A discussion about irritable bowel syndrome - or something else? D: A couple of years ago I wrote about my own digestive upsets. They always started on the third day of a trip and ended within a few hours after getting back to the car. I had all kinds of hypotheses. Obviously it was something specifically to do with backpacking, and something specific to me - other people eating the same food, drinking the same treated water, getting the same exercise - never had any symptoms. Imodium seemed to have no effect until the trip was done, when I didn't need it any more; then too much effect. This year I thought I'd figured it out - I'd been using Polarpure elemental iodine solution since 2001 as an aftertreatment after pumping through an MSR filter. It had the advantage of cleaning up everything along the way from the bottle I pumped into the bottle I drank out of into the cooking pot and into my eating cup. And beyond that - but I grew to like the sharp taste, at least when the water was cold. Of course there had been several long trips over the years when I did use the iodine and had no symptoms, but they commonly did arise on the third day, starting around 2008. But not on the third day of car camping/day hiking, when I did not need a water treatment. Finally this year I remembered a chemist hiker who had warned me to always follow the iodine treatment after half an hour with half a vitamin C tablet to bind and neutralize the iodine. And this year I met a hiker in the Russian wilderness who had used Polarpure religiously for years and now had thyroid problems. I got a new water treatment and had several symptom-free trips: a Steri-pen with a prefilter. All looked good, including a five day trip, but then over a Labor Day trip I had symptoms again - this time on the fourth day. But this time Imodium worked in about 24 hours - this was the first time I had stopped the action while I was still hiking. My conclusion is that my bowel is sensitive to various kinds of chemical and physical disruption, and I'm just as well done with the iodine. But I still need to carry plenty of extra TP and witch hazel wipes and Imodium just in case. I've tried adding metamucil and adding probiotics, and cutting out Vitamin I, but none of these were consistently effective. K: Man, your experience so closely mirrors mine. I'm 57, healthy otherwise, hike 70 days a year, but backpack only 6 or 8 days a year. My distress is relentless until my gut is completely emptied, and then I'm good for two days. Then the cycle repeats. I've gone through all the questions you did, since I use the two-part iodine (the 2nd tablet is citric acid - Vitamin C, basically). It ONLY happens on pack trips, and starts on about the 3rd day, and takes about three hours before I'm emptied out and so it makes it hard to get on the trail in the morning. I found that Imodium's benefit is limited, the cycle is otherwise unpredictable, and my bland diet is likely not the cause. But one thing I do wonder about is those rich, concentrated energy bars. Nobody wants to eat those things when not on the trail, but I have had distress the day or two after a big dayhike when I ate an energy bar. Since I'm not loyal to any brand, in fact I try every kind, the culprit could be the dense richness of their composition which they all have in common. I have had distress after eating tree nuts (pine nuts, cashews, almonds) which those bars are composed of usually. I haven't been tested for that allergy, but I avoid tree nuts now because I heard that some people can't process tree nuts. If I ever get allergy-tested, I will ensure to check for tree nut allergy. Another possible cause that I've wondered about: the intensity of the abdominal workout. When I was young, I rode dirt bikes, which actually works your entire torso all day. Abs constantly contracting and releasing; then I'd get an atomic bomb of a dump, but be done. My wonder was if the constant abdominal workout disallows the gut to solidify the load. Know what I mean? And this spring I took a rafting trip in Grand Canyon, and the first day I was in the paddle raft, torquing and twisting my torso all day, and the next morning it happened again. So maybe easier, less-elevation-gain trips, combined with a stauncher diet of less fiber can help. These are only things I suspect - the change in diet, especially those damned energy bars, and increased physical activity. I've been tested for everything: Crohn's, parasites, bacteria, viruses, gluten intolerance, got butt-scoped and perfect condition; nothing ever comes up positive, because truly, nothing is there*. So like you, I carry a lot of TP now, Imodium and Pepto tabs, and prescription dicyclomine 20mg tabs which is an anti-cramping med without side effects. When the trouble kicks in, I can moderate it with some of each. * Then when you exhaust all possibilities, the doctor says, "Can't find anything, so you have IBS." That's the catch-all solution when they can't find it. You're stuck with a sensitive gut. Stuff I know I can't do at home: anything with chilis or peppers, even green pepper. Heavy doses of beef. Beer sometimes gives me trouble, sometimes not. Maybe fish. Maybe Vitamin I. Dunno.... It might be a combination of any or all of the above, plus other unconsidered causes, and backpacking combines too many at the same time, which pushes your gut past a threshold. D: Thanks for sharing! I can vouch for me, that Cliff/Lara/whatever bars are not the problem; symptoms come with or without them. I am suspecting that the abdominal pressure from carrying a heavy pack may be part of the problem. Day hiking, I don't have the same pressure. Where I'm different is the symptoms. When it starts, I have frequent (every hour or two) bowel movements consisting mostly of gas, a fair amount of clear bubbly (from gas) mucus, and only every third or fourth time, small amounts of soft fecal matter. So it's not like typical diarrhea at all. The pisser, so to speak, is that when it's active, I can't urinate without being in danger of unpredicatable incontinence in back. So I have to position myself as if to defecate. I think this supports the idea of an irritation in the lower digestive tract. There is no sign whatever of infection and it always ends as soon as I start driving home. I think "irritable bowel syndrome" is as good a diagnosis as any at this point. > Stuff I know I can't do at home: anything with chilis or peppers, even > green pepper. Heavy doses of beef. Beer sometimes gives me trouble, > sometimes not. Maybe fish. Maybe Vitamin I. Dunno.... The only food that doesn't work for me at home is raw garlic - especially in aoli. I avoid it at home and on the trail! K: I think I might have trouble with garlic too; unsure, since I don't eat much of it. But what you describe is kinda like what I get too. Cramping, pain, pull over, and get just a little, and it's gassy and mucousy. The cramping gets so bad that I start bleeding a little, but you hit the nail on the head that it's something that really irritates the lower GI. Not an upper GI problem, it's lower GI tract irritation. Before I can get out of camp, I've left behind a turd cemetery up the hill from camp. It's crazy. The dicyclomine, I think, helped reduce the cramping, which I think for me is cause of the irritation. Feels like my gut is getting twisted into knots inside. I have considered transitioning to a Sawyer mini filter and try going without the tablets, just to see if that fixes the prob. But as for the abdominal pressure contributing to it, that part we might be stuck with. D: Definitely try going without the iodine. It might make a big difference. But don't throw away the dicyclomine! I'm going to ask my doctor about that. But cramps have never really been an issue for me. Since my hiking partners are subject to the same stresses, food, and water, and don't have these symptoms, I have to conclude it's something specific to me. Probably yours is specific to you. We can get ideas from other sufferers, but we have to each find our own specific management regimes. K: Yes, will keep the dicyclomine, and go back to filtering only. And agreement on it being just me, I hike with a group of 5 and I'm the only one that ever has GI trouble, so will have to learn how to manage it. BTW, I've tried probiotics too, several times, but they don't seem to be effective for this. I remember in scouts, one of my buddies got the runs at summer camp, and his dad, who was a surgeon, had him mix coals from the campfire pit into his drinking cup, and gulp it down. He was the kind of kid who'd eat anything on a dare, so this was fun for him, and immensely entertaining for the rest of us boys to watch. Of course, after the troubles ran their course (which, it always ends eventually, right?) he was convinced that it did the trick. According to his dad, the charcoal absorbs the excess water. "Wait", I wanted to ask, "how much water can a cupful of watered-down charcoal really absorb?" I never heard of this treatment ever again, but it was specific to treating for a bad gut bug. D: Charcoal is actually used for a lot of GI problems. It does absorb stuff. But in the particular context, it might have just been a handy way to distract the sufferer and appear to be doing something useful as the problem worked itself out. In my case, with the iodine problem, even with daily Imodium, it never resolved until I quit hiking - that eliminated the iodine and the exercise. It lasted as long as three days, a real nuisance. But with the last, non-iodine upset, Imodium was effective in 24 hours. So my conditions were similar but not identical. K: A subsequent four-day trip in late September also developed symptoms on the fourth day. I wonder now if the problem is actually more like constipation or intestinal blockage and my next experiment will be to try more coffee, more metamucil, and my regular home cereal instead of instant oatmeal in order to see if any of that matters. Imodium might be exactly wrong. D: My primary care physician advised against dicyclomine (Bentyl); it has a long list of serious side effects and is not recommended by Kaiser for seniors. https://www.healthline.com/health/dicyclomine-oral-tablet#side-effects Instead she passed along a suggestion from gastroenerology to try IBgard, https://ibgard.com/ an over-the-counter formulation of... peppermint oil! If it helps, fine, and if it doesn't, at least it will have no serious systemic side effects. I found it at a local CVS near the probiotics, metamucil, and other digestive aids. K: I only take the dicyclomine on those backpack trip days that my lower GI starts twisting itself into a knot. I don't take it otherwise. Either the dicyclomine or the loperamide or the Pepto tabs - or the combo of all three - halts my own distress after 4 trips up the hill instead of 6 or 7 or 8.