“People might have diarrhea that makes it difficult to go out, or they might even have to pull over when they are driving,” says Daniel Strand, MD, an associate professor of gastroenterology and hepatology at the University of Virginia in Charlottesville. But these challenges aren’t impossible to overcome. With the right treatment and your doctor’s help, you can start conquering both EPI and the potential disruptions that come with it.
How EPI Affects You Emotionally
If you’ve had EPI for a long time, you might be living with the stress of having five, six, or more bowel movements a day, Dr. Strand says. You might also be dealing with the symptoms of an EPI-related condition, such as cystic fibrosis, celiac disease, or diabetes, he notes. And as vital and helpful as your EPI treatment is, remembering to take your medication — and taking it correctly — can be stressful, too. EPI medication, called pancreatic enzyme replacement therapy (PERT), replaces your body’s missing pancreatic enzymes and has to be taken every time you eat, whether you’re having a snack at home or eating at a restaurant with friends. This can take away some of the pleasure of eating, explains Michael Sprang, MD, a gastroenterologist with NorthShore University HealthSystem in Skokie, Illinois. Even the cost of your medications could be a stressor, Dr. Sprang adds.
Tips to Reduce EPI Distress
Whether you’re embarrassed, frustrated, anxious, or depressed — or a combination of all four — keep in mind that EPI is treatable, and your symptoms can be improved. Fortunately, eating smaller meals, sticking to a healthy diet, avoiding alcohol and tobacco, and taking PERT will often help alleviate your physical symptoms, says Anthony Gamboa, MD, a gastroenterologist and assistant professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee. Here are 10 steps that can help you manage the emotional side of EPI.
1. Learn more about EPI.
“Understanding EPI and its treatment may help lessen the anxiety associated with having this condition,” Dr. Gamboa says. Work closely with your doctor, and don’t shy away from talking about embarrassing symptoms and asking the kinds of questions that will help you feel better.
2. Manage your other health conditions.
EPI is associated with a number of chronic conditions, such as cystic fibrosis and chronic pancreatitis — the most common cause of EPI in adults, according to The National Pancreas Foundation (NPF). If you have celiac disease and eat gluten (a protein found in wheat, barley, and rye), your pancreas may be working overtime to make the enzymes needed to digest the dietary fat you’ve eaten, which accumulates in your intestines. This can increase your risk for pancreatitis and EPI symptoms, according to research. Finally, diabetes has been linked to increased inflammation in pancreatic tissue, which worsens EPI symptoms, according to Pancreatic Cancer Action (PCA), a nonprofit dedicated to fighting pancreatic cancer. If you have one of these or another condition associated with EPI, follow the treatment plan for your condition, and you may find that your EPI symptoms lessen as well.
3. Be up front about your finances.
Don’t let the cost of your medication keep you from treating your EPI, Strand says. Ask your doctor for resources that could help lessen the price or a reference to a medical social worker who can assist you. Most manufacturers of pancreatic enzymes have programs that can help ease the financial burden, according to Mission: Cure, a nonprofit dedicated to helping people with chronic pancreatitis.
4. Confide in your loved ones.
“Family and friends often provide critical emotional support for people with new medical conditions or ongoing chronic symptoms,” Gamboa says. “They can help you stay on track with dietary changes and medications.”
5. Don’t start a “deprivation diet.”
Unfortunately, you may have to give up certain foods that worsen your EPI symptoms. Talk to your dietitian or nutritionist before making any big changes to your diet, though, according to Cancer Council Victoria, an Australian nonprofit dedicated to cancer research, including pancreatic cancer, which can cause EPI. You don’t need to stop enjoying good food and experimenting with new flavors. Ask your nutritionist about adding seasonings — such as fresh or dried garlic, onion powder, pepper, sea salt, basil, thyme, bay leaves, ginger, sesame seeds, cinnamon, or a spice blend — to your meals that can enhance the taste without aggravating your EPI, according to PCA. If you’re unsure where to find healthy recipes, The National Pancreas Foundation’s Chronic Pancreatitis Cookbook is a good place to start.
6. Dine out in style, but plan ahead.
Before going to a restaurant, check out the menu online and call with questions. Once you’re at the restaurant, ask your server any additional questions you have, and make specific requests for changes to meals, if needed. For example, some sauces contain butter or cream, both of which may aggravate EPI symptoms, so ask for the sauce on the side.
7. Prepare for the unexpected.
Taking your EPI medication as prescribed can help reduce bouts of diarrhea, according to PCA. Be sure to keep your PERT tablets with you and take them with every meal. Staying hydrated can also help prevent dehydration, which can occur with diarrhea. Finally, since frequent bowel movements and/or diarrhea also means frequent trips to the bathroom, download a bathroom-finding app, such as Flush (free, iOS and Android), to your smartphone.
8. Join an EPI support group.
“Support groups provide an opportunity to talk to other people who have similar conditions,” Gamboa says. If you can’t find a nearby in-person group, search for online support groups instead. To get started, try visiting the NPF’s online communities page.
9. Try to de-stress.
It’s not uncommon for people with EPI to feel stressed, but it’s important not to let your feelings get out of control. Practicing a stress-management technique, such as meditation or deep breathing, may help you regain control. And consider apps focused on mindfulness and meditation. According to a review, research shows that meditation can help lower stress levels and improve quality of life in people with chronic physical health conditions.
10. Ask your doctor about depression or anxiety treatment.
Depression and anxiety are common with EPI, says Strand. People with chronic medical conditions have a higher risk of depression, according to the National Institute of Mental Health (NIMH). If you’re feeling sadness or anxiety that won’t go away, talk to your doctor. Treatments include professional counseling, such as psychotherapy, and antidepressant medication, according to the NIMH.
