Irritable Bowel Syndrome: -- What to Do When Your Gut Rebels

Lin Liang Yu

Edited by: Wong Mei Yin

Physiological and Psychological Impact on You

Do you constantly feel bloated and have pain in your abdomen? Do you have frequent constipation, diarrhoea or suffer from both? Chances are that you have Irritable Bowel Syndrome (IBS). This is a group of gastro-intestinal impairments in terms of the movement of intestines, the sensitivity of the nerve in the intestines and the central nervous system controlling the intestinal function. Medical investigations have shown that there is no structural abnormality of the gastro-intestinal system.

While there is no clear etiology of the IBS, research has implicated problems in the interaction between the intestines, the autonomic nervous system and the brain. Overly sensitive large intestines, allergies to certain foods and problems with the immune system are other possible explanations for IBS. There is also research showing that abnormal levels of neuro-chemicals (e.g., Serotonin) in the Gastro-intestinal tract may cause over sensitivity. Additionally, some people who have bacterial infection of the gut may develop IBS.

The following are the common symptoms of IBS:

At least any 12 weeks (not necessary to be consecutive) in the past 1 year when there is abdominal pain/ discomfort that have 2 out of 3 of the following qualities:

¡¤ It is relieved after passing motion

¡¤ There is a change in frequency of bowel movement.

¡¤ There is a change in the appearance of the motion.

Additional symptoms include:

¡¤ Too many or too little times passing motion (more than 3 times daily or less than thrice a week)

¡¤ Feelings of straining, urgency or incomplete passing of motion

¡¤ Bloating

¡¤ Passing of whitish mucus fluid

It is advisable to visit your doctor should you exhibit these symptoms to get a clear medical diagnosis.

With these distressing symptoms, is it difficult to imagine an IBS sufferer feeling stressed out? The gut is very intimately linked to the mind and our mood. Stress has a particularly vicious effect on IBS. People with IBS also suffer from anxiety and even depression alongside the symptoms of IBS. It worsens the symptoms by causing more intestinal contractions, heightens a person's sensitivity to the arising pain, and contributes to fear, anxiety, and mood changes.

Conventional Medical Treatment

The bottom line is this: IBS involves dysfunctional contraction of the intestines and sphincters (muscles at the openings of the intestine, e.g., at the rectum), resulting in pain, improper passing of motion, bloating and other symptoms. It is discouraging to realize there is no cure found for IBS, but many other options are available to handle it. Many of the conventional medical treatments help with symptom relief through administrating medications. For some, fiber supplements or laxatives have been helpful for constipation. For the treatment of diarrhoea, doctors may prescribe medication to harden the stool. To alleviate symptoms of depression, anxiety and pain, medication would also be prescribed. However, medications are often accompanied by side effects that sufferers have to be aware of.

How evidence-based Mind-Body Medicine can be helpful

In recent years, other alternatives have been sought to help sufferers. Although conventional medical have helped people who suffer from IBS, many individuals have turned to other treatment methods as they find these more effective in dealing with their symptoms. Mind-Body Medicine (MBM) has been at the forefront in the movement for alternative treatments. This is a gigantic and versatile group of techniques based on the concept of psycho-neuroimmunology (PNI).

This concept refers to how our thoughts, feelings and actions (psycho) can influence our brains and nervous systems (neuro) and hence our resistance to illness (immunology). To put it simply, what we think and feel affects what our body does and vice versa. What are some treatments like then, in the tradition of MBM? Breathing techniques are an example. So is meditation. How many people are aware that simple diet management or exercising constitutes a part of an MBM regime?

What has research on MBM techniques told us that can help IBS sufferers? Our lifestyle has significant impact on our gastro-intestinal system. Lifestyle refers to how we manage our daily life ?our diet, what we eat, whether we exercise or not, our time management, and even how we maintain our posture. For example, diet management is important. Most IBS sufferers benefit from gradually increasing amounts of fiber intake, more consumption of water as well as avoidance of certain foods like diary products.

One of the writers who suffers from IBS, has found that taking less oily or fried foods, chewing slowly with each mouthful of food, and that 6 small meals daily instead of 3 big ones have been very helpful in aiding his IBS symptoms. In addition, he has discovered that simply standing straighter and taller (as if the top of his head were being held up by a piece of string) decreases pressure on the bladder and intestines.

Besides lifestyle management, psychological approaches like Cognitive Behavioral Therapy (CBT) ?where a person is made to examine his thoughts (cognitive), change them by changing their behaviors and also taught coping skills, appears to be pretty useful for IBS as well. CBT handles the stress, anxiety and depression accompanying IBS. It fosters in sufferers a sense of can-do-ness and agency. A technique often used in CBT interventions is the simple 2-step mindfulness meditation technique. This involves focusing your attention on a single object (e.g., the rhythm of your breath, a pleasant image, etc.; step 1) and returning your attention to this object with a nonchalant attitude (step 2) when you get distracted.

Another thought-based technique, which the writer has found particularly useful for pain and bloating is what is known as autogenic training. This is a series of instructions repeated to oneself and the body (very much like a mantra). For example, here is a brief script targeted at the gastro-intestinal system:

My stomach is very warm x 4

My intestines are very warm x 4

My stomach is very warm and heavy x 4

My intestines are very warm and heavy x 4

My stomach and intestines are very, very warm x 4

But best of all, guided-imagery, especially gut-focused guided imagery has been found to work spectacularly well with IBS symptoms. Guided imagery is a technique which makes use of a person's ability to visualize. The sufferer is guided by verbal instructions to visualize a pleasant scenario, and asked to experience it with all his senses. The image is then slowly changed to create an implicit message to the sufferer that brings about physiological changes.

Gut-focused guided imagery appears to successfully treat even IBS sufferers who resist medical treatment altogether. A growing body of research has consistently shown that 80% and above of IBS sufferers find significant relief from all their major symptoms with guided imagery. This is a number not matched by medical treatments. What is more, IBS sufferers treated with guided imagery have found long-term (5 years and counting) relief and reduction of their symptoms. Sufferers have found that their quality of life has improved drastically too (e.g., decreased abdominal pain, bloating, urinary problems, lethargy, backaches, painful sexual intercourse, etc.).

What happens in gut-focused guided-imagery? IBS sufferers are put through 1 hour long guided-imagery sessions that last for 7 to 12 sessions. They are placed into a relaxed state (very much akin to Dr. Herbert Benson's famous Relaxation Response) and told to visualize certain images associated with a perfectly healthy gut. For example, it is likely that they imagine themselves driving along an expressway which is stuck with traffic. They are asked to imagine the traffic clearing smoothly. They are told to get really engrossed in this drive. This targets constipation. Can you create a picture that deals with diarrhoea? Between sessions, sufferers are sent away with a guided imagery audio tape containing the created image, to listen to daily.

From the above examples, it seems that our imagination and our mind play an important role in the improvement of our physical symptoms. It also widens our options for handling IBS. The best thing about MBM techniques, apart from how easy they are to learn and use, is that fact that they use only those abilities that we already have (e.g., imagination, breathing, etc.). This means that MBM techniques have absolutely no side effects!

There are many of Mind-Body Medicine techniques that one can tailor to fit ones unique symptoms. At Shan You Counselling Centre, we have made it a practice to teach clients to use and even come up with their own unique Mind-Body techniques to effectively deal with their physical problems.

¡¤ Mr. Tan Wee Chong is a Behavioural Health Counsellor at Shan You Counselling Centre (he is managing his IBS very well with Mind-Body Medicine techniques)

¡¤ Miss Lin Liang Yu is a Counsellor at Shan You Counselling Centre

¡¤ Miss Wong Mei Yin is Clinical Director of Shan You Counselling Centre and is a Registered Counselling Psychologist.

Shan You Counselling Centre is at:

Block 5 Upper Boon Keng Road, # 02-15, Singapore 380005

We can be contacted at 67419293 or www.shanyou.org.sg

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