Symptoms of Irritable Bowel Syndrome (IBS) include pain in the lower abdomen (below the stomach area), changes in bowel habits with frequent, urgent diarrhea or constipation, bloating, and cramping. It is a medical disorder of the lower ‘gut’ (the stomach and intestines), which is one part of the gastrointestinal (GI) tract. It is thought to occur because of communication problems between the brain and the gut. Research suggests that people with IBS experience abnormal gut motility (changes in the rate of contractions of the gut muscles) and enhanced visceral sensitivity (an increased sensitivity in the brain to normal and painful gut activity such as painful swelling in the gut). It is not clearly understood what causes IBS. For some people it begins in childhood with a ‘sensitive stomach’ that develops into more intense symptoms in adulthood; while for others, the GI problems start suddenly during a period of stress or persist after a parasitic infection in the stomach or bowel.

Irritable Bowel Syndrome is very common. It is estimated to affect up to one in five Canadians, and occurs much more frequently in women than men. The impact on the individual and on society is significant. Life with IBS can be quite miserable. The pain, cramping and urgent trips to the washroom disrupt work and home activities. The bloating and gas are embarrassing so people often suffer in silence. IBS is the second most common reason for workplace absences. Over one-third of the patients that are seen by gastroenterologists (the ‘gut’ specialists) have Irritable Bowel Syndrome. In Canada, IBS has been estimated to cost about $352 million in direct and over $1 billion in indirect health care costs each year.

While many people think certain foods must be the culprit, there is no evidence to support the idea that IBS is a food allergy or food sensitivity type of disorder. Once IBS develops, however, the bowel is over-reactive to or easily triggered by a variety of things including diet, stress, emotional state, and even hormone fluctuations. Stress does not cause IBS, but it does appear to play a particularly important role in triggering IBS symptoms, likely because of the close communication via nerves and chemical pathways between the brain and the gut. In fact, two-thirds of healthy individuals without IBS report GI symptoms of pain or bowel upset in response to stress, and the numbers are even higher for people with IBS. Research suggests that both ‘acute stressors’ such as deadlines, exams, job interviews, or conflict with others as well as ‘chronic stressors’ such as financial concerns, time pressures, or family issues can aggravate the gut.

Can Psychology Help?

Absolutely. For those with milder IBS symptoms, use of over-the-counter medications and changes in lifestyle that ensure more regular eating and sleep routines, a healthier diet with increased fibre and water intake, as well as more regular aerobic exercise are usually sufficient to provide some relief. However, for those with moderate to severe symptoms, psychological and medical interventions are recommended. Treatments usually target specific symptoms (such as the diarrhea) or aim to decrease the triggers (for example, stress) that exacerbate the symptoms.

Conventional medical treatment has included fibre supplements, antispasmodics, gut motility agents, and medications that act on biochemicals in the GI tract and central nervous system. At this point, reviews of the effectiveness of the medication treatments have concluded that they are helpful for small subsets of people with IBS, but have been disappointing overall in their impact. For the most up-to-date information on medication treatments as they apply to your situation, you are encouraged to discuss the use of these medications with your family doctor.

Several specific psychological treatments have been found to be effective in providing relief of IBS symptoms as well as reducing the distress and coping difficulties that often occur when dealing with a chronic illness. These psychological therapies focus on ways to decrease stress and cope differently so that the stress doesn’t ‘go to the gut’.

What Psychological Treatments are Effective?

Four approaches have been carefully evaluated over the past number of years and have been found to be of benefit. These treatments are provided by professionals trained in psychological interventions for health problems.

Relaxation training teaches ways to relax the body and mind.

Cognitive Behavioral Therapy (CBT) incorporates a number of steps aimed at changing behavior to improve health and coping. It often includes information to ensure a better understanding of the illness, as well as teaching techniques to change thought patterns by challenging automatic, distressing and self-defeating thoughts that can trigger gut reactions. CBT also typically includes relaxation training.

Hypnotherapy uses mental imagery to specifically reduce gut sensations and foster a state of calmness.

Brief Dynamic Therapy focuses on significant personal relationships. In therapy, the individual is helped to identify and deal with challenging interpersonal situations and interpersonal stressors.

Evaluation studies have typically shown that psychological treatment led to greater improvement than the usual medical treatment. As well, the psychological therapies have long lasting effects months to years after treatment was completed. Medication treatments, in contrast, tend to cease to have an effect when patients stop taking the medicine. Up to 70-80% of people with IBS have reported significant improvements following psychological treatments. Recent research suggested that the amount of improvement relates in part to the effort and time the individual puts in to develop better ways of coping.

For more information about irritable bowel syndrome or similar gastrointestinal disorders:

Irritable Bowel Syndrome and the Mind-Body Brain-Gut Connection. (1997) W. Salt Parkview Publishing

Or contact:

International Foundation for Functional Gastrointestinal Disorders (414)964-1799 or write IFFGD, PO Box 17864 Milwaukee WI 53217.