Yoga Therapy Articles

Can Yoga Therapy help relieve symptoms of IBS?

Irritable bowel syndrome (IBS) is a disorder recognized by abdominal pain or discomfort, gas and altered bowel habit with chronic or recurrent diarrhoea, constipation, or both.

It is estimated that 10-15% of the world population has IBS, from children to people under 50 although anybody can be affected. In general, females are more likely to suffer from symptoms of IBS and the consequences can range from mild, occasional inconvenience to physical, emotional, economic, and social impairment.

The problems is that IBS can be quite unpredictable and it can appear in waves, with some people experiencing sudden bouts of diarrhea in public places, pain in the lower abdomen bad enough to be unable to go to work, and  bloated, gassy intestines that can make any social event embarrassing.

In some cases, constipation can also be a problem that makes life quite hard literally as there is no insight of when the eagle might land.

All these symptoms come 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 needs to be treated with anti-depressants.

ibs diagram
image:istockphoto Irina_Strelnikova

Diagnosis

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 works, 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 because IBS is not actually visible in the gut, as it might be the result from 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”, this is, by 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 Chron’s disease-, intestinal parasites, diverticulitis, and celiac disease. The severity of these illnesses are the reason why doctors will start first testing for them before IBS is considered as a possible diagnosis.

And this 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 diagnosis: 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 how a yoga teacher, yoga therapist or Ayurveda practitioner has suggested a “cleansing” diet, turmeric supplements and even colonic irrigation without referring their student first to have their symptoms checked by a medical professional.

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 now is, what then do we do when a client comes to us with symptoms of irregular bowel, 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, you can refer them to their general practitioner (GP) to make the relevant investigations. This specially applies to those clients who have diagnosed themselves with IBS, as it often happens.

Once they have a secure medical diagnosis of IBS, a yoga therapist can support their treatment with the following:

  1. Check if their doctor has already recommended them to follow a FODMAP diet. If they haven’t, you can introduce them to a local nutritionist specialized 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 on 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 our 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 the life-saving habit that can make all the difference to those times of stress which can trigger IBS.

Avoid forceful breathing practices such as Kapalabhati and Bastrika.

  • Rest and Digest

This is the job of the parasympathetic system, without which we would have slow, gassy digestions or faster than normal  digestions resulting in diarrhea. 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 mouth is going to have a major impact on how we digest.

After lunch, a gentle reclined rest with the upper body elevated for 15-20 mins is enough to allow the parasympathetic mode do its work in the middle of a busy day.

  • Sleep…

Did you know that a good night sleep will also help our internal clock regulate our digestive system? Offer your students a gentle, lying down yoga with slow breathing practice before they go to bed, and not only it will work like magic for letting go of their 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 recognize 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 total 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 with the brain, informing it of when we eat, the state of our gut bacteria, and all of 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 day after. 
  • 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 is not the same to regulate the nervous system of a mother of 4 to a just 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 thigs we like.

  1. Finally, you might have to refer you student to the psychological support your client needs to deal with any instabilities in their life. This is 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 that can appear from early childhood – as those tummy aches before school-, to anytime later in life, with debilitating symptoms.

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 the 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 the feeling of 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, so we -and our bowels- can move effortlessly in harmony with who we really are inside.