There are other therapies that can help relieve the symptoms of IBS. Many of these work on the mind-body connection which mediates between the stress we feel and the symptoms we experience in our gut.
IBS is no longer seen as being purely an illness of the gut. Recent research has led to the view that IBS is a complex disease that involves visceral hypersensitivity, alterations at the level of nervous and hormonal communication between the enteric nervous system and the central nervous system, alteration of the gut bacteria and increased intestinal permeability. Psychological and social factors can interfere wi0th the communication between the central and enteric nervous systems, and there is proof that they are involved in the onset of IBS and may influence the patient’s response to treatment. There is evidence that stressful life events are involved in the onset of IBS. Psychological features, such as anxiety and depression as well health beliefs can affect the coping of patients with IBS1.
However the role of the brain goes further than this. New evidence shows that psychosocial distress can contribute to pain perception, at least as much and sometimes more than signals from the gut itself. Patients with more severe IBS are distinguished from those with milder IBS by having greater psychological distress but no differences in the thresholds at which pain is elicited in the gut. These data highlight the importance of the brain’s processing of pain in amplifying the perception of visceral signals2.
Stresses caused by family problems, work pressures, examinations, and recurring thoughts of previous trauma may trigger symptoms of IBS in some people. People who are very anxious may find symptoms difficult to control.
This relationship between IBS and stress and anxiety means that IBS is very susceptible to inputs via the brain, such as counselling, psychotherapy, hypnotherapy and cognitive behavioural therapy (CBT). Although the research is mixed (and often of poor quality)3, there is some evidence for the efficacy of psychological therapy, hypnotherapy and CBT4. There is also evidence that relaxation techniques5 and mindfulness training can be helpful6.
1. Surdea-Blaga T, et al., Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol. 2012 February 21; 18(7): 616–626.
2. D A Drossman Brain imaging and its implications for studying centrally targeted treatments in irritable bowel syndrome: a primer for gastroenterologists. Gut 2005; 54: 569-573; Ford AC, et al., Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 2009; 58(3): 367-78.
3. Zijdenbos IL et al., Psychological treatments for the management of irritable bowel syndrome. Cochrane Database Syst Rev. 2009 Jan 21;(1)
4 Ford AC et al., Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut, 2009 Mar;58(3):367-78; Lackner JM et al., Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. J Consult Clin Psychol. 2004 Dec; 72(6):1100-13; Webb AN et al., Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database Syst Rev., 2007 Oct 17;(4); Mahvi-Shirazi M, Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment. Arch Med Sci. 2012 Feb 29;8(1):123-9.
5. Lahmann C. et al., Functional relaxation as complementary therapy in irritable bowel syndrome: a randomized, controlled clinical trial. J Altern Complement Med, 16. 1 (Jan 2010): 47-52
6. Gaylord SA et al., Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011 Sep;106(9):1678-88.