaviour change
If you try changing a habit, you may feel more aware of your symptoms for a short while. This is completely normal. As your body and mind learn a new pattern you need to focus on the symptoms and behaviours. It could mean you’re noticing patterns that were previously running on autopilot.
If you identify something in your morning routine, or toilet habits that you want to change here’s the approach I’ve found works:
- Firstly, think of this like an experiment – you want to see what will happen. Choose one habit, and make a tiny change using one of the three tactics below. Predict what you think will happen, it can be helpful to write this down. Observe what actually happens.
- Tactic 1 – Incrementally make small reductions – take the supplement every other day, spend 5 mins less on the toilet each day
- Tactic 2 – Delay the urge to do the behaviour – wait 5 mins before rushing to the toilet or chew the gum.
- Tactic 3 – Swap the behaviour for one with less of a negative impact – change the gum for peppermint tea after meals, or instead of spending half a hour on the toilet take 5 minutes, then spend 5 minutes doing some deep breathing to feel calmer.
What to do instead of unhelpful IBS habits
Over-Googling – try instead:
- Give yourself a set time for research like ten minutes once a day. Set a timer and then get stuck in, but stop at the end of the allotted time.
- Keep one trusted resource saved (my pages!, NHS pages, Monash etc).
- When you catch yourself spiralling, just say: “I’ve done my research for today” and redirect your attention. Plan what you’ll do when you come off the scrolling time, such as having a book nearby, or planning a bit of housework that needs doing.
Sitting on the toilet for too long – try instead:
- Set a three-to-five minute timer (or whatever time scales seem like a relevant reduction for you)
- If you don’t poo within this timeframe, get up and return later when the urge returns.
- Try a relaxed posture (feet on a step, lean forward slightly, breathe into the belly). This helps to relax the pelvic floor.
Checking for a poo multiple times each morning – try instead:
- Go to the toilet when you feel the urge each morning, continue to respond to strong urges
- Notice whether you go multiple times only when leaving the house, or is it every morning?
- If you’re just checking to see if anything will come out, try to resist these extra visits to the bathroom by reducing the number of visits slowly over a few days.
Finding all the toilets – try instead:
- Notice when you do need the toilet how long you have between feeling the urge to go and having to go when you’re at home. Can you hold things in for 2 minutes, 10 minutes?
- Practice using deep calming breaths when you feel the urge to go. It’s normal for people with diarrhoea predominant IBS to have toilet anxiety about accidents if they’ve happened before or you’ve had close calls.
Taking the same supplements for ever – try instead:
- Reduce your intake gradually to see what happens. Sometimes that thing that you think has been holding you up isn’t making so much difference.
- Alternatively just stop one day and see if you notice a difference.
Skipping meals – try instead:
- Add something small and predictable (e.g. eggs, oats, yoghurt with a low FODMAP fruit).
- Stick to regular eating times to keep digestion more steady.
If you notice that your IBS habits are taking up more time, keeping you house-bound or increasing your anxiety, it can help to work with someone who understands both IBS and these behavioural patterns. You don’t need to face this on your own.
Work with me in the 3 month Gut Reset for support to change your diet and digestion.
IBS Nutritionist
Hi, I’m Anna Mapson, registered Nutritional Therapist.
I help people with IBS and SIBO get control of unpredictable gut symptoms to find long term relief from painful and embarrassing IBS without restrictive dieting.
I can help you to:
- understand your digestion better, so you recognise your triggers
- eat a well balanced diet, with tasty meals that are simple to prepare
- reintroduce your trigger foods so you can get back to enjoying food again
Find more about my 3 month 1:1 Gut Reset programme.
