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Hello Heather:
Thank you so much for creating this new forum to respond to specific questions. I haven't been on your site for a few years because I have been very stable on your diet, but now I have a huge challenge for which I need advice!
I need to have some major surgery on my liver in which more than half may be removed. For the past 2+ years I have been IBS-C (constipation) predominate. I am able to successfully manage my condition on your diet.
My questions in regards to my surgery are as follows ...
1. Will an enema (if required before the surgery) create IBS discomfort and potentially put me in agony)?
2. After surgery, I would like to only receive intravenous medications ... nothing orally because I am fearful medications will trigger an IBS attack ... and especially because I won't be able to take medications safely with soluble fiber (since I will be on a liquid diet for awhile). In the past, I have been unable to orally tolerate painkillers (other than a small dose of children's Tylenol). What painkiller received intravenously (morphine is commonly used here in Canada) would be the least likely to exacerbate my constipation? (I understand painkillers received intravenously or orally cause severe constipation.)
3. Will the painkiller have any other IBS impact other than constipation?
4. What can I do to combat constipation if I get it from painkillers, combined with my IBS? (I already have severe constipation, I can't take laxatives because they exacerbate my IBS condition and I will be on an initially liquid, later pureed, diet)
5. Do you have any idea what affect reducing the size of my liver might have on my IBS? (Hopefully over time things will get better because the liver regenerates)
I have no idea how to find out this information. I hope you may have some connections to find out. I am trying to figure out how best to manage my situation for the surgery. I will also need to receive painkillers when I get home, but I am not sure how I can take them if they can't be given intravenously. I hate being a person with special needs due to my IBS because the medical profession doesn't seem to know how to deal with it.
Thank you!!
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Hi Belinda - I am so sorry you have to go through this, and I hope you have a super easy time and speedy recovery.
I do not know how the end result of this will impact IBS, hopefully it will not.
An enema might cause symptoms to flare, that is not uncommon. If you can try to just overwhelm your gut with peppermint tea in advance of this - that will prevent spasms and keep things calm.
A liquid diet can still include soluble fiber. If you can dissolve your fiber supplement in clear water, and it just stays looking/feeling like clear water, docs normally okay that use. Ask to be sure, but typically this is fine, so if that's the case you can keep up your soluble fiber supplement to head off the constipation.
You may need to gradually increase your soluble fiber after surgery to help counteract the constipating effects of the painkillers they will have you on. Oral or IV painkillers will all have that side effect if they are opioids. Morphine will for sure. It would have to be non-opioid to not be constipating, and those won't be strong painkillers - that would be things like NSAIDS or Tylenol.
Other than constipation, the opioid painkillers won't hurt IBS, and they'll certainly stop/prevent painful spasms and cramps.
Push your doc about continuing your soluble fiber along with your liquid diet - don't let them say no because they don't understand the question or importance. If you can drink anything liquid, you should be able to have your soluble fiber in that liquid. That would keep the constipation at bay.
Good luck and please keep me posted!
XXOO
Heather
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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
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Thank you so much, Heather.
I am going to have a chat with the surgeon next week. I doubt I would be allowed to drink or eat anything before the enema, if one is required. I also probably won't be able to have much more than water or chicken broth after the surgery.
I'm going to ask if I could take a non-opiad intravenous painkiller ... one that doesn't cause constipation. It is causing me so much anxiety worrying about whether I am going to have an IBS attack when I go for surgery. I have been stable for so many years. I shudder at the thought of returning to my unstable days. I would rather endure a little pain to avoid an IBS attack because it inflames my tummy and takes weeks to recover.
I will try and keep you posted. I hope everything is going well for you. I hope we can meet one day in person when I am visiting the west coast. I still make trips several times a year to the San Francisco/Bay Area. Perhaps one day I will make it to Seattle too!
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Hello Heather,
First and foremost, I am so grateful to have stumbled upon your books. I bought them thinking they wouldn't be much help, but oh how they are. My boyfriend was diagnosed with IBS a little under a year ago and it caused a lot of stress in our relationship. Because of you, I was finally able to help and sympathize with him more (since prior to his condition I had no idea that IBS even existed), he stopped having constant diarrhea, and was able to be a normal person.
He has come so far in such a small amount of time and I am so grateful for that. Although he has been getting better he still feels so drained of energy at all times (especially after work). I was wondering what could be done so that he can start having more energy.
I really look forward to hearing back from you and from anyone that has the same problem. Thank you so much for all that you have done and continue to do.
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Hi Daniela - thanks so much for your kind comments!
Make sure he's eating small but frequent snacks/meals, and using his soluble fiber foods as a safe foundation to add in small amounts of IBS safe proteins (seafood, skinless white meat poultry, egg whites, finely ground nuts, pureed beans/lentils) and small amounts of heart healthy fats (olive, flax, avocado, etc.). Both the proteins and fats are important for energy and satiety, but use them as additions to the foundation of soluble fiber foods so his gut stays calm.
If he's eliminated coffee but needs the caffeine he can use black or green teas.
He may also just need some extra rest and sleep. IBS can be really draining and exhausting, physically and mentally. It is a wonderful sign that he's feeling better, and as that continues he should see his energy pick up as well.
If he can add in some gentle (not extreme, like sprinting) exercise that will help him increase his energy levels as well, and also likely help IBS. Yoga is the perfect fit for both of these.
Please keep me posted, and give him a hug for me. And you too - caretakers need taking care of, as well. 
XXOXO
Heather
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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
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Hi Heather,
I was diagnosed (because all my other tests came back normal) with IBS-d about 10 years ago. I found your site researching on my own and the diet was the only thing that saved me! I am so appreciative.
I had my gallbladder removed last week and it seems all the early problems I had with IBS-D have came right back...immediately having to go, painful cramping, etc. I have been trying to stay on a liquid diet but introduced white rice and toast and it didn’t go so well.
Has anyone had issues with their gallbladder removal and setbacks? I’ve been researching enzymes, probiotics, etc but I’m afraid to ask the surgeon later this week because I fear he won’t know anything that can help!
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Hi - I am so sorry! This is actually super common - see here https://www.helpforibs.com/news/gallbladder-ibs.asp
Keep up your soluble fiber supplement, gradually increase that if you need to.
Ask that doc about Questran or equivalents - he should hear about this side effect from the surgery all the time. No stupid questions here - you do not have to live with this aftermath at all, so don't let him just blow you off.
XOXO
Heather
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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
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Is there a website where you can find out the fiber content of foods -- insoluble and soluble? A lot of ingredient listings just give grams of fiber without specifying which.
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Hi - you'd think there would be! But this is a really poorly documented area of food science - see a whole post about this on the IBS diet board:
https://www.helpforibs.com/messageboards/ubbthreads/showthreaded.php?Cat=&Board=diet&Number=284172&page=0&view=expanded&sb=5&o=&fpart=1
XOXO
Heather
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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
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What can I do to move my bowels faster? It takes me at least an hour every day. It is ruining my life. I am not constipated. It is worse when I have a pending appointment or am being rushed.
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