Natural Treatment Approach for Irritable Bowel Syndrome

What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a group of symptoms that affect the gastrointestinal tract. It can be characterized by altered bowel movements (diarrhea, constipation), abdominal pain/cramps related to passing bowel movement, bloating and excessive gas. IBS is a very common condition, with 10-15% of adults in the United States and it’s been found that women are twice as likely to have it than men. To be diagnosed with IBS, the Rome IV Criteria is utilized which uses three different factors to rule in the condition. There are three different types of IBS, each of which depends on the type of bowel movement problems: IBS with constipation, IBS with diarrhea or IBS with mixed bowel habits. Risk factors for developing IBS include family history, food intolerances and mental health conditions such as anxiety or depression. 

What causes Irritable Bowel Syndrome?

The exact cause of IBS is unknown however it’s recognized that IBS is a type of functional gastrointestinal disorder, meaning there is dysregulation in the connection between gut and brain. Recent evidence reflects that IBS is a combination of irritable bowel and irritable brain1. Disrupted signaling between these two can cause nerves in the gut to be overly sensitive to any changes in abdomen (from gas or stool) as well as increased pain perception to normal processes in digestion. Symptoms of IBS can be triggered by certain food triggers as well as managing anxiety/stress. Treatment varies for IBS, as no specific therapy will work for everyone. Typical treatment options include dietary changes (food trigger elimination, increased fluids), increased exercise or medications (anti-diarrheal, tricyclic antidepressants). Alternative options include nutrient therapy, botanical medicine and mindfulness-based training. Specifically, the mind body technique called biofeedback has been found as a particularly useful tool in helping to regulate the nervous system’s response to stress, thus alleviating the effects of stress on the digestive system.

How Stress impacts Irritable Bowel Syndrome

Stress responses are elicited by the central nervous system; examples of responses could be feelings of chest tightness, muscle tension and specifically for the digestive system as abdominal pain, indigestion or bloating. These symptoms as well as consequences of diarrhea and constipation lead to what many people call symptoms of irritable bowel syndrome or IBS. The central nervous system controls most of the functions of the body and consists of the brain and nerves of the spinal cord. This nervous system is classically divided into two parts, the sympathetic and parasympathetic nervous system; new research is coming out that there is a third part called the enteric nervous system, which controls the gastrointestinal tract. The sympathetic nervous system is often referred to as the “fight or flight” response, activated during times of stress. These triggers can come in the form of back-to-back Zoom meetings, Seattle traffic or upcoming deadlines. Changes are made in the body to help you survive a trigger, such as increasing blood flow to organs that are vital (increasing heart rate) and away from organs that aren’t (slowing digestive processes). On the other hand, the parasympathetic nervous system is our “rest and digest” response – this side controls bodily functions when your body is relaxed, resting or eating. These two branches of the central nervous system are responsible for the homeostatic regulation of gut function². 

So how does physiological stress affect the gut? The connection between stress and IBS is seen to originate from the gut-brain axis. The brain (central nervous system) receives constant information from the gut (enteric nervous system), where it formulates a response to the information and sends messages back to the gut to regulate function. The brain makes adjustments to gut function in response to emotions and stress³. Studies have shown that stress has an impact on intestinal sensitivity, motility, secretion and permeability along with alterations in neuro-endocrine-immune pathway¹. When triggered, stress stimulates the HPA (hypothalamic-pituitary-adrenal) axis to release certain hormones called CRF, ACTH and cortisol. The HPA axis, a neuroendocrine system, is responsible for regulating various body processes such as digestion, immune function by release of various hormones; it maintains homeostasis throughout your body to allow for adaptation. The hormones secreted during stress directly and indirectly affect gut function, gut microbiota while stimulating the “fight or flight” response. Additionally, stress alters the quantity of white blood cells in the gut which are involved in immune response against allergens and infections¹. The net effect of these changes can lead to other challenges with irritable bowel syndrome including increased risk of small intestinal bacterial overgrowth or SIBO, or bacterial dysbiosis including candida or yeast overgrowth.

Using Mindfulness with Irritable Bowel Syndrome

Mindfulness based therapies to manage stress and pain is a helpful approach to IBS symptoms because brain-gut interactions are recognized to have an important role in controlling gut function3. Symptoms such as increased pain perception from abdominal distention, selective attention to gastrointestinal sensations and anxiety about sensations are examples of what is targeted during training. A 2011 randomized controlled trial by Gaylord et al. studied 75 women with IBS. They investigated the effects of mindfulness training versus a support group; the results showed a significant reduction in IBS symptom severity for women in the mindfulness groups compared to the other group3.

Irritable Bowel Syndrome treatment with Biofeedback

Biofeedback is a mind-body technique that helps control your physiological response to stress through functional breathing and mindfulness. During a session, different sensors are used as a way to provide feedback of how your body responds to stress. These sensors measure heart rate, blood flow, temperature regulation, muscle tension, respiration and heart rate variability. Heart rate variability (HRV) is a method of measuring the balance/imbalance between the sympathetic and parasympathetic nervous system, by studying the variation in time between each heartbeat. If you’re in a more stressed state, the variation is low between subsequent heartbeats. Lower HRV is a marker for increased illness, depression and mortality. Oppositely, higher variation is found in a relaxed state. A greater variability reflects a healthier balance, which can present as increased resilience to stress or increased cardiovascular fitness⁴. A meta-analysis by Mazurek et al. showed that the majority of studies reported no difference in HRV when IBS populations were compared to healthy controls, however there was differences in HRV if the IBS population was divided into subgroups – severity of symptoms, presence of depressive symptoms. A systematic review and meta-analysis by Sadowski et al. found significant differences in HRV between patients with IBS versus healthy controls with parasympathetic nervous system activity lower in IBS groups6. It would be reasonable to utilize heart rate variability as a tool to observe possible imbalances in the nervous system in patients with IBS, with the goal of increasing HRV through intentional breathing and meditation through mindfulness.