IBS Awareness Month
IBS may not be the sexiest conversation, but let’s have it anyway.
April is IBS Awareness Month. IBS, or irritable bowel syndrome, affects 10-15% of all adults. In the US, that includes between 25-45 million adults, most of whom are assigned female at birth and under the age of 50. Those assigned male at birth and children can be affected as well. Though not a life-threatening illness, it can greatly affect quality of life. Sufferers of IBS miss three times more work due to exacerbated symptoms and is second only to the common cold as the reason to call in sick. Social lives are often affected due to anxiety and social distress caused by fear of a flare up while in public. A healthy sex life may be affected as well because of the imbalance or the extra pressure in the pelvic area, and this physical pain caused by this condition may make sex unappealing or even painful. It takes an IBS sufferer on average about 6.6 years to get a proper diagnosis. Why? IBS is a functional condition - though the pelvic floor muscles can be involved as overactive and underactive - meaning there is nothing physically wrong with the organs of the digestive system, namely the large and small intestines. Rather, “irritable” refers to the nerves of the intestines, affecting control and sensation, with things that naturally stimulate the bowels (eating, menstruating) creating unpleasant side effects. Without it showing up in imaging or lab work, it often goes undetected by doctors, and treatments are often ineffective. Often IBD, or Inflammatory Bowel Disease, as well as celiac disease, are ruled out via a number of diagnostic tests and a diagnosis of IBS is made. Symptoms may vary, from mild to debilitating, and can include painful abdominal cramps, constipation, diarrhea, foul breath, flatulence, and bloating. For severe cases where no other treatment has been effective, medications are sometimes prescribed to treat IBS, including opioids and antidepressants, among others. Unfortunately, most of these medications have side effects that can influence recovery. In addition, some of these medications have bounced between being approved and then removed from the market by the FDA, or have not been tested for long term use.
Theories of Causes of IBS
It is difficult to determine what exactly causes IBS but there are some theories. Those theories seem to be broken further down into triggers. Possible causes include the following:
Altered GI motor activity - People with IBS have an exaggerated gastrocolic reflex, the signal the stomach sends to the colon to stimulate contractions after food intake.
Increased intestinal permeability (leaky gut syndrome) - This is a digestive condition in which bacteria and toxins are able to “leak” through the intestinal wall, though many medical professionals do not recognize this as a real condition.
Altered gut microflora and microbiome - the diversity and stability of gut microbiota may be reduced in those with IBS. This conclusion was made from a study done in March 2020: “It is now evident that microbial factors play key roles in IBS pathophysiology. Acute gastroenteritis following exposure to pathogens can precipitate the development of IBS, and studies have demonstrated changes in the gut microbiome in IBS patients. These changes may explain some of the symptoms of IBS, including visceral hypersensitivity, as gut microbes exert effects on the host immune system and gut barrier function.”
A hypersensitive nervous system - One example of this: serotonin, a neurotransmitter produced in the gut and located inside the enteric nerve cells, may also play a role in the disorder. The GI tract is very sensitive to changes in serotonin levels and it’s possible that low levels may contribute to IBS-associated constipation while high levels contribute to diarrhea.
Then there are the triggers. One such trigger is food, though that is a tricky category to nail down, as everyone reacts differently to different foods. Elimination diets are often recommended in order to find trigger foods that are individual to that person. FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are short-chain carbohydrates {sugars} that the small intestine absorbs poorly) are often thought to be a culprit, as well as alcohol and fats, but again, this varies from person to person. Another trigger is stress. There definitely seems to be a connection to psychological health as many sufferers also have anxiety and depression, though it is hard to determine if unresolved issues from the past - which may lead to this anxiety and depression - are causing the unwanted symptoms, or the other way around. Hormones are yet another trigger. It is common to have a flare right before or after a period, which sometimes confuses the diagnosis for endometriosis or other gynecological issues. Lastly, IBS can be triggered by other illnesses, such as infectious diarrhea or an imbalance of bacteria. It is imperative that anyone suffering from IBS-like issues work with a specialist to rule out more serious conditions.
How is IBS diagnosed?
Diagnoses are made by using what’s called the Rome Criteria, and are based on at least several months of suffering from at least two of the following:
the pain is relieved by defecation,
the pain is associated with an increase or
decrease in bowel movement frequency, and/or
the pain is associated with the bowel movements becoming harder or softer in consistency.
Thankfully, more holistic approaches to treating IBS are being recognized. Among them are physical therapy, which leans towards approaching it from a musculoskeletal and nervous system related disorder. Breathing, gentle stretching and massage techniques targeting the abdomino-pelvic region are often included. One example of something a PT may explore is pudendal neuralgia, or irritation or pain along the distribution of the pudenal nerve, that may result in sensory symptoms in any or all areas it supplies, including the bowels and intestines, and may cause spasms in the muscles. Linking all of the causal elements and triggers together, PTs are able to help their patients to learn to relax, stretch, strengthen their bodies, and stay physically active through a consistent and committed, yet effective, routine. In Amy Stein’s book, Heal Pelvic Pain, an entire chapter is dedicated to “End the Pain” due to a myriad of conditions, including IBS. Also spelled out in the book is the ILU (or I Love U) self-massage, named for the tracing of those letters along your abdomen, and for the love and self-care that you are giving to yourself.
Speaking of letters, we certainly can’t end this blog post without talking about the letters CBD and IBS! As with anything related to CBD moving into the space of healing and wellness, little research has been done regarding the efficacy of it for treating IBS, but there have been some studies. One recent and promising study, from 2020, found this:
“Phytocannabinoids exert potent actions throughout the body. Data reported mainly from preclinical research, but also from the available clinical evidence, have demonstrated their high therapeutic potential to treat the diseased GI tract, from functional to organic pathologies. This not only applies to the well-known psychoactive compound, THC, but also to non-psychoactive molecules like CBD and others which have been more scarcely studied so far.” Adding this to the potential benefits of easing stress and anxiety, CBD products are a promising tool for IBS sufferers to consider adding to their healing kit. Full-spectrum products have been shown to be most effective due to the entourage effect caused by all the terpenes, cannabinoids, and (minimal) THC found naturally in the hemp plant working together synergistically, with tonics, gummies, and other ingestibles being the preferred method of delivery.
Recommended application for IBS, constipation and diarrhea
Apply a generous amount of our Solomon’s seal + arnica + calendula salve to the large intestine and follow the ILU massage. (See below for details on how to perform this massage at home.) Additionally, using our Solomon’s seal + ginger tonic daily may help ease overall inflammation and stress, thus further reducing symptoms associated with IBS.
How to perform the ILU massage at home:
Lie on your back and wedge a couple of pillows under your knees, if desired. Use your hand in the most comfortable way possible - either as a fist, using your fingers, or using the edge of the palm. Begin on the left side of your belly button, just beneath the left rib cage, and massage down toward the pubic bone in a straight line. In other words, draw the letter I from the bottom of your rib cage downward. In doing so, you are massaging your descending colon. Draw the I 10-15 times.
Now for the L, this time on the right side of your belly button, just below your rib cage. Massage from right to left, then down toward the pubic bone across, then down, as in the letter L. This also massages the descending colon, but it massages the transverse colon as well. Do this 10-15 times.
Finally, draw the U. Start to the right of the belly button, but this time begin at the top edge of the pelvic bone and massage up toward the right side of the rib cage, then across to the left, then down to the top of the pelvic bone. Repeat 10-15 times. This adds the ascending colon to the massage.
Massage with moderate firmness - lighter pressure if you have discomfort or diarrhea. You want to feel this massage and make sure you are getting to the soft tissue beneath the skin, but you do not want it to hurt.
End the ILU massage with a post-massage that just circles the belly button and massages the small intestine. Do this clockwise, which is the direction of the small intestine.
Sources:
https://www.physio-pedia.com/Irritable_Bowel_Syndrome
https://pubmed.ncbi.nlm.nih.gov/32026278/
“Heal Pelvic Pain” by Amy Stein, DPT