April is Irritable Bowel Syndrome Awareness month, another month aimed at raising awareness and understanding in those unaffected by it.
Irritable Bowel Syndrome, or IBS as it’s generally referred to, is common. Very common. In my role as a pharmacist, I must speak to someone at least once every day about diagnosis, how to manage their symptoms or about the current ‘best’ treatment.
What is IBS?
IBS sufferers have a set of symptoms that are not only unpleasant, but can have a really limiting effect on their daily life. Many end up semi-housebound, or at least restricted by the availability of handy toilets while out, or in pain from chronic constipation while others struggle to fit into their clothes when the bloating is at its worst. Some patients fear social outings because their systems seem to react oddly to food or alcohol and the only answer they find is to eat a very limited diet, or even not eat at all outside of their home.
Nearly all of them find that their symptoms are worse in times of stress, or during life changing events such as divorce or marriage, moving house, work worries, or bereavement.
IBS or ‘functional bowel disorder’ (FBD) as it is also known, is defined by doctors as “a variable combination of gastrointestinal symptoms not explained by any structural or biochemical abnormalities”. These symptoms include abdominal pain, associated with changes in bowel habit, distension or bloating, and constipation or diarrhoea. It is a disease of the western, industrialised world, with similar rates worldwide, but lower reported cases in rural areas and the developing world generally.
No one has come up with a satisfactory explanation for how all the IBS symptoms are caused, but it seems to be linked to changes in how quickly and efficiently food passes through the intestines. An ‘over-sensitivity’ to the sensations of intestinal movements may also be to blame in some people, alongside differences in how they perceive ‘pain’ in the gut.
IBS or FBD is generally diagnosed after excluding anything else more worrying such as cancer, coeliac disease, or inflammatory conditions like Crohn’s disease by a battery of embarrassing tests, undignified examinations and indelicate questions about bowel habits. If nothing is picked up during these appointments, consultations with the specialist result in the annoyingly unsatisfactory conclusion that ‘there’s nothing else causing the symptoms so it must be IBS’.
Who can suffer with IBS?
Our general reluctance to discuss our toilet habits makes it difficult to accurately assess the total number of IBS sufferers, but a recent community survey by researchers showed that up to 42% of women and around 30% of men reported the most common symptoms of spasms, pain, bloating, and constipation or diarrhoea. However, only about a quarter of these had actually consulted a doctor (most of those were women, but that’s a subject for another blog!) Those that DO pluck up the courage to talk to their doctor about their bowel problems account for around 40-50% of referrals to hospital gastroenterologists, So, IBS is a huge workload for the NHS.
Once diagnosed, patients are then given either vague or bafflingly restrictive dietary guidelines, and referred back to their GP for management.
Recommendations are necessarily vague because everyone’s IBS symptoms are slightly different and seem to respond to food, especially fibre, in different ways.
Conversely, restrictive diets such as the ‘FODMAP’ regime, are aimed at minimising fermentation within the gut by cutting out certain foods, but can be complicated to follow closely.
How does the NHS treat IBS?
This lack of clear guidance is where it gets frustrating for many patients, particularly because effective treatment choices for the GP are pretty limited.
Pharmaceutically speaking, there is no ‘cure’. Medication is aimed at relieving the symptoms, so patients are often given a bewildering array of different drugs.
- Drugs to treat constipation.
- Drugs that treat diarrhoea.
The drugs that relieve constipation often cause diarrhoea, so a cycle of balancing one drug against the other starts as the drugs that stop the diarrhoea then result in constipation!
Anti-spasmodic drugs may stop painful cramps, but they can cause constipation, requiring another careful balancing act; while laxatives to relieve the constipation frequently cause bloating.
Some doctors will prescribe low doses of antidepressants for their effects in minimising the pain associated with IBS, but since the older drugs can cause diarrhoea or constipation themselves, patients find that the side effects are too troublesome to make them worth taking.
It’s all very confusing!
If all that sounded complicated and confusing, you’re starting to get a picture of the challenges faced by IBS sufferers.
All this confusion leads many patients to become disillusioned with their medicines and go back to the GP, not only in the hope of a better treatment, but also through the nagging fear that ‘something may have been missed’ for the symptoms to remain.
So, it’s easy to see why so many people resort to untested supplements or unregulated herbal treatments that can even make the problem worse.
Most simply end up suffering in silence, modifying their working day, their diet, their social life, and their clothes to cope with their symptoms and worrying about what to do next.
Where does hypnotherapy come in, then?
Interestingly, studies as far back as 1869 noticed that symptoms typical of what we would today call IBS were worse in patients who were anxious, or ‘mentally fatigued’ as they might have said back then. This is equally if not more true today – many patients struggling with their mental health also report IBS-type problems (up to 94% in some studies) and anyone that suffers with IBS knows that their symptoms are always worse in times of stress.
And that’s where hypnotherapy comes in.
Many studies have shown that just reducing stress and anxiety improves IBS, but studies by Professor Whorwell at the Wythenshawe Hospital in Manchester showed that patients treated with hypnotherapy improved even more.
They improved so much, in fact, that up to 95% of patients were symptom-free long after their course of sessions with a hypnotherapist had finished.
Even the hard-to-impress ‘NICE’, the organisation that advises the NHS on best practices, recommends hypnotherapy as an effective treatment for IBS, especially in cases that don’t respond to standard drug treatments.
Unfortunately, it goes on to say that “expertise and facilities may not be available in all regions”, so it’s not widely used to treat patients – but wouldn’t it be great to change that?
The solution focused approach
Solution focused hypnotherapists are experts in reducing stress and anxiety. It’s what we do best. We see many of our hypnotherapy clients, who come to us for help with sleep or anxiety, find that their physical symptoms often improve.
We know that times of stress, anxiety, fear, or excitement have an influence on our intestines, dramatically or with milder flutters, and we know that this is linked to changes in our nervous system as it drives blood away from our guts to focus elsewhere – this stop/start function is probably behind the symptomology of IBS.
By supporting our clients to cope better with stress and anxiety, we can help them to recalibrate this gut response to stress, and relieve the symptoms of IBS. This allows them to move away from relying on complicated medication regimes and to feel more in control of their health, in a lasting way. The hypnotherapy practiced at Professor Whorwell’s clinic was more about visualising good healthy gut movements, and not our solution focused approach; but there’s plenty of evidence from years of our CORP research scores to show that our neuroscience-based work acts very effectively to get clients symptom free in just a few sessions.
The sharper-eyed of you will have noticed my reference to GPs using antidepressants to treat IBS! With our background in looking at the connection and communication between the body and the brain in responding to stress, it’s no surprise to us that this can be effective. But we also know that our work in showing our clients how to naturally increase serotonin and other neurotransmitter levels in the brain underpins this, allowing us to make the most of our innate ability to heal ourselves.
But perhaps the best bit about using solution focused hypnotherapy to improve IBS is that it informs and supports clients to stay well, to be resilient to the effects of stress, and leaves them with a well-developed strategy to cope, not just with IBS but with life when it becomes challenging.