What is 'irritable bowel syndrome'?
Irritable Bowel Syndrome (or IBS) is a common disorder characterized by chronic abdominal pain, bloating, gas, diarrhoea and/or constipation. The cause of IBS is not known, but there is an association with stress and certain psychological symptoms/disorders (e.g. trauma, anxiety, depression).
IBS is the most commonly diagnosed gastrointestinal disorder. About 10 - 15% of the population suffer from it.
IBS is the most commonly diagnosed gastrointestinal disorder. About 10 - 15% of the population suffer from it.
Symptoms
The symptoms of irritable bowel syndrome vary widely from one person to another. The most common symptoms are:
Some alarm (or so-called "atypical") symptoms include:
- chronic abdominal pain or cramps
- bloating, gas
- diarrhea or/and constipation (sometimes alternating)
- mucus in the stool
Some alarm (or so-called "atypical") symptoms include:
- rectal bleeding
- weight loss
- pain at night / progressive pain
- abnormal laboratory tests (e.g. anemia, inflammatory markers)
Causes
The exact cause of irritable bowel syndrome is not known. Though there are several interacting factors that play a role. Some of the factors involve the smooth muscles that contract to move food through the intestines, and others involve abnormalities in the nervous system regulating the digestion, such as an overreaction to the stretches of the gut caused by gas or stool.
Gastrointestinal motility
Abnormalities in the contraction of the muscles that mix and propel the contents in the intestines are present in many people suffering from IBS. The intestines in people with IBS may contract more often or less often than normal and in an irregular way.
Hypersensitivity
The intestines of persons suffering from irritable bowel syndrome may respond more sensitive to various stimuli (e.g. bloating and distension). Some patients also report worsening symptoms after eating certain kinds of food.
Psychological factors
There are several psychological factors that predict whether someone will get irritable bowel syndrome or not:
Gastrointestinal motility
Abnormalities in the contraction of the muscles that mix and propel the contents in the intestines are present in many people suffering from IBS. The intestines in people with IBS may contract more often or less often than normal and in an irregular way.
Hypersensitivity
The intestines of persons suffering from irritable bowel syndrome may respond more sensitive to various stimuli (e.g. bloating and distension). Some patients also report worsening symptoms after eating certain kinds of food.
Psychological factors
There are several psychological factors that predict whether someone will get irritable bowel syndrome or not:
- stress
- anxiety
- depression
- sleep problems
- somatization (a tendency to experience and communicate stress in the form of somatic symptoms)
diagnosis
Because there are many other disorders with symptoms similar to irritable bowel syndrome, a physician must rule out other causes of those symptoms, by taking a detailed case history, doing a physical exam and guide a number of diagnostic tests (e.g. laboratory). In addition to these tests, there are two sets of symptom-based criteria to help the physician in the diagnosis of IBS:
Manning criteria for the diagnosis of irritable bowel syndrome
Rome III diagnostic criteria for irritable bowel syndrome
Manning criteria for the diagnosis of irritable bowel syndrome
- pain relieved with defecation
- more frequent stools at the onset of pain
- looser stools at the onset of pain
- visible abdominal distension
- passage of mucus
- sensation of incomplete evacuation
Rome III diagnostic criteria for irritable bowel syndrome
- Recurrent abdominal pain of discomfort, 3 days per month in the last 3 months, associated with two or more of the following:
- improvement with defecation
- onset associated with a change in frequency of stool
- onset associated with a change in form (appearance) of stool
Treatment
dietary changes
- Eliminating gas-producing foods: e.g. beans, onions, celery, carrots, raisins, bananas, apricots, prunes, broccoli, cauliflowers, Brussels sprouts, wheat germ, pretzels, bagels, caffeine, alcohol
- Avoiding lactose: if suffering from lactose intolerance, such patients should be put on a lactose-restricted diet
- Low FODMAP diet
- If elimination of gas-producing foods does not provide relief in patients with abdominal bloating or pain, a diet low in fermentable oligo-, di-, and monosaccharides and polls (FODMAP) is recommended
- Eliminating gluten
Physical activity
Twenty to sixty minutes of moderate to vigorous activity three to five days of the week can reduce the severity of IBS symptoms.
Psychotherapy and clinical hypnosis
How do emotions such as anger and happiness affect our digestion?
Can we actually measure the effects of physiological and psychological stress on the body? Using hypnosis is a safe and highly reproducible way to induce specific emotions.
Emotions such as excitement and anger increase the contractions of the intestine, and happiness has a calming effect on our digestive system (a reduction of the contraction rate). This might explain some everyday experiences such as abdominal cramps or more frequent defection during especially stressful events in our life, and also help to understand why hypnosis is effective in the treatment of irritable bowel syndrome.
In another blog post, I explained the experiments in detail: How emotions affect our digestion.
Hypnosis is effective in the treatment of irritable bowel syndrome
What are the indications to use psychotherapy and clinical hypnosis in IBS?
Can we actually measure the effects of physiological and psychological stress on the body? Using hypnosis is a safe and highly reproducible way to induce specific emotions.
Emotions such as excitement and anger increase the contractions of the intestine, and happiness has a calming effect on our digestive system (a reduction of the contraction rate). This might explain some everyday experiences such as abdominal cramps or more frequent defection during especially stressful events in our life, and also help to understand why hypnosis is effective in the treatment of irritable bowel syndrome.
In another blog post, I explained the experiments in detail: How emotions affect our digestion.
Hypnosis is effective in the treatment of irritable bowel syndrome
- 7 – 12 sessions over a 2-3 months period are sufficient for marked symptom improvements
- All of the central symptoms of IBS improve substantially
- Pain
- Constipation / diarrhea
- Bloating /distenstion
- Pain
- Compared to medications, hypnosis has lots of “positive side effects”: There are improvements of
- Quality of life, psychological well-being, self-efficacy
- symptoms of anxiety, depression, somatization
- Long-term improvements retained for years in majority of patients who respond to hypnotherapy
- Quality of life, psychological well-being, self-efficacy
What are the indications to use psychotherapy and clinical hypnosis in IBS?
- Psychotherapeutic methods (gut-directed hypnotherapy, cognitive-behavioral therapy, psychodynamic therapy) are effective in the treatment of IBS and should be integrated into the therapy concept (German Society for Gastroenterology, DGVS).
- Referral for psychological interventions (cognitive behavioural therapy [CBT], hypnotherapy and/or psychological therapy) should be considered for people with IBS who do not respond to pharmacological treatments after 12 months and who develop a continuing symptom profile (UK NICE [National Institute for Health and Care Excellence] guidelines).
medications
Constipation
- laxatives
- Lubiprostone
- This drug is mainly used for women with persistent constipation not responding to laxatives. Research has shown that overall response to this drug is relatively low compared to placebo (10% versus 18%; Drossman et al. 2009).
- antidiarrheal agents (e.g. loperamide)
- antispasmodic agents (e.g. peppermint oil)
- antidepressants (e.g. Amitriptyline)
- antibiotics (e.g. rifaximin)