The gut has its own complex nervous system ( the enteric nervous system), which links through to the sympathetic nervous system (as well as the rest of the nervous system). When you become anxious, stress hormones are released into your body, and these can be picked up by the gut. These can cause the colon to spasm, instead of calmly working on your digestion. You already know that your gut responds to your mood – such as butterflies in your tummy. We talk about feeling things “in my gut”, having a “gut response”. And in Japanese culture, the gut was the location of the soul, thus when commiting ritual suicide, the warrior cut his belly open. The expression “ hara ga suwaru” – literally “the gut is settled” – means to be calm and without anxiety. Once the nerves of the gut have made the link with the stress hormones, the colon becomes sensitised and responds quickly and intensely. And we are generally very sensitive to stress, and we associate these painful IBS symptoms with suffering. Hypnotherapy can help because it is tried and tested for controlling stress. With hypnotherapy you can learn to calm down quickly when you feel the onset of stress, and also learn how to change your personal circumstances to reduce your overall risk of stress.
Dr Mark Porter on BBC Radio 4’s Case Notes, presented a really good programme about Constipation. The programme suggested that the main reasons for constipation are: - diet low in fibre such as fruit and veg
- IBS
- sluggish bowel with slow transit,
- those who have trouble emptying their rectum even if the rest of the gut is working well
- neurological problems – pelvic surgery or back injuries for example
The programme reminded us that there is a close link between the gut and brain. For example, they said, the rectum sends a message to the brain to say that you are ready to empty your bowel, and also to tell you the consistency of the poo, and whether it is just wind. The urge is strong in the morning, because the bowel switches off at night and gets woken up by the brain in the morning. The bowel contracts after eating a meal and so the sensation of urge can be strongest after a meal. The rectum is very sensitive to being stretched and this stretch makes us feel the urge sensation. We learn to respond to this urge by going to the loo – this is what potty training is. The programme recommended the best way to go to the loo. Crouching, as the French did on their old-fashioned outdoor loos is the goal - like babies sitting on potties. You can mimic this by putting a child’s loo step or a pile of books in front of the loo and put your feet on there. Your knees are high up by your waist. Lean forward and rest your elbows on your knees. Rather than straining from your shoulders and going red in the face, we need to be relaxed. Take a nice relaxed deep breath in, then a deep breath out pushing your belly out and bigger, to open the general abominal area. Relax our muscles in the pelvic floor. Consciously relax the anal sphincter. This opens all those low down muscles. One interesting technique which I learned with having babies, is to open your mouthIt is a technique to learn and practice. If we don’t recognise the urge sensations or we leave it too long, the squeeze muscles in the bowel can become too limp and weak to expel stool from the rectum. Persistent strainers might end up with a swollen bowel lining and this gives a feeling of a need to go to the loo, which can result in further straining and long-term damage to the rectum. The programme discussed different sorts of laxative. There has not been a lot of research on which type is best for which sort of constipation but this is what the programme suggested. - bulking agents such as psyllium husk, for runny stools
- stool softeners make the stool moist and make it easier to pass the stool. These are currently being advertised on the telly.
- osmotic laxatives for hard stools. They retain fluid inside the colon to make the stool mushy – Milk of Magnesia and lactulose are well known and there is a new one, Movicol.
- Stimulant laxatives – use for slow transit constipation or for codeine induced constipation – sennakot for example. These should not be used on a regular basis as they would damage your gut and upset your potassium balance.
This is not a subject much talked about, but very important. I applaud them for dealing with this tricky subject.
Dr Emeran Mayer in the New England Journal of Medicine reported a case study of a woman with IBS who worried that she might soil her clothes when she went out, so spent a long time in the bathroom, and felt anxious and fatiqued as a result of the things she felt she needed to do to ensure her safety. Anxiety and stress can trigger bouts of IBS so working on these worries can be very beneficial.
His report shows that getting a doctor's diagnosis of IBS is very helpful to be sure that there is no underlying disease. Once you have that diagnosis, then you know that there is no physical damage.
In these circumstances, hypnosis and cognitive behavioural therapy have been shown to work, starting on the anxiety and the worries so that you start to feel that you are in control once again. If you have been avoiding going out for fears of embarrassment as a result of IBS, then cognitive behavioural hypnotherapy is well worth a try.
Tried, tested, and successful. Recommended by NICE.
IBS is the most common gastrointestinal diagnosis. The symptoms of irritable bowel syndrome are similar to those of small intestinal bacterial overgrowth. A study by Dr Mark Pimentel and colleagues set out to see whether overgrowth is associated with irritable bowel syndrome and whether treatment of overgrowth reduces patient's intestinal complaints. They found that after treatment with antibiotics, half of IBS sufferers from both IBS and overgrowth, the IBS symptoms disappeared. The overgrowth test can be done in doctors' surgeries.
Two bits of recent research show that a bout of food poisoning is a major independent risk factor for developing IBS. Spanish researchers Luis A García Rodríguez and Ana Ruigómez found that in the general population the rate of classic IBS (as determined by the modified Rome criteria) was 0.3% and in those who had suffered gastroenteritis, the rate was much higher at 4.4%. This is about the same as the rate of 7% found by Keith R Neal, John Hebden and Robin Spiller of the Department of Gastroenterology Queens Medical Centre Nottingham. They also found that 25% had some digestive problems 6 months on. If you get a serious gastric infection, be sure to get it properly treated by your GP.
IBS is one of the causes of bloating. But it can also be caused by insufficient bile, so that fats are not properly digested. Or if you are eating new foods, your body has not developed sufficient enzymes to digest these newcomers, so the food hangs around in the gut for overlong and gases develop. You may have tried probiotics. But according to the Glenn Gibson, professor of microbiology at Reading University, nearly 50 per cent of the probiotic yoghurts, powders and capsules sold in their millions every year simply do not have the minimum of 10 million bacteria per dose necessary to have any impact on our digestive systems.
Hypnotherapy was recommended by NICE in 2008 for chronic cases of irritable bowel syndrome. Click here for NICE guidelines
Dr Peter Whorwell of Manchester University Medical School is the leading expert in the treatment of IBS with hypnotherapy. Click here for more. Dr Wendy Gonalkorale is a researcher working with Dr Whorwell. Read about her research here.
Although no-one really knows the cause of irritable bowel syndrome, the methods developed by Dr Whorwell have been shown to improve the symptoms with over 70% success. Dr Whorwell explains that IBS is ideal for treatment with hypnosis. "During hypnotherapy, sufferers learn how to influence and gain control of their gut function, and then seem able to change the way the brain modulates their gut activity. We have found it to help all the symptoms, whereas some of the drugs available reduce only a few". As you will know, IBS is called a functional disorder because it is the function of the gut which is impaired rather than the tissue itself. Often in trying to work out the cause of IBS , invasive investigations are carried out which can cause permanent structural damage. Hypnosis is a non-invasive treatment, and it has a successful track record. Here is a useful IBS factsheet
The brain areas of interest in IBS also light up for stress. Researchers have discovered that with IBS, the Anterior Cingulate Cortex (ACC) responds to distension of the rectum (this is the bit they were researching, but it is suggestive that it might also apply to other parts of the gut). The ACC is also the area which responds to anxiety, stressful life events and failures to cope properly. These research findings support observations that there are connections between psychological distress and IBS, along with a greater sensitivity to pain. This is one of the reasons perhaps that hypnosis works so well. Hypnosis is a powerful treatment for all forms of anxiety. I shall write more shortly about work done on the brain-gut link.
 Our inside bits where IBS happens are well-hidden, so it is worth just checking where they all are.The stomach (the size of your fist – really quite small!) is higher up than you might imagine!This excellent review of our insides is from the Canadian Society of Intestinal Research.Intestinal AnatomyTo understand IBS better, a basic explanation of the gastrointestinal (GI) tract is essential. The upper part of the GI tract includes the mouth, esophagus, stomach, and duodenum. Other vital components are the liver, gallbladder, pancreas, and spleen. The lower part of the digestive tract consists of two main parts, the small bowel/intestine (about 6 metres in length), and the large bowel/intestine or colon (about 1.25 metres). The upper portion of the small bowel is the duodenum and jejunum and the lower is the ileum. The colon follows the small intestine and consists of various segments, starting at the cecum and ending in the rectum and anus. (See diagram.)Digestion begins in the mouth with chewing and mixing with saliva. Further “food processing” is continued in the stomach; however, it is the small intestine’s principal function to absorb dietary nutrients, including proteins, carbohydrates, fats, vitamins, and minerals. Bacteria (the healthy bacteria we hear about on the ads) residing primarily in the colon aid the digestive process, while the colon extracts water. The small and large intestines work together in concert with the liver, gall bladder, and pancreas to break down complex foods and to extract the right amount of each nutrient.The intestine has a thin inner lining, the mucosa, with a surrounding submucosa, where the blood vessels and lymph channels run. Around this is a thick muscular wall, covered by a thin membrane called the serosa. When food enters the esophagus, ring-like smooth muscle contractions intricately timed with nearby muscle relaxations in a process called peristalsis, propel food along the digestive tract. Long muscles farther along in the digestive tract contract differently, helping to mix food with the enzymes produced in the gut, whose role is to break the tiny particles of food into even smaller molecules (and there are enzymes throughout the gut, including in saliva – for more on enzymes click here), further processing and propelling meal contents and promoting the passage of waste. Although most individuals are aware of intestinal movement only through having bowel movements, movement occurs constantly and is particularly prominent after meals. Ordinarily, a meal passes through the digestive tract in 24 to 40 hours but this transit time varies greatly from person to person, often depending on dietary intake composition and quantity.
If you want to bone up on the enteric nervous system, the system controlling all the goings on in your gut, then this is the place. The nervous system in your gut is almost as complex as your brain. Amazingly the gut can (if necessary) work on its own, without any connections to your brain. Because is so similar in terms of structure, we are sometimes offered anti-depressants to deal with the symptoms of IBS. That also may be why hypnotherapy is so useful.
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