Irritable bowel syndrome (IBS) is a disorder diagnosed by a collection of symptoms such as abdominal pain or discomfort, bloating, gas and altered bowel habit with chronic or recurrent diarrhoea, constipation, or both.It is estimated that 10-15% of the worlds population has IBS, from children to people under 50, although anybody can be affected. In general, females are more likely to suffer from the symptoms of IBS and the consequences can range from mild, occasional inconvenience to physical, emotional, economic and social impairment.
The problem is that IBS can be quite unpredictable and it can appear in waves. Some people may experience sudden bouts of diarrhoea in public places, pain in the lower abdomen that is severe enough to prevent going to work and bloated, gassy intestines that can make a social event embarrassing. Constipation can bring its own problems and make life uncomfortable and awkward.
All of these symptoms can be accompanied by a general lack of energy, frustration, embarrassment, a sense of secrecy (who would want to share their bowel issues?), anxiety and depression, which is often treated with anti-depressants.
To add even more trouble to the mix, the cause of IBS remains unknown. People suffering from these symptoms can go through years of medical tests from blood work, scans, stool tests to colonoscopies, only to be told that there is absolutely nothing wrong with them.
It is estimated that people with IBS are finally diagnosed after more than 6 years from the onset of their first symptoms. The reason is that IBS is not actually visible in the gut. It could be the result of a disturbance in the way the gut, brain and nervous system interact.
The good news is that regardless of the nasty symptoms, there are actually no changes in the tissues and no abnormal cell behaviour or malignancies, so its diagnosis is done by “elimination” i.e. eliminating other possible health issues that might, in some cases, need more urgent medical attention.
The symptoms of IBS can be similar to those experienced by people with colon cancer, inflammatory bowel disease (including Crohn’s disease), intestinal parasites, diverticulitis and coeliac disease. The severity of these illnesses is the reason why doctors will start testing for these first, before IBS is considered as a possible diagnosis. This is also a major reason why we should never self-diagnose or diagnose others with Irritable Bowel Syndrome.
The Yoga Therapy perspective
Yoga Therapists have a very simple scope of practice when it comes to making diagnoses: we don’t make them.
It is reasonable to imagine how one might be tempted to consider IBS when a client with a nervous disposition and high levels of stress tells you that their bowel is all over the place.
I have seen and heard, far too many times, a yoga teacher, Yoga Therapist or Ayurveda practitioner suggesting a “cleansing” diet, turmeric supplements and even colonic irrigation without referring their student to have their symptoms checked by a medical professional, first. Suggesting such methods, without a previous medical diagnosis, can be dangerous to your client or student’s health, and it can delay the discovery of a potentially life-threatening illness that needs urgent treatment.
What can we do?
The question you might be asking yourself is: What do we do when a client comes to us with symptoms of an irregular bowel or a painful and bloated belly?
First of all, find out if they have seen their doctor and which tests have been carried out. If they haven’t seen a doctor, you can refer them to their general practitioner (GP) to investigate further. This applies, particularly, to those clients who have diagnosed themselves with IBS, as often happens.
Once they have a secure medical diagnosis of IBS, a Yoga Therapist can support their treatment in the following way:
- Check if their doctor has already recommended that they follow a FODMAP diet. If they haven’t, you can introduce them to a local nutritionist specialised in this kind of diet for relief of their symptoms.
One of the most reliable sources and specialists in this field is the Monash University in Melbourne, Australia (https://www.monashfodmap.com). It is worth checking it out to find out more about IBS and how some foods can support symptom prevention and management. Always ask your student to check with their doctor before changing their diet.
- Get vertical!
If there are no other contraindications, standing practices such as Qi-Gong and Standing Yoga Asanas, with their adapted modifications, can help relieve gas, constipation and prevent painful cramps.
Ask your student to invest in a standing desk as this can make a huge difference to their work-related IBS episodes.
- Get moving!
An article published in the World Journal of Gastroenterology cited how “an increase in physical activity has positive long-term effects on IBS symptoms and psychological symptoms”.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4294172/)
Specifically recommended are walking, cycling and aerobic exercise such as swimming, all of them low cost and easy to introduce in a client’s lifestyle. Yoga Therapy sessions can also be made more active! (See contraindications below).
- Avoid compression of the belly and long sitting practices.
The best for IBS is standing and lying down practices – either on the back or on the side – involving opening of the abdominal area. Dynamic movements with the breath and dancing-like movements are another way to encourage natural peristalsis and bring on a sense of well-being.
- Get breathing!
As we often say, yoga is not yoga without the breath and since IBS is an issue related to the nervous system, breathing appears to be the most direct way to help regulate the nerves. Teaching your students “low-in-the-belly, slow breathing through the nose” -with gentle inhalations and slightly longer exhalations – will be a life-saving habit that can prevent stress triggering IBS. Avoid forceful breathing practices such as Kapalabhati and Bastrika.
- Rest and Digest.
This is the job of the parasympathetic nervous system, without which we would have slow, gassy digestion or faster than normal digestion, resulting in diarrhoea. Introduce gentle guided meditations such as Yoga Nidra to your students, either during class or pre-recorded, so they can listen to them at home. One recommendation that is often overlooked is to practice relaxation before eating! The stomach has to relax and stretch in order to receive the food we eat, so the state of our nerves, before we take the spoon to our mouths, is going to have a major impact on how we digest what we eat. After lunch, a gentle reclined rest with the upper body elevated for 15-20 minutes is enough to allow the parasympathetic mode do its work, in the middle of a busy day.
Did you know that a good nights sleep will also help our body’s internal clock regulate our digestive system? Offer your students a gentle, lying down yoga practice with slow breathing before they go to bed. Not only will it work like magic for letting go of the day but it will also encourage the emptying of the bowels in the morning.
- “Regular life, regular bowel.”
Having worked with clients suffering from IBS for many years, I have come to recognise a very important common pattern: the lack of regularity. When we talk about irregular, irritable, all-over-the-place bowels, we are describing irregular, irritable, all-over-the-place lives. Irregular hours of work, skipping meals, broken sleep, unstable relationships, absence of planning, fear and stress are a recipe for disaster for a digestive system that requires predictability and regularity.
The functioning of our gastrointestinal tract is governed by its own intrinsic network of nerves: the enteric nervous system. This nervous system has a direct line to the brain, informing it when we eat, the state of our gut bacteria and all the ins and outs of our whole gastrointestinal tract. It is deeply connected with our circadian rhythm, in the way that it works within regular patterns in our 24 hour clock, and like any other nervous system, it is negatively affected by stress. Introducing regular patterns, in harmony with our circadian rhythm, is a good start and can positively affect symptoms of IBS.
Here is an example of a schedule that I introduced to one of my students with IBS:
- Wake up at the same time every day
- 30 mins of Standing Yoga Practices or Qi Gong
- Eat breakfast at the same time every day
- 1st Working part of the day: stand and move as much as possible
- 15 mins rest before lunch, either short walk in nature or lying down in silence/relaxing music
- Eat lunch at the same time every day
- 15-20 mins rest after lunch with the upper part of body elevated. Yoga Nidra, a short nap or reading a relaxing book or listening to a podcast (avoid the news or anything stressful)
- 2nd Working part of the day: stand and move as much as possible
- 15-20 min walk in nature before dinner
- Dinner at the same time of the day
- 15-20 mins walk after dinner
- End the day: clear the kitchen, tidy up, write your schedule for tomorrow, prepare your clothes or anything for the next day
- Gentle Yoga practice before bedtime
- Write your 5 gratitude list
- Go to bed at the same time every day
You can adapt the schedule to your client’s life, as it will not be the same to regulate the nervous system of a mother of 4 to a retired 65 year old, for instance. Either way it is vital to introduce the idea – and the practice – of regular times, meals, exercise, wake up and bedtime.
Some people might see these schedules as limiting or hard to implement, but they are worth doing! As life becomes more regulated, so do bowel movements and intestinal motility, which means that we are actually more free to do the things we like.
Finally, you might have to refer you student for psychological support to deal with any instabilities in their life. This will be the case when there are any signs of trauma, conflictive relationships and family issues which can affect your client’s health, and which should be addressed by the relevant specialist.
A reflection of our world
IBS is a non-life threatening yet complex health issue, with debilitating symptoms, that can appear from early childhood, with tummy aches before school, to anytime later in life.
In a way, IBS reflects how the majority of us live our lives: in a hurry, without paying attention to what we do in our day, pulled like puppets by forces outside of ourselves, in what could be described as feeling ‘out of control’.
Interestingly, some really successful forms of hypnotherapy for IBS, practiced in the UK, involve relaxation techniques combined with the concept of taking control, inducing self-awareness and self-regulation of our physical and emotional reactions.
This approach is an essential part of managing the symptoms of IBS. By taking control of our own lives and bringing conscious awareness of our daily actions, we – and our bowels – can move effortlessly in harmony with who we really are within.