IBS Services

Most people wait 6.6 years on average for a diagnosis of IBS

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Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) disorder with a worldwide prevalence of 10-20%.  Estimates by the International Foundation for Functional Gastrointestinal Disorders state that IBS affects between 25 and 45 million people in the United States (10 to 15% of the population).  About 2 in 3 IBS sufferers are female, with about 1 in 3 IBS sufferers male.   Affecting people of all ages, IBS is even seen in children.  Most persons with IBS are under the age of 50. It has components of chronic pain and has a prevalence rate at least as common as hypertension.  IBS is much more common than the health conditions of asthma, diabetes, and congestive heart failure combined.  In terms of impairment, IBS is second only to the common cold for work loss days due to its impact on patients’ quality of life.

Defined as a “functional disorder” since the locus of the problem is in how the gut functions and not in abnormalities of its physical structure, the exact cause of IBS is not known. Symptoms may result from a disturbance in the way the gut, brain, and nervous system interact. This can cause changes in normal bowel movement and sensation.  IBS is characterized by abdominal pain or discomfort, and altered bowel habit (chronic or recurrent diarrhea, constipation, or both – either mixed or in alternation).

The impact of IBS can range from mild inconvenience to severe debilitation. It can control many aspects of a person’s emotional, social and professional life. Persons with moderate to severe IBS must struggle with symptoms that often impair their physical, emotional, economic, educational and social well-being.  Chronic pain symptoms, as well as anxiety symptoms, are associated with IBS.  It is common for sufferers to not seek medical advice.  It is suspected that individuals with IBS spend time and resources self-medicating with OTC medications.  Due to cultural norms that shame and silence discussions of bowels, sufferers often resist seeking treatment.   Often, those who do seek physician care return to doctors again and again for treatment.  Long-term symptoms can disrupt personal and professional activities, and limit individual potential.  Anxiety and depression are common among IBS sufferers; so is the tendency to avoid seeking medical care.

Recently, the IFFGD conducted a survey of nearly 2,000 patients with IBS.  They reported that diagnosis of their IBS was typically made 6.6 years after the symptoms began.  Approximately 20 to 40% of all visits to gastroenterologists are due to IBS symptoms.

Nutrition therapy and mental health counseling help regulate IBS

One difficulty with this disorder is its unpredictability.  Symptoms vary and are sometimes contradictory. Diarrhea can alternate with constipation.   Another issue with IBS is the difficulty with which it is properly diagnosed.  Since IBS can look present as much more serious intestinal disorders, and since, by definition, it is related to the “function” of the gut (in contrast to “dysfunction” of the gut) physicians worked together to come up with standard criteria that MDs can use to name the disorder.  This definition, named the Rome criteria, was developed in the 1995 by an international group of specialists who continue to meet and refine the diagnostic treatment for IBS[1].  There are two definitions for use by medical professionals in diagnosing IBS, Rome II (1995) and Rome III (2006).

The problem of IBS is best understood by drawing from theories of mind, brain and body in their context.  Interventions for IBS can then be multidimensional and multileveled, to work with the problem connections from many different points of entry.  The integration of these states brings approaches for integrative treatments.  IBS is considered a classic FOOD/MOOD disorder, with multidimensional treatment approaches necessary to fully resolve the condition and restore quality of life.
Treating IBS – Even without fully understanding the causes of IBS, dietary recommendations and techniques for reducing stress, along with the use of medications for specific symptoms have been shown to be very effective. Since both diet and stress can be managed (with support) by many patients, having some control over IBS has proven psychologically helpful.  Strategies include shifting towards whole foods, plant-based diet, adding more fiber, avoiding certain foods, the use of prebiotic and probiotic supplements, drinking lots of water, and following a moderate exercise program which includes yoga and meditation.  Learning how to manage anxiety and the role of cognitions in IBS through psychological counseling has been shown in clinical studies to be very effective.  It should be noted that not all of these strategies are empirically based, but the most powerful research backs certain dietary strategies, medication management, psychotherapy, meditation/relaxation/hypnotherapy/yoga techniques, and the use of Chinese herbs, pre-and-probiotics, and Peppermint Oil therapy.

Psychotherapy and stress management- Psychological factors in general and cognitive processes, in particular, play an important role in the onset, expression and outcome of IBS patients, especially those with “severe” IBS.  Studies show that IBS patients as a group tend to label gut sensations negatively and show a lower tolerance for gut sensations.   A high rate of psychiatric co-morbidity (especially anxiety disorders) is seen among treatment seeking IBS patients.  Given the 6.5 year average time to medical diagnosis for the average IBS patient, a psychological component is likely.  It is not clear which comes first:  the anxiety (and sometimes depression) or the GI problems.  Researchers now believe that evidence shows that mental illness does not cause IBS, but if a patient has anxiety and depression, they are more likely to have or be concerned about IBS symptoms.  And, severe IBS symptoms affect mental health.

Yoga and IBS- The smooth functioning of digestion depends on the action of the autonomic nervous system, especially the parasympathetic branch (PNS), associated with relaxation and restoration.  Stress activates the sympathetic side (SNS), the fight or flight system, which can interfere with the bowels.  Exercise is known to lower stress levels.  Beyond this general effect of physical activity, specific yoga postures can offer help with a wide variety of IBS symptoms.  For example, people with constipation often benefit from gentle yoga stretches and twists, and if they are able, more vigorous poses like Sun Salutations and inversions.  Since stress can lead to both constipation and diarrhea, a variety of practices from asana to breathing exercises designed to calm down the SNS and shift the balance more toward the restorative PNS side of the equation, can facilitate balanced bowel function.

Serious students of yoga practice meditation techniques along with the physical practices (asana), as well as self-study (svadhyaya).  Self-study encourages figuring out what stressors are at play for the individual student, and whether there is a connection between them and symptoms.  Self-study also involves looking at the link between certain foods eaten and how they make the student feel.  Through self-study, if the student continues to eat the offending foods anyway, yoga suggests looking further to ascertain why that might be.  Keeping a yoga journal which includes diet, yoga practice, IBS symptoms, stressors and any other salient information can be instructive and helpful.

Yoga encourages the study of HOW the patient eats.  Rapid eating can be a contributor to IBS symptoms through the ingestion of air and inadequately chewed food, worsening gas and bloating.  The process of mindful (yogic) eating encourages slowing down, savoring each bite, being in the moment with food and our senses, and relaxing.  Bringing more yogic awareness to the entire process of eating can facilitate relaxation by making it more of a meditation.  The practitioner of yoga also can experience a multitude of other health benefits from adopting a more yogic lifestyle, including choosing healthier foods, limiting caffeine and alcohol, using asana practices as stress management, meditating to improve mood, and tuning in to the physical body in ways that invite symptom management.  Rather than plowing through life, anxiously rushing from one activity to another, inviting more anxiety through IBS flare ups, the practitioner can slow down, learn to say no to outside stressors, and watch anxious thoughts come and go.  A yoga practice is the perfect complement to therapy, meditation, and CAM management of IBS symptoms.

There is some scientific evidence for the benefits of yoga and IBS symptom improvement.  One example is of a RCT of 100 patients with IBS which was conducted in India in 1992 (Kumar, 1992).  Patients were divided into three groups; one group was given traditional drug treatment, one a yoga program, and one a combination of drugs and yoga.  The yoga intervention consisted of asana, pranayama (breathing), kriyas (yogic cleansing techniques), and mediation.  The drug therapy included anti-anxiety drugs, antispasmodics, and fiber supplements.  After two weeks of training, the groups were asked to practice 30 minutes per day for the next two months.   Both drugs and yoga used alone were effective in significantly reducing abdominal pain, constipation, diarrhea, anxiety, and other symptoms, with yoga generally more effective the medication.  The combination of yoga and modern drug therapy was consistently more effective than either modality alone, eliminating all symptoms within six weeks, with the benefits persisting at the conclusion of the study.

Due to the low risk of complications, the extensive benefits that yoga provides, as well as overall improvements in self-efficacy and body awareness which accompany a regular yoga practice, IBS patients would benefit from the development of a regular yoga practice tailored for IBS, designed by a competent, certified instructor.  Evidence based, researched yoga protocol for IBS can be found HERE.

Yoga also helps with anxiety in a number of ways.  It offers specific techniques that can reduce symptoms, both in the short and longer term.  Because of its focus on tuning in to inward states, yoga can also help one get beneath the surface of anxiety to figure out what is triggering it, including habitual though patterns or unresolved conflicts.  One of the key yogic techniques used to counter anxiety is to focus on the breath.  The connection between the mind and the breath is most obvious with anxiety.  When one is engaged in anxious, fearful, or stressful states, breathing is changed in a number of ways.  It can become choppy, restrained, shallow, rapid, or even stop altogether for periods of time.  In a calm state, breathing is smooth and rhythmic.

Yoga’s focus on deep abdominal breathing, which focuses on slower, more relaxed patterns, helps the anxious client.  Ironically, lifetime patterns of anxiety can lead to muscle tension restricting the abdominal muscles that circle the belly.  Anytime the belly can’t move freely, breathing is impaired.  Impaired breathing leads to anxiety, and chronic tightness in the intercostal muscles that lie in between the ribs can also impact the breath.  A regular practice of yoga including breath work (Pranayama) is an effective method of combating anxiety, according to scientific studies.  Voluntarily slowing the breath during periods of stress counters many of the physiological components of stress while reducing feelings of anxiety.  Techniques include increasing the length of exhalation relative to the inhalation, relaxed, diaphragmatic breathing, and other practices.

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[1] The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of functional gastrointestinal disorders (FGIDs). Their mission is to improve the lives of people with functional GI disorders. The Rome foundation is based out of the University of North Carolina (Chapel Hill).