IBS, known as irritable bowel syndrome, is a condition that affects the large intestines and can result in symptoms of cramping, abdominal pain, bloating, gas, diarrhea and constipation (1, 2).

IBS is a persistent/chronic condition that requires a long term lifestyle change. Unlike ulcerative colitis and Chron’s disease, IBS doesn’t cause damage to the tissues of the bowel (2).

IBS emerges from a complex interaction of biological, psychological and social factors rather than a single cause/event (1). IBS may be considered as an emergent property. This means, IBS is a larger manifestation of a series of smaller/simpler changes in the body/mind that over time develop into this larger entity (3). An example would be a severe weather storm. The storm is not the result of cloud formation but a series of changes in the air, pressure systems and temperatures that creates the right atmosphere for a storm to form.

So this blog will explore these smaller entities that have been associated with IBS in hopes that it may give you a better understanding and direction for seeking a combination of treatment options so that you can live a fulfilled life.

Biology:

  1. IBS sufferers tend to have an enhanced organ pain perception. This means it takes less stimulation to produce a pain response in the gut. The gut is sensitive to changes in chemical composition such as inflammation, stress hormones or even reproductive hormones, more specifically in women (4).
  2. Estrogen and progesterone can act on GI motility (movement) and colonic permeability (absorption)(4). Estrogen plays a role in creating a defense barrier in the intestinal wall so changes in estrogen can impact symptoms.
  3. Sufferers have changes in their autonomic nervous system (4). We have two systems that make up the autonomic nervous system: our sympathetic system: known as our flight, fright, freeze system, and parasympathetic system: rest, digest, repair system. Typically IBS sufferers are sympathetically up regulated. This means your body is responding from a place of stress more consistently instead of a place of relaxation. When the body is in a state of stress consistently, your body always on the tipping point of having an IBS reaction.
  4. Genetics, sex hormones and gut microbiome also play a role in IBS presentation (4). Although we cannot take medication to change our genetics, we can impact the expression of our genes by living a balanced lifestyle in mind/body/spirit. For sex hormones and gut microbiome, we can make changes through lifestyle, diet, supplements and/or medications specifically targeting hormones.

Psychological

Psychological distress is an important risk factor to consider because if it is present it has the ability to make symptoms worse. Psychological distress in IBS can be a consequence of symptoms or a cause (1).

When participants are asked about their IBS the most common theme that comes up is a sense of frustration, isolation and restriction on activities (4). This can be enough to create psychological distress and whether cause or effect, if present it will impact IBS.

So what psychological distresses are we talking about?

  1. Mood disorders: depression/suicidal thoughts: ~30%
  2. Anxiety: this is the most common 30-50% of IBS sufferers.
  3. Other mental processes such as symptom-specific anxiety, attention bias, hyper vigilance, catastrophizing and other psychiatric conditions (1).

Social

  1. Environmental influences
    1. Childhood environment: parental beliefs and behaviours
      1. What you learn from your parents beliefs and behaviours can impact your risk for developing IBS and how you deal with IBS (1).
      2. For example it was found that children of mothers who reinforce illness behavior experience more stomach aches and school absences.
  • Parents who worry more or have negative thoughts about their conditions increases the likelihood that children will do the same (1).
  1. Adverse life events: (sexual, physical, emotional abuse). Individuals with IBS report a higher incidence of adverse life events
    1. You could also develop IBS following a severely life threatening event or even a break up of an intimate relationship (1).
    2. Under this category chronic life stress can also be present (1)
  2. Lack of social support
    1. Lack of support has been associated with severity of IBS symptoms because social support acts as a stress relief.
    2. Having negative social relationships is also strongly related to IBS severity
  3. Culture
    1. Cultural beliefs and norms impacts how we interact with family, friends other support systems and the world at large (1) and should not be overlooked in IBS (1)

 

Treatment options:

  1. Medications: should be discussed with a doctor or specialist for IBS and a discussion around depression/anxiety may be warranted (1)
  2. Naturopathy: an alternative option to look at supplements (such as probiotics), hormone balancing, food sensitivity testing and dietary changes, perhaps even acupuncture may be helpful.
  3. Cognitive behavioural therapy: this is a key treatment to help with a variety of things
    1. Self monitoring: learning how to identify internal and external triggers by learning about one’s self and body because you cannot change something, you are not aware of.
      1. Learning to identify your thoughts, sensations and feelings during a flare-up( 1)
    2. Cognitive strategies: learning about how you think about the problem. There is a tendency to overestimate risk and magnitude of threat which can impact stress and symptoms. A therapist can help you think about your life and symptoms differently (1).
    3. Problem solving: knowing what to do during a flare up when you are in the middle of one can be challenging. Therapy focuses on helping you to identify your own solutions, implement them and evaluate the outcomes (1).
    4. Exposure: IBS sufferers tend to have some unhealthy beliefs and avoidance behaviours when it comes to their IBS. Exposure therapy is a way to gradually help you overcome your fears and beliefs that may be holding you back from living a full life.
  4. Relaxation: both in CBT and pelvic health physiotherapy we teach relaxation. It is an integral part to have when you have IBS. Relaxation comes in many different forms: progressive muscle relaxation, meditation, breathing, exercises.
  5. Exercise: can take many different forms but is part of living a healthy lifestyle. Exercise is great for stress management. If you manage stress better, you will see a difference in symptoms.
  6. Visceral/fascial mobilization: some pelvic health physiotherapists undergo additional training to treat bowel dysfunction. In that training we learn how to mobilize tissue in the case of tightness and/or adhesions to free movement and improve function of the digestive system. If interested in seeking out this therapy approach in Canada you can see www.pelvichealthsolutions.ca to find a therapist near you. You are looking for a therapist who has completed the study of Bowel dysfunction and/or fascial courses.

 

I hope this article shed a bit of light on a complex syndrome. I hope it at least gives you the ability to ask more questions and/or seek out alternative approaches to managing IBS symptoms

References:

  1. Van Oudenhove et al. 2016. Biopsychosocial aspect of functional gastrointestinal disorders: how central and environmental processes contribute to the development and expression of functional gastrointestinal disorders. Gastroenterology 150: 1335-1367.
  2. Mayo clinic “Irritable bowel syndrome” mayoclinic.org. Accessed July 21 2017
  3. Emergence. En. M. Wikipedia.Org. Accessed July 21, 2017.
  4. Houghton et al. 2016. Age, Gender, and Women’s Health and the Patient. Gastroenterology, 150: 1332-1343.

 

IBS – Irritable Bowel Syndrome