Lauren White, University of Sheffield
Irritable Bowel Syndrome (IBS) is a common 'functional' bowel disorder, characterised by symptoms of abdominal pain and changing bowel habits. Although IBS is common, there is little understanding of patients' experiences and coping strategies. This article investigates the impact of IBS on the everyday personal relationships of women. Drawing upon theoretical perspectives surrounding taboo, manners and stigma, this article explores how individuals manage and conceal the stigma of bowel disorders. It reports on eight semi-structured interviews of women who identify with IBS, to examine how women manage their IBS by toilet-mapping and discretion in their social interactions. The interviews findings suggest that the management of IBS symptoms is shaped by gendered notions of femininity, particularly how the control of bodily functions is shaped around gendered expectations.
Keywords: Irritable Bowel Syndrome, IBS, women's health problems, long-term health problems, health-related stigma.
Irritable Bowel Syndrome (IBS) is a common 'functional' gastrointestinal disorder; that is, a chronic and relapsing condition that affects the functioning of the digestive system. The symptoms include abdominal pain, bloating, changes in bowel habits and urgency to use the toilet. IBS is one of the most common illnesses seen within primary care (Mayer, 2008: 1692). According to the National Institute for Clinical Excellence (NICE, 2015) IBS affects up to 20 per cent of the population, with most affected individuals being between 20 and 30 years old. At present, there is no cure or consistently effective treatment for IBS. It is diagnosed by the exclusion of other chronic pelvic conditions (such as bowel cancer and Inflammatory Bowel Disease (IBD)). Since IBS is not pathologically 'life threatening', it is not considered a serious condition (Stenner et al., 2000: 439). However, serious recognition of IBS is vital for the understanding of the experiences.
IBS can be painful and debilitating, which can impact an individual's quality of life (NICE, 2015). It can be socially disruptive, with symptoms resulting in embarrassment and in interference with employment, social activities and personal relationships (Dancey and Backhouse, 1993: 1445–46; Bertram et al., 2001: 524). Sociological literature suggests that having a chronic illness (such as IBS) can affect daily life, social relationships and sense of self (Nettleton, 2006b: 71). Crucially, the embarrassment associated with IBS symptoms often makes it a challenge to seek help in the first place (Payne, 2004: 19). The lack of understanding into the diagnosis along with the silence of symptoms leads us to a deficit in awareness of experiences.
One key factor in the diagnosis and social experience of IBS is that individuals are twice as likely to be female (NICE, 2015). Gender differences of femininity and masculinity ideals have been documented in the experiences of IBS (Bjorkman et al., 2014; Lu et al., 2009; Payne, 2004). Moreover, the gendered nature of health and illness is evident by the fact that women are more likely to report their health problems and issues surrounding 'neuroticism', interference in daily life and risk-taking behaviours (Payne, 2004: 23; Hunt et al., 2012: 207–21). However, there is little sociological contribution into how 'girls with guts' experience life with IBS.
This article reports on eight interviews that investigated the impact that IBS had on women and their social relationships and interactions. The interviews presented provide insights into the feelings around disclosure, concealment, and more broadly into how IBS affects a woman's quality of life and sustaining relationships in everyday life. Overall, the article aims to contribute to the understanding of IBS, focusing specifically on the social interaction of individuals living with IBS, and contribute more widely to understandings of stigmatised and misunderstood illness.
IBS: a sociological perspective
Much of the literature to date regarding IBS has revolved around a biomedical model, with a focus on the troublesome biology of IBS, and ideas that IBS may be of a psychosomatic origin (Lackner et al., 2004; Payne, 2004: 21–22). It has been argued that this suspected psychosomatic cause of IBS is intertwined with social assumptions of 'the gastrointestinal woman' grounded by hysteria, with unjustified anxiety, self-blame and a potential to delay diagnosis (Vidali, 2013: 33). Women with IBS and their experiences and symptoms are arguably not taken seriously. Studies that have explored the lived experience of IBS have mostly focused their research from a medical and nursing perspective (Bjorkman et al., 2014; Hakanson et al., 2009). There is little published work on the distinct sociological understandings of the everyday experiences which shape the lives of those with IBS.
IBS is not just a physical experience, but a social one too; complicated by the silences in everyday life. While Parsons (1951) considered that illness was a form of deviance, for which the individual could not be held responsible, Annandale (2014: 7–8) has argued that access to a Parsonian 'sick role' is contested. IBS, an invisible illness with a problematic diagnosis and treatment, does not comply with the sick-role model. Moreover, IBS is associated with bowels and flatulence; taboo subjects within contemporary western society (Bjorkman et al., 2014: 1339). Failure to live up to the expectations that social behaviour assumes of us allows for embarrassment (Goffman, 1956). Individuals worry about an embarrassing incident, an excretion, a moment of incontinence (Billig, 2001). These social encounters and attitudes from the external world are fundamental to understanding relationships to taboo illnesses and their symptoms in society.
Previous research into other digestive conditions such as IBD has shown negative feelings of body image, sexual functioning and interpersonal relationships (Tratcher et al., 2002). A study on individuals with colitis (a form of IBD) emphasised the importance of developing coping techniques for disclosing their condition such as being frank, or simply withdrawing such identity (Kelly, 1992: 87–89). Studies surrounding IBS have suggested that individuals were more self-conscious and reserved, and less likely to seek to form friendships (Day et al., 2001; Bevan, 2009). Studies suggest that women, particularly women living with digestive difficulties, may find forming new relationships particularly challenging; they face fears about their attractiveness, relationship difficulties and barriers in sexual activity (Basson, 1998; Bjorkman et al., 2014: 1340; Hakanson et al., 2009: 32–35; Ronnevig, 2009: 1683). Many individuals avoid discussing their suffering, avoid being heard, smelled or seen in their IBS state (Ronnevig, 2009: 1683). There can be a fear of rejection, and individuals must establish a level of rapport and trust before they feel they can disclose their condition, whether to a health professional or a romantic partner.
Managing these challenges in relationships is controlling the potential stigma from others. Goffman (1968: 57) distinguishes between individuals that stigma has already discredited, and those that are discreditable. For Goffman, those whose stigma is discreditable seek to manage their undisclosed information by 'passing' as normal (Goffman, 1968: 58). To control such interaction is dependent upon what others may or may not know, whether it be seen or heard. When a condition is visible, the stigmatised may exercise what Goffman terms 'covering'. Those with IBS may cover the bloated stomach, the smell of excretion, the sound of the toilet, or the time they took in the bathroom. Covering the activity of the bathroom and the body offers insights into societal understandings and attitudes of bodily fluids. For example, studies into menstruation have similarly shown how hygiene practices imply that bodily fluids are an atrocity (Rozin and Fallon, 1987). Koutroulis (2001) draws upon Goffmanian perspectives in her analysis of menstruation, naming it the s(p)oiled identity. Those with IBS may also feel the soiled state of their identity.
Gender differences have been documented in how IBS is experienced in social life (Payne, 2004). It has been suggested that women with IBS are concerned about common 'feminine' issues such as shame and bodily function, bloating and physical appearance (Toner and Akman, 2000: 11; Chang et al., 2006: 1439). Women with IBS often feel 'ashamed' due to the underlying strains of femininity (Toner and Akman, 2000: 13–16; Chang et al., 2006: 1439). Excretion is something to be kept private, something that is dirty. Women have historically been stereotyped as spending a great deal of time in the toilet, with social ideals of modesty, 'powdering their nose', dress codes, along with physiological understandings around menstruation (Twigg, 2006: 158).
Douglas (1984) explored 'dirt' as a metaphor for something that is symbolically polluting and offensive against the social order, a threat to social boundaries. Douglas (1984) acknowledged that we distinguish the clean and the dirty, with outside presentation considered the purest form, with disorder and dirt in the place of the internal being. To cross this barrier, for example by the excretion of bodily fluids, people become abhorrent. Payne (2004: 24) highlights that women may also have the pressure of maintaining the presentation of cleanliness, femininity and purity as a result of menstruation, as well as the hidden pressure of hiding IBS.
The research used qualitative semi-structured interviews, in order to explore the feelings and experiences of women and their social relationships when living with IBS. Women diagnosed with IBS were chosen to explore the feminine ideals in relation to everyday life and relationships. Respondents were recruited by means of an advertisement on the website of a national charity for people diagnosed with IBS, known as the IBS Network. Eight people replied to the advertisement and were interviewed in the allocated timeframe; all were British heterosexual females, with ages ranging from 20 to 57. Due to the geographical spread of respondents, interviews were largely conducted over the telephone. The semi-structured interviews were based on an interview guide with broad themes based on existing literature and the outstanding research questions. Interviews lasted for around one hour. Telephone interviews proved to be a 'versatile' means of data collection (Carr and Worth, 2001: 521). They enabled the participants to choose their own location and time, something important when considering the sensitive nature of the research subject, yet limited the research in negotiations of body language, and rapport gained from face to face interaction.
Data analysis adopted an inductive approach through the discursive analysis of transcripts (Bryman and Burgess, 1994; Dey, 1993). Following data collection, there was a process of thematic analysis, in which themes were identified for potential analysis within the rich, detailed and complex amount of data (Braun and Clarke, 2006); this allowed for the development of the key summary themes or categories from the raw data, linking contextual interpretation of transcripts to existing literature. Each transcript was manually coded in search of recurrent themes which were both relevant to previous literature and existing knowledge, but also to contributions shared by all informants. This process resulted in the identification of four key themes around dirtiness and diarrhoea: public and private issues of toilet behaviour, gender roles, sexuality and relationships, and social situations and stigma. Pseudonyms were used for all informants in order to maintain their confidentiality. The research was approved by the ethical committee of the University of Sheffield.
Social situations, silence and stigma
IBS labelling and its acceptance seemed to be of paramount importance in IBS experience. Many of the informants compared their IBS status to other illnesses, such as IBD, often described as 'real things'. Often, this is traced from medical professionals' perception of IBS. Laura (22) explained:
I just went to the doctor's and they shrugged it off. They just said it was just IBS … it's good in a way, but at the same time you want a cure don't you?
This blurred and conflicted understanding often makes experiences problematic. There is a paradox in which they do not want to have illness, yet want to have an illness that can be treated, and treated seriously. The women explored situations in their lives that were affected by their IBS. They became fearful of social activities, further complicated by the silence of IBS or any narrative of bowel functioning in society. Stigma and embarrassment were at the root of this silence; in particular, how individuals reveal their potentially discrediting information (Goffman, 1968). The account of Tracy (23) illustrates this:
I was just out with my sister … I told her I was speaking to you, I had to whisper it because people near are like, 'What's IBS?' I think I find it embarrassing. The wind, the diarrhoea, it's not something you openly talk about is it?
Many of the women stated in their interviews how they wanted to share their IBS experience with others, given the opportunity to speak and challenge these norms. However, there was a barrier between discussions and disclosure, and this has implications for involvements in social life.
Avoidance of social situations and relationships was common for the women who lived with IBS. This had consequences for the sustaining of relationships, particularly friendships and romantic relationships. Charlotte (42) demonstrated that her friendships began deteriorating as her IBS had worsened; over the years, she began declining offers to go out. She felt that people stop asking her out, thinking she will always say no:
People have got to the point where they stop asking me to events … it does make you feel really isolated.
Furthermore, as many social interactions involve food and drink, this can be challenging for those with IBS. Many of the participants explained the problems in social situations when it came to eating and drinking, and doing enough of it. Some felt that eating and drinking out was almost impossible, risking bowel disruption and pain. The social arena was important in negotiating their IBS, as understanding from others was fundamental. At the time of the interviews, Christmas was approaching. Many stated the pressure of food and drink. Natalie (31) said:
At a Christmas meal there was a choice of three courses, and I said I only wanted one and everyone was like, 'Oh, why? Why? Have a pudding!' I can't eat much, but I couldn't bring myself to say that. I was too embarrassed.
Many also stressed that western culture placed an emphasis on drinking alcohol. Drinking seemed to be central to spending time with friends, going on dates, and work social events. Avoiding drinking alcohol meant that they were less 'sociable'. Samantha (32) told a story of this experience with friends:
I can't drink alcohol really. But when I go out I want to be like everyone else so I do and then I suffer for weeks after. Even if I just have a couple of drinks to be social.
Even those considered close in relationship circles are limited in their knowledge of Samantha's experiences of IBS. The women in the study conceal other senses of IBS such as being heard, smelled or seen repeatedly visiting the bathroom. Tracy said:
Close friends know about it [IBS] but when I've been seeing a guy … I'm just so worried. I have a lot of flatulence as well. I'll call it that so I don't get embarrassed. Because I suffer with that as well I never want to get too close to someone because I don't want people to stay over at my house.
'ENGAGED': opening the door on toilet behaviour
Toilet activity is an integral part of daily life, with a complex relationship between the public and private performance of excretion. The women regarded toilet-mapping, discretion and sharing bathrooms fundamental in managing their IBS condition. Amanda (20) said:
I do know where the toilets are, I know exactly where the toilets are.
Similarly, Jane (22) gave a powerful account:
It's one of the main things you think about before you go out. You wonder where the toilets might be … Every single day you think about it.
This was a common experience for the women with IBS. Questions surrounding toilet behaviour sparked a consciousness of an everyday activity that is not actively discussed. For those with IBS, there is a conscious effort to track the toilet. Samantha explained how she knew which shops would let her use the bathroom. Many made a mental check of toilet locations when entering a building, and planned their outings on toilet availability. Maisie (57) noted:
Going to work on the London underground, I knew where every toilet was ... If I was going to a job interview, I'd go look for the toilets before I took the job.
The notion of toilet-mapping has a profound effect on the everyday activities. Many of the women also stated how they manage toilet activity. Jane explained that she would carry air fresheners. Charlotte spoke of sharing hotel rooms, and due to the closeness of the bathroom, she chose a more public place to visit the toilet. However, many expressed desire to use private bathrooms due to the decreased risk in exposure. Natalie said:
The only thing I do like is when there's more than one toilet. The stress of worrying that I'm holding up a queue outside exacerbates my symptoms to be honest. If there are three or four toilets, I'm fine. If there is only one, I'm worrying someone is waiting for me or watching.
Discretion became obvious in negotiating toilet activity and managing symptoms in relation to others. Techniques used to disguise their toilet visit, such as 'going to make a phone call', running the shower or playing music. For example, Samantha said:
When I'm at work it's the hardest as the bathroom is next to our office … So I walk out with an envelope like I'm going to the post and then go to the bathroom on the way so people don't know where I'm going.
Charlotte stated that she kept having dreams where the cubicle walls come down and people can see her. Laura tells of another experience in the home, where she feels she does not need to be as discreet, yet she does not use the downstairs toilet as this is most likely to be used by others, including her boyfriend. Following on from this, sharing bathrooms was something of an issue for all of the women. Sound, time, place and space are important.
'Diarrhoea': a dirty word?
Throughout the interviews, it seemed that there was hesitance, almost an expectation of the researcher to acknowledge the grotesque nature of the topic or even complete avoidance in speaking the word 'diarrhoea'. It seems more common to say stomach, in opposition to bowels, or intestines. This may seem trivial at first glance, but the methodological observation of the unspoken word speaks a lot for the sociological implication. Tracy's account demonstrated a reluctance:
I had like, oh god I don't like saying this … loose bowel movements … every time I went. Erm … quite a bit of diarrhoea.
Eventually, Tracy said 'diarrhoea' after hesitance and perhaps the reassurance that it was okay to disclose such information to the researcher, after time spent building rapport. Some women did say the word diarrhoea. However, we must not underestimate the hesitance from several of the women. Furthermore, many of the women documented their diarrhoea by every possible explanation without saying the word itself, such as the medically defined example above of 'loose bowel movements'. Laura never said the word diarrhoea throughout her whole account of explaining her IBS experiences, despite the fact it was one of her symptoms. Instead, Laura tended to say 'quite ill'. However, there seemed to be no qualms of saying constipation, perhaps due to the concealment of excretion. Laura claimed:
I shift from constipation, and you know … the opposite [diarrhoea].
Feelings of hygiene for women were a common concern when dealing with IBS in everyday life, particularly those with diarrhoea. This was something further highlighted by those with IBS in pushing arguments of natural and universal bowel function, or perhaps dysfunction. Bowel movements are a natural phenomenon, yet something we accept, as Amanda said, as 'gross'. Many of the women spoke of this experience, including Samantha:
Before my IBS was bad, I had predominantly diarrhoea. I was going about seven to eight times a day ... I've had accidents. You do become paranoid that you're going to have an accident while you're out. You feel unclean.
Moreover, it became apparent that there was a hierarchy in digestive functioning itself, in relation to how clean and how dirty each motion was. Many of the women felt that constipation and vomiting did not necessarily have the same effect on cleanliness as diarrhoea did, something significant when considering the variance in IBS symptoms for individuals. For many of the women, it seemed more acceptable to be sick or constipated, than to have diarrhoea. Charlotte explained this:
I was so mortified and embarrassed to say I'd got this horrendous diarrhoea so I'd say 'I've just been really sick!' as somehow it seemed more socially acceptable. There's just something really horrible about anything to do with the other end … If I was being sick it wouldn't be the same ... I think it's about being dirty, sick coming from the top end rather than the bottom end – there's just something with a real stigma about it.
This research suggests that somehow, diarrhoea is the most unacceptable, perhaps rooted in the uncontrollable nature and the invasion between boundaries. Further contributing to this is the issue of wind. The smell associated with wind is a signal of stigma, something which the women aimed to conceal. Jane gave her account:
I carry baby wipes and deodorant around. You don't want to come out of the loo and it smells. If you were at a friend's house, everyone would think you were the one that caused the massive stink.
'Girls don't poo'
There seemed an apparent attitude to females with IBS and the consequent implications for relationships and closeness to others. Gender socialisation is something we cannot escape from and it influences us from a very young age. Amanda spoke of this, and discussed her thoughts surrounding lad culture and boys growing up and 'doing disgusting things'. Many of the women expressed their feelings that women were not allowed to talk about bowels, and men were in denial that women were associated with that 'natural' function of life. Laura explained how men have an idea that women simply do not go to the toilet and that toilet humour is a 'manly thing'. Also, as Tracy explained:
When I'm at home and let it go [wind] it's like 'Jesus Christ! I'm a girl that's not supposed to happen' … Girl's aren't … obviously we have wind, but you always get called for it, don't you? So you think, 'oh god, no one can know' … that's definitely the hardest part; not being able to talk about it because we're [girls] not expected to poo … I could never imagine telling a lad.
One of the women constructed an understanding that digestive symptoms were against the social norms of what it means to be a woman. When women display digestive symptoms, they visit the doctor for a diagnosis and a cure from the stigmatising symptoms.
It was widely acknowledged that bowels were something that could be joked about; the women felt that men could joke about digestive issues such as wind and smells. Many of the women felt that men could 'laugh it off' and they 'don't care' if they had a digestive issue. Tracy said:
I think it's harder for us [girls] but it's not easy for us to talk about. Whereas guys if they're farting a lot they can laugh it off.
Likewise, Charlotte explained her comparison to her father:
My dad would say about his bowel problem 'Corr, I'd leave that half an hour before you go in' … whereas I'd be dying of embarrassment spraying deodorant and opening windows.
The use of humour seems to be an attempt to manage the stigmatisation that an individual faces, to mask any potential embarrassment. There is a paradox in humour, in that it may be either repressive or enabling. It seems that this is manifested in different ways according to gender, in women's perceptions of themselves but also the perception of men. The women felt that often it was only men that can make digestive jokes, and felt too shameful for women. This appeared to have implications for men and women's relationship to each other.
Following on from this, issues of closeness and intimacy arose from the accounts of women exploring issues around their relationships. Amanda noted:
I never stay at my boyfriend's house, he always stays at mine … one morning I could wake up and be fine and the next it's not. I don't want to risk it and be embarrassed.
Amanda explained that when an IBS attack occurred, this created a barrier in how close they were. Amanda feels that she must get to a particular level before she is comfortable, and she hopes that this is something that will happen in the future.
The aim of this study was to investigate the impact that IBS has on women's social relationships and everyday interactions. Moreover, how their diagnosis affects their interactions, their feelings surrounding the condition and how this affects relationships, whether they choose to disclose or conceal their IBS. For those living with IBS, it is not 'just a stomach ache', it is a failing recognition of their experience. The treatment (or lack thereof) for those with IBS has implications for these women's sense of self and relations to others. As Nettleton (2006a: 1176) suggests, individuals are rarely given acknowledgement of their illness in the absence of pathological disease. There is a double discrimination with IBS; firstly, that of positioning the experience in the medical hierarchy of disease, but also of the stigmatised symptoms.
Many women in this study avoid social situations to avoid embarrassment. Miller states (1996: 164) 'for many of us, a quiet but compelling drive to avoid embarrassment pervades our daily life'. The symptoms of IBS make it challenging to manage social activities in everyday life: the afternoon out with family, the Christmas party at work, the anxious glance for the toilet in a busy restaurant. The interviews suggest that those who are affected by the condition manage their IBS in everyday life by toilet-mapping, planning social events, or avoiding them. As Charlotte explained, social outings and relationships began to decline when IBS took over her everyday life, due to the stigma and the silence. As previous studies have shown (Dancey and Backhouse, 1993: 1445–46; Bertram et al., 2001: 524), severe IBS can prevent social activities, forming relationships and engaging in new interests.
Social events mean social uses of toilets. There is a complicated interplay between the public and the private with regard to toilet behaviour. As Molotch and Noren (2010: 1) note, the 'public and private do not sit well together … the public restroom opens a tense domain'. Those who possess a stigma are increasingly subjected to situations to become more adept at tackling them (Goffman, 1968: 31). Bathroom-mapping is one of the most common survival skills and adaptations for negotiating IBS, whether it is on the way to the office, or a trip to the shopping centre (McCormick et al., 2012: 7). Managing toilet trips for those with IBS is problematic; they feel they have something more to hide, whether it is the splash of the toilet bowl, the ticking clock, the impatient queue which forms while they are constipated, or the smell. For Goffman (1968: 123) we display signals, such as the smell that is associated with wind, which may be stigmatised, for example, when Jane explained the use of baby wipes and deodorant to mask the 'massive stink'.
The findings of this study are similar to previous research: that women feel shame and uncleanliness from the fear of incontinence in line with constructions of femininity (Toner and Akman, 2000: 13). Arguably, Koutroulis's (2001) term 's(p)oiled identity' is applicable to the bowel excretions. The discussion of bowels and excretion is frowned upon in society (Elias, 1978). Euphemisms are employed in a similar fashion to those used for menstruation: 'mother nature' and 'time of the month' are akin to 'loose bowel movements' and 'stomach upset', when what speakers really mean is diarrhoea (Kissling, 1996: 481; Johnston-Robledo and Chrisler, 2013: 12). Moreover, there is a binary of constipation and diarrhoea, an interplay of dirtiness and concealment. Human behaviour distinguishes between the clean and the dirty, and when the line is crossed, individuals are repulsed (Douglas, 1984). The separation of the clean and the dirty is divided in a state of order, a hierarchy, in relation to each other, perhaps with women's bowel excretion right at the bottom of that order.
This sense of self arguably starts from a young age, particularly in relation to gender. By adolescence, many girls hear 'girls don't poo'. This is damaging to women who live with IBS. Tracy said she could not imagine telling 'a lad' about her IBS, because girls are not 'expected' to poo. Despite statistics stating that IBS is a condition that affects women twice as much as men, there is also an understanding that men are less likely to seek medical advice (Hunt et al., 2012: 207). It is argued that women are more susceptible to visiting the bathroom, experiencing abdominal pain, and being sensitive and vulnerable.
More broadly, managing the IBS identity is centred on being discreet. Relationships for those with IBS can be problematic, with intimate relationships most challenging; there can be problems in forming relationships, due to a fear of rejection and the need to establish trust before disclosing their illness (Basson, 1998: 361). There is a barrier whereby intimacy and closeness become difficult, particularly the sharing of space, the bedroom or the bathroom, where lines are crossed in our intimate lives and our bodies. Issues around concealment, management of symptoms, and interactions with others have a significant effect on the confidence of individuals. There must be a wider understanding of IBS in everyday life, an understanding that is shaped by gender ideals.
This study has been a small-scale account of the lives of eight women with IBS and their relationships and interactions in everyday life. The research has the potential to reach a wider demographic of those diagnosed with IBS, of both genders. It must be appreciated that those who participated have a level of agency which allows them openly to discuss their experiences, and for many, this may not yet be the case. For further research, I would advocate a specific focus on the masculine perspective in the social effects of managing IBS. More research should explore the impact of the IBS diagnosis universally for all individuals, which is crucial for enhancing quality of life and legitimising the experiences of people living with the condition.
Thank you to the women who shared their intimate IBS stories. Thank you to the IBS Network Charity for facilitating this work and to Dr Ilke Turkmendag for her wonderful supervision. This work is dedicated to you all, and to those who have come forward to tell their story, since deciding to speak.
Lauren White is now an ESRC funded PhD student in the department of Sociological Studies at the University of Sheffield. She has an undergraduate degree in Sociology and a Masters degree in Social Research from the University of Sheffield. Her research is specifically focused on the experiences of irritable bowel syndrome in everyday life and how individuals manage symptoms from a sociological perspective. Lauren aims to pursue a career in academia, namely in the sociology of health and illness.
Annandale, E. (2014) The Sociology of Health and Medicine: A Critical Introduction (2nd edition), Cambridge: Polity Press
Basson, R. (1998), 'Sexual Health of Women with Disabilities', Canadian Medical Association Journal, 159 (4), 359–62
Bertram, S., M. Kurland, E. Lydick, G. R. Locke III and B. P. Yawn (2001), 'The Patient's Perspective of Irritable Bowel Syndrome', Journal of Family Practice, 50 (6), 521–25
Bevan, J. L. (2009), 'Interpersonal Communication Apprehension, Topic Avoidance, and the Experience of Irritable Bowel Syndrome', Personal Relationships, 16 (2), 147–65
Bjorkman, I., L. Dellenborg, G. Ringstrom, M. Simren and E. Jakobsson Ung (2014), 'The Gendered Impact of Irritable Bowel Syndrome: A Qualitative Study of Patients' Experiences', Journal of Advanced Nursing, 70 (6), 1334–43
Billig, M. (2001), 'Humour and Embarrassment Limits of 'Nice-Guy' Theories of Social Life', Theory, Culture and Society, 18 (5), 23–43
Braun, V. and V. Clarke (2006), 'Using Thematic Analysis in Psychology', Qualitative Research in Psychology, 3 (2), 77–101
Bryman, A. and R. G. Burgess (eds) (1994), Analysing Qualitative Data, London: Routledge
Carr, E. C. and A. Worth (2001), 'The Use of the Telephone Interview for Research', NT Research, 6 (1), 511–24
Chang, L., B. B. Toner, S. Fukudo, E. Guthrie, G. R. Locke, N. J. Norton and A. D. Sperber (2006), 'Gender, Age, Society, Culture, and the Patient's Perspective in the Functional Gastrointestinal Disorders', Gastroenterology, 130 (5), 1435–46
Dancey, C. P. and S. Backhouse (1993), 'Towards a Better Understanding of Patients with Irritable Bowel Syndrome', Journal of Advanced Nursing, 18 (9), 1443–50
Day, I., A. D. Stuart and H. G. Pretorius (2001), 'Self-Concept and Relational Concomitants of Irritable Bowel Syndrome: A Preliminary Study', South African Journal of Psychology, 31 (4), 13–20
Dey, I. (1993), Qualitative Data Analysis: A User-Friendly Guide for Social Scientists, London: Routledge
Douglas, M. (1984), Purity and Danger: An Analysis of the Concepts of Pollution and Taboo, London: Routledge
Elias, N. (1978), The Civilising Process: The Development of Manners, New York: Urizen Books
Goffman, E. (1956), 'Embarrassment and Social Organisation', American Journal of Sociology, 62 (3), 264–71
Goffman, E. (1959), The Presentation of Self in Everyday Life, New York: Double Day
Goffman, E. (1968), Stigma: Notes on the Management of Spoiled Identity, Englewood Cliffs NJ: Prentice Hall
Hakanson, C., E. Sahlberg-Blom, H. Nyhlin and B. M. Ternestedt (2009), 'Struggling with an Unfamiliar and Unreliable Body: the Experience of Irritable Bowel Syndrome', Journal of Nursing and Healthcare of Chronic Illness, 1 (1), 29–38
Hunt, K., J. Adamson and P. Galdas (2012), 'Gender and Help Seeking: Towards Gender-Comparative Studies', in Kuhlmann, E. and E. Annandale (eds), The Palgrave Handbook of Gender and Health Care, London: Palgrave, pp. 207–21
Johnston-Robledo, I. and J. C. Chrisler (2013), 'The Menstrual Mark: Menstruation as Social Stigma', Sex Roles, 68 (1), 9–18
Kelly, M. (1992), Colitis, London: Routledge
Kissling, E. A. (1996), 'Bleeding out Loud: Communication About Menstruation', Feminism and Psychology, 6 (4), 481–504
Koutroulis, G. (2001), 'Soiled Identity: Memory-work Narratives of Menstruation', Health, 5 (2), 187–205
Lackner, J. M., C. Mesmer, S. Morley, C. Dowzer and S. Hamilton (2004), 'Psychological Treatments for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis', Journal of Consulting and Clinical Psychology, 72 (6), 1100–13
Lacy, B. E. and R. D. Lee (2005), 'Irritable Bowel Syndrome: A Syndrome in Evolution', Journal of Clinical Gastroenterology, 39 (5) S230–42
Lu, Z. Y., W. L. Chen, H. C. Chen and M. Ou (2009), 'Irritable Bowel Syndrome: the Bodily Experiences of Taiwanese Women', Journal of Nursing Research, 17 (1), 42–51
Mayer, E. A. (2008), 'Clinical Practice. Irritable Bowel Syndrome', New England Journal of Medicine, 358 (16), 1692–99
McCormick, J. B., R. R. Hammer, R. M. Farrell, G. Geller, K. M. James, E. V. Loftus Jr, M. B. Mercer, J. C. Tilburt and R. R. Sharp (2012), 'Experiences of Patients with Chronic Gastrointestinal Conditions: in their own words', Health and Quality of Life Outcomes, 10 (25), 1–11
Miller, R. S. (1996), Embarrassment, New York: Guilford Press
Molotch, H. and L. Noren (2010), Toilet: Public Restrooms and the Politics of Sharing, New York: University Press
National Institute for Health and Care Excellence (2015) 'Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care' in NICE Clinical Guideline 61, available at www.guidance.nice.org.uk/cg61
Nettleton, S. (2006a), ''I Just Want Permission to be Ill': Towards a Sociology of Medically Unexplained Symptoms', Social Science and Medicine, 62 (5), 1167–78
Nettleton, S. (2006b), The Sociology of Health and Illness (2nd edition), Cambridge: Polity Press
Parsons, T. (1951), The Social System, London: Routledge and Kegan Paul
Payne, S. (2004), 'Sex, Gender and Irritable Bowel Syndrome: Making the Connections', Gender Medicine, 1 (1), 18–28
Ronnevig, M., P. O.Vandik and I. Bergbom (2009), 'Patients' Experiences of Living with Irritable Bowel Syndrome', Journal of Advanced Nursing, 65 (8), 1676–85
Rozin, P. and A. E. Fallon (1987), 'A Perspective on Disgust', Psychological Review, 94 (1), 688–701
Stenner, P. H. D., C. P. Dancey and S. Watts (2000), 'The Understanding of their Illness amongst People with Irritable Bowel Syndrome: A Q Methodological Study', Social Science & Medicine, 51 (3), 439–52
The IBS Network (2015) The National Charity for IBS, available at http://www.theibsnetwork.org/, accessed 21 November 2015
Toner, B. B. and D. Akman (2000), 'Gender Role and Irritable Bowel Syndrome: Literature Review and Hypothesis', American Journal of Gastroenterology, 95 (1), 11–16
Toner, B., Z. Segal, S. Emmott and D. Myran (2000), Cognitive-Behavioural Treatment of Irritable Bowel Syndrome: The Brain-Gut Connection, London/New York: Guilford Press
Trachter, A. B., A. I. Rogers and S. R. Leiblum (2002), 'Inflammatory Bowel Disease in Women: Impact on Relationship and Sexual Health', Inflammatory Bowel Diseases, 8 (6), 413–42
Twigg, J. (2006), The Body in Health and Social Care, Basingstoke: Palgrave Macmillan
To cite this paper please use the following details: White, L. (2016), 'That Girl’s Got Guts: Relationships and Everyday Life for Women with Irritable Bowel Syndrome (IBS)', Reinvention: an International Journal of Undergraduate Research, Volume 9, Issue 2, http://www.warwick.ac.uk/reinventionjournal/archive/volume9issue2/white Date accessed [insert date]. If you cite this article or use it in any teaching or other related activities please let us know by e-mailing us at Reinventionjournal at warwick dot ac dot uk.