Visions of vacations dance in many heads at this time of year. But if you're one of the estimated 58 million people in the U.S. with irritable bowel syndrome (IBS), the idea may sound torturous.
It's bad enough to worry about recurring symptoms of bloating, gas, stomach cramping, constipation, or diarrhea when in your own hometown. What about when in unfamiliar territory?
Plus, your digestive system may be so finicky that any changes in routine may aggravate symptoms.
Such worries prevent many people from taking out-of-town trips. In a survey of 1,000 Americans, 28% of respondents with IBS-like symptoms avoided travel at least once in the past year, reports the International Foundation for Functional Gastrointestinal Disorders (IFFGD).
Nonetheless, IBS patients need not be deprived of holiday travel.
"If it's something that you're really looking forward to doing, by all means, do it," says Nancy Norton, the IFFGD's president and founder. "We talk to people (with IBS) all the time who have been apprehensive about traveling, but they go and let us know they've had a wonderful time."
With courage, preparation, and determination, it is possible to explore new places with IBS. Perhaps the trip, if relaxing, could even have a therapeutic effect.
Of course the hassles of travel, such as lost luggage, unhappy kids, or a bout of traveler's diarrhea, could work against that. But even then, you may be able to use the same stress management strategies used for daily pressures at home.
Stress busters include eating a well-balanced diet appropriate for your IBS, getting enough sleep and exercise, meditation, and doing something enjoyable.
Reducing stress may, indeed, be one of the crucial elements to a good retreat.
"There's definitely a benefit to taking a vacation, but people need to plan it so that it's not too stressful," says Sheila Crowe, MD, a gastroenterologist and spokeswoman for the American Gastroenterological Association (AGA). "Don't feel like you have to see all the sights in the city. Maybe just enjoy a leisurely breakfast, and then only see two sights instead of four."
It's important to do things you want to do rather than things you feel you ought to do, such as visiting everything and everyone, says Crowe. Resist over-planning and leave room for spontaneity. Yet plan enough so that you know there are safe places to go to the bathroom.
Here are a few more tips from the experts on how to ease travel with IBS:
Before Your Trip
- Choose a destination that you will enjoy. "Anyplace calm and relaxing is probably good," says Edward Blanchard, PhD, professor of psychology at the State University of New York at Albany. He says a frenetic, multicity tour of Europe might be more difficult for IBS patients.
- Check travel advisories for different parts of the world. This is a smart thing to do even if you don't have IBS. The CDC web site (www.cdc.gov) has a traveler's health section. It contains information about disease risks (such as travelers' diarrhea), vaccinations, and other prophylactics. Make sure to visit the site well before your trip as some immunizations take weeks to become effective.
- Ask a lot of questions. Knowing the who, what, when, where, and how of your journey can help avert stress and anxiety. Allow enough time to get to places to avoid rushing and to have time to assess a situation. "The less surprised one is, the better," says Leslie Bonci, MPH, RD, author of the American Dietetic Association Guide to Better Digestion. "The only surprises should be delightful surprises because you're in a beautiful place, or you discover a fantastic buy on silver."
Some questions to ask include:
Is there an early check-in for the hotel if I arrive in the morning?
Is there a late check-out if I need one?
Is there a refrigerator for my own snacks in the hotel?
Is there a restaurant on the premises? What is on the menu?
Are there grocery stores and restaurants in the area?
Will I be able to request special meals in the plane, hotel, or restaurant?
- Investigate the bathroom situation. Is there a toilet on the bus? Are there designated times when airplane passengers cannot leave their seats? Will I need special coins or to buy toilet paper at certain restrooms? The answers to these questions could help better plan lavatory trips.
Some IBS patients request aisle seats rows closest to the bathroom. Others feel more comfortable driving to their destination so they can stop as many times as they want. When driving, or out and about in an unfamiliar place, it may help to know the location of the nearest bathroom.
Norton says people have checked the Internet for bathroom diaries and have mapped out the location of large chain bookstores with restrooms. Palm Pilot users have used Vindigo, a high-tech directory service.
- Learn how to say key words if traveling to a foreign country. Besides knowing how to say 'Where's the bathroom?' it will also help to be able to ask the locals things like: 'Can you make (a dish) without ...' and 'I can't tolerate. ...' You fill in the blanks with your particular food sensitivity or intolerance. This may mean going to a local library, a university, or private companies such as Berlitz for consultation on language, says Bonci.
- Be up front with your travel companions. The destination may not matter as much if people are honest with tour guides and travel buddies. "People have gone through bus tours of Europe, and they let (guides) know in the very beginning that if they needed to stop for a restroom, they would appreciate it," says Norton, noting that people are usually very understanding.
- Pack essentials. Bring a carry-on bag with extra clothes, medications, fiber supplements, bottled water, and snacks. You will want all of this with you in case your luggage gets lost and when there are no good food choices in transportation terminals. For emergencies, it will help to have handy your doctor's contact information and possible sites for medical care at your destination.
During Your Trip
- Premedicate. For a long trip, it's a good idea for IBS patients with diarrhea to take antidiarrheal medicines such as Imodium or Lomotil if they know they can tolerate it, says Crowe. Some people become too constipated with the drugs.
Crowe says IBS patients need to pay attention to their symptoms and to bring their usual medications and fiber supplements. "You want to have them in the plane or train, where you can't purchase these things," she says, noting that some destinations may also not have these drugs readily available.
There are travelers, for example, who experience gas with changes in altitude. For these people, Crowe recommends bringing antiflatulents such as Gas-X. Other drugs that might give relief, depending on symptoms, include antacids, prescription antispasmodics (such as Levbid and Bentyl), and laxatives (such as Lactulose and MiraLax).
Visit your doctor to find out the appropriate treatment for you.
- Keep meals as consistent as possible. Try to keep to the same serving amount and to the same number of meals. Many people end up miserable because they don't eat or drink enough, they gorge, or they eat foods that aren't agreeable to their systems.
"Somebody might say, 'Hey, I didn't snack because I'm in a hotel room and there's nothing available,'" says Bonci. To this, she offers the following solution: Bring healthy snack foods you can tolerate, such as nuts, crackers, trail mix, a sports bar, or yogurt. They are better options than the fare offered in vending machines and transportation hubs.
- Watch your food and drink choices. To keep hydrated, opt for bottled water or Gatorade instead of carbonated beverages. It's better to buy liquids and other edibles from a hotel restaurant or grocery store instead of small fruit stands. Americanized guts may not be able to tolerate some foods in these places, says Bonci.
If you decide to try a new food, experiment in small amounts, and try only one new thing per day, advises Bonci.
However, Norton says vacation isn't a good time for people to experiment. "Stick with foods you're comfortable with," she says.
- Don't despair if IBS symptoms flare up. "I would invite people to think of vacation as almost like a scientific experiment," says Mary-Joan Gerson, PhD, a clinical psychologist in private practice in New York. "That gives people a sense of control."
She suggests IBS patients ask themselves, 'What kind of IBS person am I?' Then try to learn something from the answers.
In addition, Gerson says vacation is the perfect time to experiment with meditation and its healing properties. "If you start a simple type of meditation a week before (vacation), you can shift into that state at a moment's notice, even for 5 minutes somewhere, whether at a beach or pool-side," she says.
Bonci recommends different foods, depending on the symptoms. Chamomile tea has an antispasmodic effect for stomach cramping. For constipation, she suggests traveling with fiber supplements or a box of ground or milled flaxseed. The dietary supplement can be sprinkled on salads, cooked vegetables, or cereals.
To ease diarrhea, try fruit pectins such as Sure-Jell or Certo. "Fruit pectins are used to make jelly - to make jelly gel - but they also have a wonderful effect of slowing the emptying from the gut," says Bonci.
Oatmeal can apparently do the same thing. The good news is that both oatmeal and fruit pectins come in small, easily transportable packets.
While on vacation, it is, indeed, important to look out for your personal needs with IBS. After that, just try to take whatever comes your way in stride.
Remember, traveling with any ailment takes some effort, but with IBS, it is entirely possible to take an out-of-town journey, and have fun. But make sure you first check in with your doctor for appropriate treatments.
Bon voyage!
