You probably wouldn’t think of using osteopathy to treat IBS, but because the gut has a blood and nerve supply and is a muscular structure, it is also susceptible to manual treatment. The gut has its own “brain”, the enteric nervous system (ENS), which has 100 million more neurons than the spinal cord. The brain is connected to the ENS by the vagus nerve, but also by stress hormones which stimulate the neurons in the gut and this over-stimulation can cause diarrhoea. These inputs can also affect the stomach, leading to overproduction of stomach acid and heartburn.
In a patient who has suffered from IBS for a long time, the gut may be palpably congested and hard. There may also be adhesions or areas of tension in the mesentery, the large fan-shaped ligament which holds the large bowel in place (see fig 1). Both the bowel and the mesentery can be manipulated through the abdominal wall. This involves massage and stretching and it may be a little painful, but usually does relieve symptoms to some extent. Stretching the mesentery helps to improve the blood and nerve supply to the gut as well. In someone who is constipated it is also possible to use massage to get the stools moving.
Mobilising the spine can help to improve the function of the nerves which supply the gut, and this can lead to calming the nerves and relaxation of the smooth muscle of the gut. Part of the gut is innervated by the vagus nerve which passes through the side of the neck and may be subject to compression by tight muscles there, so treatment may also involve work on the neck.
In addition to this, IBS symptoms may be triggered (or made worse) by stress, and osteopathic treatment has the effect of relaxing the body which may also alleviate some of your feelings of stress. Mobilisation of the spine can calm down the sympathetic nerves, which mediate the stress response. This could further act to reduce the severity of your IBS symptoms or may prevent them from recurring.
Unfortunately there is not a great deal of research into osteopathic treatment for IBS. However two studies have shown that when compared with standard medical care, osteopathic treatment for IBS yields some improvement when patients receive only two or three sessions1, but dramatic improvements follow a course of six treatments2 . Furthermore in one study these gains were maintained in a 6 month follow-up3 .
1 Florance BM et al., Osteopathy improves the severity of irritable bowel syndrome: a pilot randomized sham-controlled study. Eur J Gastroenterol Hepatol., 2012 Aug; 24(8): 944-9. Scheuchl FG, Treatment of irritable bowel syndrome with osteopathy. Osteopathic Research Web, 01 October 2011.
2 Hundscheid HW et al., Treatment of irritable bowel syndrome with osteopathy: results of a randomized controlled pilot study. J Gastroenterol Hepatol., 2007 Sep;22(9):1394-8. Müller A et al., Osteopathy as a promising short-term strategy for irritable bowel syndrome: randomized controlled trial. Osteopathic Research Web, 01 October 2002
3 Hundscheid HW et al., Treatment of irritable bowel syndrome with osteopathy: results of a randomized controlled pilot study. J Gastroenterol Hepatol., 2007 Sep;22(9):1394-8.
Sorrel Pindar, Osteopath