Irritable bowel syndrome (IBS) is a chronic health condition which is primarily functional. It manifests with repeated episodes of diarrhea and/or constipation, abdominal pain, and often bloating. It is associated with a reduced quality of life.
Current treatment strategies focus on alleviating the gastrointestinal symptoms, using medications and lifestyle management. However, the importance of the psychological element in the etiology of this condition should not be overlooked. Thus the management of IBS should involve approaches such as:
- Cognitive behavioral therapy (CBT)
- Psychodynamic therapy
- Stress reduction
Holistic Approach to Disease Management
For most patients with IBS, both mind and body need to be considered in order to bring about the best resolution of symptoms. The gastrointestinal changes such as altered bowel motility, bacterial overgrowth in the small intestine, and hypersensitivity to visceral stimuli such as intestinal distension, must be understood as coming from a common root of emotional hyperresponsiveness.
The enteric nervous system (ENS, often termed the little or second brain) is both large and highly complex. It is under the involuntary control of the central nervous system. Some researchers have suggested that IBS symptoms arise as a result of the patient’s abnormal sensitivity to external stimuli from social interactions and situation, the psychological makeup, and over-vigilance to stimuli originating from the internal organs.
The change in bowel habits is accounted for by the autonomic imbalance, while the pain is due to increased pain sensitivity caused by stress. This also makes the patient more alert and responsive to internal sensations.
One episode of actual pain associated with such sensations may also condition the patient to fear them, thus producing IBS symptoms even without real intestinal dysfunction. This may thus instigate a vicious cycle between negative and fearful thinking and functional abnormalities of the gut, which both reinforce and perpetuate each other.
Reducing stress is thus of primary importance in breaking this CNS-ENS cycle. This may involve:
- Relaxation techniques such as taking a retreat, slow deep breathing exercises.
- Exercise which relaxes and tones the body, and also strengthens the mind-body connection, such as yoga postures, Pilates, or tai chi. Even walking, running, or swimming can help a lot, by distracting the mind from the internal sensations and providing new and better stimuli as well as a sense of well-being and achievement. In addition, of course, there is the physical benefit of exercise.
Feelings of anxiety and stress are often difficult to work through. Techniques which help with this include cognitive behavioral therapy (CBT), dynamic psychotherapy and, sometimes, hypnotherapy.
CBT focuses on the nature of the thoughts which trigger the emotional dysfunction leading to altered gut function. Thoughts can be altered to bring about changes in behavior, which is the underlying principle of this technique. It can be used to address stressors in life itself, or to change the way the patient thinks about and responds to IBS symptoms.
Dynamic psychotherapy is also a form of talk therapy which has been found to succeed with as few as four sessions. It helps the patients identify the connection between their inner and outer beings, resolve conflicts, and find inner support to deal with the stress.
On the other hand, hypnotherapy induces a state of altered consciousness, and uses the power of suggestion to introduce alternative ways of dealing with pain rather than becoming anxious, withdrawn, defensive, or depressed.
Reviewed by: Dr Tomislav Meštrović, MD, PhD