Irritable bowel syndrome (IBS) is a complex digestive disorder marked by fluctuating abdominal pain, bloating, and altered bowel habits. While its exact causes remain elusive, emerging research suggests a profound interplay between the mind and the gut in influencing its manifestation.
This intimate connection, known as the gut-brain axis, allows mental states like stress or anxiety to induce gastrointestinal disturbances. Meanwhile, gut imbalances can transmit distress signals to the brain, potentially influencing emotions and psychological well-being.
Though a one-size-fits-all remedy for IBS remains elusive, an integrated approach emphasising both gut health and emotional well-being may offer symptom relief for many sufferers.
What causes IBS, and who is likely to have it?
Irritable Bowel Syndrome (IBS) presents a range of symptoms, varying in intensity and frequency from person to person. Here are some of the most common symptoms associated with IBS:
Abdominal pain or cramping: This is often described as a sharp, stabbing, or cramp-like pain that may be relieved after a bowel movement.
Bloating: A feeling of fullness or swelling in the abdomen.
Gas: Excess flatulence can be a common complaint.
Diarrhea (IBS-D): Frequent loose stools, sometimes urgent.
Constipation (IBS-C): Difficulty or infrequency in passing stools, which may be hard and lumpy.
Alternating diarrhoea and constipation (IBS-M or IBS-A): Some people experience alternating periods of both symptoms.
Mucus in the stool: This can be a less common symptom but can be present in some individuals with IBS.
Food intolerances: Certain foods can trigger IBS symptoms in some individuals.
Fatigue and difficulty sleeping: These are not directly symptoms of IBS but can be related to the discomfort and disruption caused by other symptoms.
Urgency: The need to quickly find a restroom when symptoms flare up.
The feeling of incomplete evacuation: A sensation that not all stool has been passed after going to the toilet.
What causes IBS, and who is likely to have it?
Certain populations and demographics are observed to be more prone to IBS:
Age: IBS often first appears in young adulthood but can occur at any age.
Gender: Women are about twice as likely to develop IBS, which ,hormonal fluctuations might influence and may be triggered by the immune system. Many women report that symptoms are more severe around their menstrual period, possibly due to stress response.
Family History: Those with a family history of IBS are at a higher risk, suggesting a potential genetic component.
Mental Health Issues: People with a history of anxiety, depression, or other mental health disorders are more prone to IBS.
History of Physical or Sexual Abuse: Individuals who have been victims of physical or sexual abuse may have an increased risk, likely due to the interplay of psychological stress and gut function.a deliberate attack. These misconceptions can lead to a long-lasting fear of wasps.
How do stress and anxiety affect your gut?
Stress and anxiety can significantly affect the gut in various ways due to the intricate connection between the brain and the gastrointestinal (GI) system, often called the “gut-brain axis.” Here are some ways in which stress and anxiety can impact your gut:
Gastrointestinal Motility: Stress can either speed up or slow down the movement of food through the digestive system. This can lead to diarrhoea or constipation, respectively.
Stomach Acid Production: Stress can increase stomach acid production, resulting in symptoms like heartburn or acid reflux.
GI Barrier Function: Chronic stress can affect the permeability of the intestines. A compromised barrier can increase susceptibility to pathogens and contribute to conditions like “leaky gut,” where larger particles pass into the bloodstream, potentially leading to inflammation and immune responses.
Microbiome Composition: The gut is home to trillions of microorganisms, including bacteria, viruses, and fungi, collectively called the microbiome. Stress can alter the balance and composition of these microbes, which can impact overall gut health, nutrient absorption, and even immune function.
Immune Response: Chronic stress can suppress or overstimulate the immune response in the gut, leading to inflammation or increased susceptibility to infections.
Increased Sensitivity: People with irritable bowel syndrome (IBS) or other functional GI disorders may find that stress exacerbates their symptoms. They might experience increased pain or discomfort in response to stimuli that wouldn’t bother others.
Brain-Gut Signal Disruption: The brain communicates with the gut through neural, endocrine, and immune pathways. Stress and anxiety can disrupt these signals, leading to various gut symptoms and altered gut function.
Behavioural Factors: Stress and anxiety might lead individuals to adopt behaviours that can adversely affect the gut, such as smoking, drinking alcohol, overeating, or consuming a poor diet.
It’s worth noting that while stress and anxiety can lead to gut problems, the reverse is also true. Gut issues can contribute to increased stress and anxiety, creating a feedback loop that can exacerbate both mental and physical symptoms.
Can stress and anxiety cause stomach pain and IBS?
The connection between the gut and the mind, often referred to as the “gut-brain axis,” is a bidirectional communication system that links the central nervous system (involving the brain and spinal cord) with the enteric nervous system (the nerve network within the gastrointestinal tract). This connection is complex and involves neural, hormonal, and immunological pathways.
Here are some key aspects of the gut-brain connection:
Neural Communication: The gut and the brain are connected through the vagus nerve, one of the largest nerves connecting the brain to other parts of the body. This nerve transmits information in both directions: from the gut to the brain and from the brain to the gut.
Gut Hormones and Neurotransmitters: The gut produces many of the same neurotransmitters found in the brain, such as serotonin, dopamine, and gamma-aminobutyric acid (GABA). Most (about 90%) of the body’s serotonin, a neurotransmitter crucial for mood regulation, is produced in the gut.
Gut Microbiota: The trillions of microorganisms residing in our gut, known collectively as the gut microbiome, play a pivotal role in the gut-brain axis. These microbes produce various chemicals and neurotransmitters that can influence brain function. They also play a role in regulating inflammation, which can impact brain health and mood.
Immune System Regulation: The gut is a significant site of immune activity. Gut health and permeability can influence systemic inflammation and immune responses, impacting brain function and mood.
Psychological Stress and Gut Function: Psychological stress can alter gut motility, barrier function, and gut microbiota composition. Conversely, gut disturbances can send distress signals to the brain, potentially influencing mood and behaviour.
Developmental Aspects: Early life events, such as antibiotic use, infections, birth method (cesarean vs vaginal delivery), and early life stress, can influence the development of the gut microbiome and may have long-term effects on brain health and behaviour.
The second brain-gut axis
This interconnectedness explains why our gut is sometimes called the “second brain.” It also explains why gut health might influence various conditions and diseases, from mood disorders like depression and anxiety to neurodegenerative diseases like Parkinson’s.
Moreover, this connection is the basis for ongoing research into the therapeutic potential of interventions like probiotics, prebiotics, and diet modifications to potentially benefit both gut and mental health.
IBS and stress
People with irritable bowel syndrome (IBS) often grapple with unpredictable and recurrent bouts of abdominal pain, bloating, and shifts in bowel habits, such as diarrhoea or constipation. These symptoms can disrupt daily activities, leading to missed work or social events.
Additionally, the unpredictability of flare-ups can contribute to anxiety and stress, creating a cyclical relationship where psychological distress further exacerbates IBS symptoms due to the body’s stress response. Over time, this condition can also take an emotional toll, affecting an individual’s self-esteem, social interactions, and overall quality of life.
Treating stress and IBS symptoms
Addressing both stress and the symptoms of Irritable Bowel Syndrome (IBS) is essential for a comprehensive approach to managing the condition. Here are several strategies for treating stress and alleviating IBS symptoms:
Low FODMAP Diet: Some people with Irritable Bowel Syndrome benefit from following a low FODMAP diet, which limits certain carbohydrates that might ferment in the gut.
Fibre Intake: Soluble fibre (found in oats, psyllium husk, and some fruits) can help with both diarrhoea and constipation. However, some people may find insoluble fibre (like whole wheat) exacerbates symptoms.
Cognitive Behavioral Therapy (CBT): This type of talk therapy can help individuals recognise and manage stressors and develop coping strategies.
Relaxation Techniques: Deep breathing, meditation, and progressive muscle relaxation can help reduce stress levels.
Regular Exercise: Walking, yoga, or swimming can decrease stress and promote gut motility.
Antispasmodics: Medications like dicyclomine can help reduce abdominal cramping.
Laxatives or Anti-diarrheals: Depending on the Irritable Bowel Syndrome type (constipation-predominant or diarrhea-predominant), medications can help regulate bowel movements.
Antidepressants: Low doses of tricyclic antidepressants or SSRIs can help modulate pain and bowel activity. They also address co-existing anxiety or depression.
Probiotics: They can help balance the gut microbiota, potentially alleviating some IBS symptoms. However, the efficacy of probiotics is still a topic of research, and results can vary among individuals.
Hypnosis: Beyond CBT, other forms of therapy, such as gut-directed hypnotherapy, have shown promise in treating IBS.
Biofeedback: This method teaches individuals to control physiological functions to reduce symptoms.
Peppermint Oil: Some studies have shown that peppermint oil can help reduce IBS symptoms due to its antispasmodic properties.
Regular Sleep: Establishing a regular sleep pattern can help reduce stress and potentially alleviate some IBS symptoms that appear due to stress response.
Avoiding Triggers: Some individuals might notice that specific foods, drinks, or situations exacerbate their IBS. Keeping a symptom diary can help identify and avoid these triggers.
Support Groups: Joining an IBS support group can provide emotional support and a platform to share experiences and coping strategies.
Hypnotherapy for managing IBS
Hypnotherapy, specifically gut-directed hypnotherapy (GDH), has emerged as a promising intervention for managing the symptoms of Irritable Bowel Syndrome (IBS). The approach is based on the close connection between the brain and the gut, often called the gut-brain axis.
Here’s a deeper look into the application and efficacy of hypnotherapy for Irritable Bowel Syndrome:
What is Gut-Directed Hypnotherapy (GDH)?
GDH is a specialised form of hypnotherapy tailored to address the symptoms and stressors associated with gastrointestinal disorders, particularly Irritable Bowel Syndrome. During sessions, patients are led into a relaxed, trance-like state and provided with positive suggestions for gut function and pain control.
How Does it Work?
The exact mechanism isn’t fully understood, but GDH is believed to work by affecting the gut-brain axis, potentially reducing visceral hypersensitivity, improving gut motility, and reducing the impact of stress on gut function.
Multiple clinical studies have shown that hypnotherapy can reduce the frequency and severity of IBS symptoms. Benefits include reduced abdominal pain, bloating, and bowel irregularities.
Some studies have shown that the beneficial effects of GDH on IBS symptoms can persist long after therapy has ended. This suggests that, in some people, hypnotherapy can induce lasting changes in how the brain perceives and modulates gut activity.
It’s also been found to improve secondary symptoms such as anxiety and depression, which often co-exist with Irritable Bowel Syndrome.
Duration and Sessions
Typically, a full course of GDH for Irritable Bowel Syndrome might involve several sessions (e.g., 6-12) over a few months. However, the exact number can vary based on individual needs.
Some practitioners may also provide recordings for patients to listen to at home, reinforcing the therapeutic effects.
It’s worth noting that while many people benefit from GDH, it might not be effective for IBS patients. Hypnotherapy is generally considered safe, but it’s essential to find a certified therapist with experience in gut-directed hypnotherapy to ensure the best outcome. As with all treatments, patients should discuss the potential benefits and risks of GDH with their healthcare provider.
- Non-invasive and drug-free approach.
- It can help address both physical symptoms of IBS, Irritable Bowel Syndrome and related psychological stressors.
- Potential for long-term relief even after the cessation of therapy sessions.
Hypnotherapy has been investigated for its potential benefits in treating various conditions, including irritable bowel syndrome (IBS) and functional gastrointestinal disorders. Here’s a selection of references that discuss the use of hypnotherapy for IBS:
Whorwell, P. J., Prior, A., & Faragher, E. B. (1984). Controlled trial of hypnotherapy in the treatment of severe refractory irritable bowel syndrome. The Lancet, 324(8414), 1232-1234.
Palsson, O. S., Turner, M. J., Johnson, D. A., Burnett, C. K., & Whitehead, W. E. (2002). Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Digestive Diseases and Sciences, 47(11), 2605-2614.
Gonsalkorale, W. M., Miller, V., Afzal, A., & Whorwell, P. J. (2003). Long-term benefits of hypnotherapy for irritable bowel syndrome. Gut, 52(11), 1623-1629.
Lindfors, P., Unge, P., Arvidsson, P., Nyhlin, H., Björnsson, E., Abrahamsson, H., & Simrén, M. (2012). Effects of gut-directed hypnotherapy on IBS in different clinical settings—results from two randomised, controlled trials. American Journal of Gastroenterology, 107(2), 276-285.
Moser, G., Trägner, S., Gajowniczek, E. E., Mikulits, A., Michalski, M., Kazemi-Shirazi, L., … & Miehsler, W. (2013). Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomised controlled trial. The American Journal of Gastroenterology, 108(4), 602-609.
In summary, gut-directed hypnotherapy is a well-tolerated and potentially effective therapeutic option for many Irritable Bowel Syndrome patients. When used in conjunction with other recommended treatments and lifestyle changes, it can be a valuable component of a comprehensive IBS management strategy.