Hypnotherapy and other treatments for Irritable Bowel Syndrome (IBS)

As a pharmacist I used to see many people coming into the pharmacy buying laxatives or diarrhoea treatments week in and week out. When I spoke to them about why they needed the medicines they invariably said they had been told they has IBS and this is what the doctor had recommended.

One woman in her early 30’s particularly stood out to me.  She had suffered for many years with the misery and discomfort of IBS.  It had ruined her exams at school and her whole life seemed to be governed by what was happening with her gut. 

About a year after I had stopped working in that pharmacy, she had heard I was now practising as a hypnotherapist and came to see me to see if she could use hypnotherapy for IBS.  As soon as we started working together there was a clear improvement in her condition.  With a mixture of relaxation and learning self-hypnosis she was able to feel much more free to do the things she wanted to do. Although the IBS appeared now and again, within 6 months she reported that she had this under control.  

Not everyone I treated for this condition had such dramatic results but all reported feeling a greater sense of control and were more relaxed about going out in public.

So what is Irritable Bowel Syndrome (IBS)?

IBS is a common gastrointestinal disorder that affects the large intestine, leading to symptoms such as abdominal pain, bloating, diarrhoea, and constipation.

Nearly 20% of people will suffer at some stage in their lives. It is more common in women and people between 20 and 30 years.

The exact cause of IBS is not clear but there seems to be a combination of gut-brain interactions, altered gut movement, and increased gut sensitivity.

Different people experience IBS in different ways so managing it often requires a tailored approach that addresses both the physical and psychological aspects of the condition.

Some of the potential treatments are shown below – for more detailed information see the NHS website https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/

1. Dietary Modifications

The first type of treatment will probably involve dietary modification such as the Low FODMAP Diet: This is a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) which can significantly reduce symptoms in many individuals with IBS. These are carbohydrates that are poorly absorbed in the gut, leading to wind and bloating.

Fibre Adjustments: Soluble fibre, such as psyllium, can help regulate bowel movements and alleviate symptoms. However, you do need to pick the right fibre because insoluble fibre, like wheat bran, may worsen symptoms in some individuals.

2. Medications

·       Antispasmodics: Drugs like hyoscine (buscopan®) or peppermint oil (Colpermin®) capsules can reduce abdominal cramping by relaxing the muscles in the gut.

·       Laxatives and Anti-Diarrhoeal Agents: If the constipation element is the most troublesome, osmotic laxatives like polyethylene glycol are often recommended. These increase the amount of water in the faeces making it easier to pass.

If diarrhoea is the main problem, something to slow the gut down might be used for example loperamide.(Imodium®). 

·       Gut-Targeted Antibiotics: In some cases antibiotics may be used to reduce symptoms for patients suffering bloating due to overgrowth of bacteria in the small intestine.

·       Antidepressant drugs: Medications such as citalopram or amitriptyline, may help counteract the effect of serotoinin in the gut.  

3. Psychological Interventions

Cognitive Behavioural Therapies: Various Cognitive behavioural approaches have shown effectiveness in helping individuals with IBS manage their symptoms by addressing negative thought patterns and stress, which can exacerbate symptoms.

Hypnotherapy: Gut-directed hypnotherapy has gained recognition as a particularly effective treatment for IBS. This approach may involve guided relaxation and suggestion to improve gut function and alleviate symptoms. A systematic review published in the journal Clinical Gastroenterology and Hepatology (2015) found hypnotherapy to be beneficial for long-term symptom relief in IBS patients, with some studies reporting sustained improvements for up to five years.Hypnotherapy really works as an option for IBS because it addresses the gut-brain connection directly. This therapy typically involves:

• Deep Relaxation: Helping patients achieve a calm state, which can reduce gut hypersensitivity.

• Positive Suggestions: Reframing how the brain perceives gut discomfort and improving overall gut function.

• Visualization: Encouraging patients to imagine their digestive system functioning smoothly.

A randomized controlled trial published in The American Journal of Gastroenterology (2016) demonstrated that gut-directed hypnotherapy significantly reduced IBS symptoms and improved quality of life compared to standard medical care.

When combined with the thought changing Cognitive Behavioural techniques the effectiveness may be increased.

4. Lifestyle and Behavioural Changes

Stress Management: Stress is a significant trigger for IBS symptoms. Practices such as self-hypnosis, yoga, mindfulness meditation, and deep-breathing exercises can reduce stress and improve overall well-being.

Regular Exercise: Physical activity can enhance gut motility and reduce stress levels, contributing to symptom relief.

5. Probiotics and Prebiotics

Certain probiotics, such as Bifidobacterium and Lactobacillus species, have shown promise in alleviating symptoms of IBS. They work by balancing the gut microbiome and reducing inflammation.

6. Alternative and Complementary Therapies

Acupuncture: While the evidence is mixed, some studies suggest that acupuncture may help alleviate IBS symptoms by modulating pain perception and stress.

Herbal Remedies: Peppermint oil, as an antispasmodic, has been widely studied and shown to reduce abdominal pain and bloating in IBS patients. It is often used in conventional medicine for this purpose.

Conclusion

IBS is a complex condition that often evades effective treatment , but Cognitive Behavioural Hypnotherapy approaches may prove to give relief where other methods have fallen short.

References

1. Ford, A. C., et al. "Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis." BMJ (2008).

2. Palsson, O. S., et al. "Hypnosis treatment for gastrointestinal disorders: A comprehensive review of the empirical evidence." The American Journal of Clinical Hypnosis (2015).

3. Moayyedi, P., et al. "The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review." Gut (2010).

4. Vasant, D. H., et al. "British Society of Gastroenterology guidelines on the management of irritable bowel syndrome." Gut (2021).