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IBS: Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a condition characterised by a mixture of symptoms which are believed to be due to a disorder of intestinal motor function. It is the commonest condition seen by gastroenterologists. The normal gut moves contents along the gut through muscular contractions (propulsion), but also has areas of hold-up (segmentation). The combination of propulsion and segmentation is called peristalsis, and when it is working normally, one is completely unaware of it. The control of peristalsis is complex and the best way to regard irritable bowel is as a loss of co-ordination of these muscular contractions. In addition, there is evidence that patients with irritable bowel syndrome have increased sensitivity to stimuli arising within the gut.
In addition to the intestinal symptoms, psychological factors are commonly involved. This is not to say that the symptoms are not real (they are), but irritable bowel syndrome is often the outcome of a complex interaction between psychological and physical factors.
The disorder of gut function can affect the gut anywhere from the mouth to the anus, which accounts for the diversity of symptoms seen in this condition.
Some old-fashioned names for irritable bowel syndrome are still in common usage. These include irritable colon, spastic colon and mucous colitis. These are misleading since, as indicated above, the condition not only affects the colon, but also the remainder of the gut.
Although irritable bowel syndrome can be a distressing condition with many unpleasant symptoms, it never causes bowel cancer or other damage to the bowel.
In the UK about 13 per cent of women and 5 per cent of men suffer from IBS.
What causes irritable bowel syndrome?
Although the cause is unknown, about half of all patients will date the onset of their symptoms to a major life event such as change of house or job, or bereavement. This suggests that there may be a psychological trigger in susceptible patients. Approximately 10 to 20 per cent of patients will date the onset of their symptoms to an acute gastroenteritis. In the remainder, the trigger factor remains unidentified.
The abnormalities in peristalsis mentioned above can often be seen in close relatives of patients (although without symptoms), suggesting that a trigger sets off the condition in susceptible people. Nerve-signalling chemicals, particularly serotonin, appear to have an important role.
What are the symptoms of irritable bowel syndrome?
The symptoms vary from patient to patient, and may occur at any age. However, they most commonly start in late teenage years or early adulthood. The symptoms will depend on which parts of the gut are involved and there is often overlap between areas of the gut. Some patients may have only one part of the gut involved, while others have several. Moreover, the symptoms may vary over time.
Oesophagus
- A sensation like a golf ball in the throat between meals which does not interfere with swallowing (globus).
- Heartburn - burning pain often felt behind the breastbone.
- Painful swallowing (odynophagia), but without hold-up of food.
- Sticking of food (dysphagia) - this requires investigation.
Stomach
- Non-ulcer dyspepsia (symptoms suggestive of a stomach or duodenal ulcer, but which has not been confirmed on investigation).
- Feeling full after small meals. This may reach the stage of not being able to finish a meal.
- Abdominal bloating after meals.
Small bowel
- Increased gurgling noises which may be loud enough to cause social embarrassment (borborygmi).
- Abdominal bloating which may be so severe that women describe themselves as looking pregnant.
- Generalised abdominal tenderness associated with bloating.
- Abdominal bloating of both types usually subsides overnight and returns the following day.
Large bowel
- Abdominal bloating of both types usually subsides overnight and returns the following day.
- Right-sided abdominal pain, either low, or tucked up under the right ribs. Does not always get better on opening the bowels.
- Pain tucked up under the left ribs (splenic flexure syndrome). When the pain is bad, it may enter the left armpit.
- Variable and erratic bowel habits alternating from constipation to diarrhoea.
- Increased gastro-colic reflex. This is an awakening of the childhood reflex where food in the stomach stimulates colonic activity, resulting in the need to open the bowels.
- Severe, short stabbing pains in the rectum, called proctalgia fugax.
Other organs
- Headaches are common.
- In women, left-sided abdominal pain on sexual intercourse is not uncommon.
- Increased frequency of passing urine is common.
- Fatigue and tiredness are very common.
- Sleep disturbance is also frequent.
- Loss of appetite is common, as is nausea.
- Features of depression occur in about one third of patients.
- Anxiety and stress-related symptoms are common and may interact with the gut symptoms.
Research: Whorwell, P. J., Prior, A. and Colgan, S. M. (1987). Hypnotherapy in severe irritable bowel syndrome: Further experience. Gut. 28(4). 423-425.
Patients below the age of 50 with classical irritable bowel syndrome exhibited a 100% response rate. This study confirms the successful effect of hypnotherapy in a larger series of patients with irritable bowel syndrome and defines some subgroup variations.
Whorwell, P. J., Prior, A. and Faragher, E. B. (1984). Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet. 2(8414). 1232-1243.
The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the three-month follow-up period, and no substitution symptoms were observed.
Research: Harvey, R. F., Hinton, R. A., Gunary, R. M. and Barry, R. E. (1989).
Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet. 1(8635). 424-425. Thirty-three patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over seven weeks. Twenty improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for three months without further formal treatment.
Research: Abela, M. B. (1999). Hypnotherapy for Crohn's disease: a promising complementary/alternative therapy. Integrative Medicine. 2(2/3). 127-31.
Abstract: Crohn's disease is a nonspecific chronic syndrome of unknown origin for which, to date, no conventional (i. e., medical or surgical) cure exists. However, recent clinical case studies and anecdotal reports have shown that the use of different forms of hypnotherapy for the treatment of Crohn's have actually resulted in cures. This report reviews and compares the effectiveness of hypnotherapy in the treatment of Crohn's disease vis-a-vis current medical and surgical therapies, in addition to reviewing evidence of the modulation of immune function parameters by hypnosis, while providing support for current etiological hypotheses of Crohn's disease as an autoimmune disorder.
Research: THE IMPACT OF GUT DIRECTED HYPNOTHERAPY UPON HEALTH RELATED QUALITY OF LIFE IN PATIENTS SUFFERING FROM IRRITABLE BOWEL SYNDROME
G.D. Smith, K.R. Palmer. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
Introduction: Health related quality of life (HRQoL) is impaired in patients suffering from irritable bowel syndrome (IBS), but measurement of this remains poorly quantified. The treatment of severe IBS is often unsuccessful, although gut directed hypnotherapy has been shown to improve IBS symptoms but its effect upon HRQoL status has not been defined.
Aim: In this study we have defined the impact of gut directed hypnotherapy upon HRQoL status in IBS patients. http://gut.bmjjournals.com/cgi/content/full/50/suppl_2/a1
Methods: Seventy five patients (55 females; median age 37.1) with a diagnosis of IBS (consistent with Rome II diagnostic criteria) underwent gut directed hypnotherapy. The predominant symptoms were abdominal pain in 46 patients (61%), altered bowel habit in 24 (32.5%) and abdominal bloating in 5 (6.5%). Physical symptoms were prospectively recorded using seven day diary cards. Outcome measures were Hospital Anxiety and Depression Scales (HAD-A & HAD-D) and a IBS disease specific quality of life tool (IBSQoL). Measurements were taken at baseline (pre-treatment ) and at three months (post-treatment). Pre and post treatment scores were coded and compared using Wilcoxon signed ranks test.
Results: There were statistical improvements in all domains of the IBSQoL (emotional health, mental health, physical health, sleep, energy, diet, social role and physical role) after treatment. Improvements were most marked in female patients, particularly those with predominant abdominal pain. Significant improvements were seen for both males and females for anxiety and HAD-A / HAD-D.
Summary/Conclusion: Gut directed hypnotherapy has a very positive impact upon psychological well being and HRQoL in IBS. This appears most effective in patients with a predominant symptom of abdominal pain and bloating. A randomised controlled study of hypnotherapy is recommended in IBS.
Hypnosis home treatment for irritable bowel syndrome: a pilot study
Palsson, Olafur S; Turner, Marsha J; Whitehead, William E. January 2006 The International Journal Of Clinical And Experimental Hypnosis 54 (1): 85-99
DESIGN: Pilot controlled study with 6 months follow-up
SUBJECTS: 19 IBS patients
OBJECTIVE: To assess whether self-hypnosis home treatment can improve symptoms with IBS patients.
INTERVENTIONS: A 3-month home-treatment version of a scripted self-hypnosis protocol.
RESULTS: Ten of the hypnosis subjects (53%) responded to treatment by 3-month follow-up (response defined as more than 50% reduction in IBS severity) vs. 15 (26%) of controls. Hypnosis subjects improved more in quality of life scores compared to controls. Hypnosis responders remained improved at 6-month follow-up.
CONCLUSIONS: Although response rate was lower than previously observed in therapist-delivered treatment, hypnosis home treatment may double the proportion of IBS patients improving significantly across 6 months.
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