Fibromyalgia and digestive disorders: understanding the link and relieving the symptoms

What is fibromyalgia? 

Fibromyalgia affects around 2% of the British population, mainly women (80% of cases), with the highest incidence between the ages of 40 and 50. Although not dangerous, this disease causes disabling symptoms such as chronic pain, intense fatigue and sleep disorders, making it difficult for patients to go about their daily activities. The intensity of these symptoms varies from patient to patient.

Fibromyalgia alters the perception of pain, causing hypersensitivity: excessive pain to normal stimuli (allodynia) or amplified pain (hyperalgesia). Factors such as stress, trauma or a history of depression play a role in triggering and maintaining the pain.

Diagnosis of fibromyalgia is complex and relies on ruling out similar diseases (e.g. rheumatoid arthritis), an assessment of symptoms and a clinical examination. The doctor looks for diffuse pain lasting more than 3 months, often by testing the 18 pressure points, and assesses other associated problems (fatigue, digestion, concentration). A survey may be used to complete the assessment.

Treatment for fibromyalgia combines medication to relieve symptoms and non-drug treatment, such as physical exercise.

Fibromyalgia patients often present with other disorders such as anxiety, depression, obsessive-compulsive disorder (OCD), migraine, restless legs syndrome and Gougerot-Sjögren syndrome.

They also frequently suffer from digestive disorders such as irritable bowel syndrome, which aggravates their condition and requires comprehensive treatment.

What are the most common digestive disorders in people with fibromyalgia? 

The most common digestive disorders in fibromyalgia patients are constipation, diarrhoea, bloating, abdominal pain and gastro-oesophageal reflux disease (GERD). According to several studies, these symptoms are present in between 30% and 70% of cases of fibromyalgia.

One of the most common disorders is irritable bowel syndrome (IBS), which is characterised by recurrent abdominal pain and changes in bowel habits, such as episodes of diarrhoea or constipation. GERD, which means frequent heartburn, is also often seen in these patients. These digestive disorders can be bothersome and interfere with the treatment of fibromyalgia, creating a vicious circle of symptoms.

Why do people with fibromyalgia suffer from digestive disorders? 

The reasons why people with fibromyalgia suffer from digestive problems are still being widely studied, but several factors seem to be involved.

The link between the nervous system and the gut 

The central nervous system and the gut are closely connected. This phenomenon, known as the ‘brain-gut axis’, explains why emotional disorders such as stress or anxiety can affect the functioning of the digestive tract. In people with fibromyalgia, this connection appears to be particularly sensitive, exacerbating digestive symptoms.

Intestinal microbiota

The intestinal microbiota, made up of billions of bacteria and other micro-organisms, plays a key role in digestion and overall health. Imbalances in this microbiota can contribute to both fibromyalgia and digestive disorders such as IBS. Studies show that people with fibromyalgia often have an altered gut microbiota, which could explain the onset of digestive symptoms.

Chronic inflammation

Although fibromyalgia is not considered an inflammatory disease, studies suggest that chronic inflammation present in this illness may have an impact on patients' gut health. Chronic inflammation affects intestinal motility and the permeability of the intestinal wall, leading to digestive disorders. This chronic inflammation is also known as low-grade inflammation, a mild, chronic inflammation that remains silent, without causing any visible symptoms, but is present all the time, at low intensity, and can affect the whole body. 

What can be done to relieve the symptoms of digestive disorders caused by fibromyalgia? 

There are various solutions that can help relieve the digestive symptoms associated with fibromyalgia.

Diet 

Eating a balanced diet rich in fibre (oatmeal, psyllium) is beneficial, particularly in the fight against constipation. Foods rich in probiotics, such as yoghurt, kefir and fermented vegetables, help to improve the balance of the intestinal microbiota, as do foods with anti-inflammatory properties (turmeric, oily fish, eggs). Red fruit, rich in antioxidants, is also beneficial. Avoiding irritating foods, such as fatty, spicy or gluten-containing foods, also reduces digestive symptoms.
It is recommended to avoid foods rich in FODMAP (Fermentable Oligo, Di, Monosaccharides And Polyols), carbohydrates that are difficult to digest and that ferment in the intestine, causing bloating, pain and transit problems. These effects aggravate the digestive symptoms common in fibromyalgia patients, who often suffer from irritable bowel syndrome (IBS). 

Stress management

Stress plays a key role in aggravating digestive disorders and fibromyalgia, by increasing pain and discomfort. It is therefore important to adopt relaxation techniques to better manage its impact. Meditation, deep breathing, yoga and sophrology can calm the nervous system, reducing muscular tension, chronic pain and associated digestive problems. These practices also promote better sleep, increased mental well-being and an overall relief of fibromyalgia-related symptoms.

Drug treatment 

To relieve the digestive problems associated with fibromyalgia, medications such as antispasmodics or laxatives can also be used if necessary. In addition, certain treatments targeting fibromyalgia, such as antidepressants or epilepsy drugs, can also improve digestive symptoms. These drugs act by modulating pain perception and nervous system function, helping to reduce digestive discomfort.

NB: 

Fibromyalgia is a chronic illness that causes widespread pain, intense fatigue, and sleep and mood disorders. It is often associated with digestive disorders, such as irritable bowel syndrome (IBS), which have an even greater impact on quality of life.

These disorders result from factors such as hypersensitivity of the ‘brain-gut axis’, an imbalance in the intestinal microbiota, or low-grade inflammation.

To alleviate digestive symptoms, patients can do many things, such as follow a well-balanced diet (low in FODMAPs, high in fibre and probiotics), improve their stress management, or take medication.