Irritable Bowel Syndrome (IBS) affects up to 5% of the world's population (1). In this article, I am going to explore the role of increased gut sensitivity in IBS and the use of a Hypnotherapy technique to support your IBS journey.
• Disorder: a state of confusion (lack of order) within an otherwise well-functioning system (in this case – your body)
• Irritable bowel: recurrent abdominal pain associated with a change in bowel habit (Rome IV criteria)
• Gut – brain connection: bi-directional communication between the gut and brain via the nervous system
• Hypnotherapy: fixed attention (focus) upon a dominant idea with a positive expectation (Braid, 1860)
Historically, we believed that bowel disorders were the result of structural problems like ulcers, inflammation and bleeding. But as you have likely been told with your IBS, there’s nothing wrong with the structure of your gut. So there must be more to the story!
IBS is a poorly misunderstood condition by patients and doctors alike. Originally, it was said to be a ‘psychosomatic’ condition and then a ‘functional’ syndrome – which both carry a degree of stigma and dismissal. Hypnotherapy is the same, plagued by historical narratives which persist due to lack of valid, well presented information. So let’s strip it back and start at the very beginning.
Gut – brain talk
Think of the gut as one long tube from mouth to bottom that has both structure (layers of cells, nerves, blood vessels which make it up) and function (digestion, motion and sensitivity). If this isn’t complex enough, combine it with the immune system, nervous system and the trillions of gut microbes and you get an interaction called the gut brain axis.
For decades, the brain was believed to be the master of the gut, but in fact, it may be the other way around. We now know that the gut has more connections leading up to the brain, than the brain has down to the gut. No wonder things go wrong when one of these systems get irritable! What’s important to understand, is that all these systems play a very important role in IBS symptoms (2).
Following exclusion of more significant medical issues involving the structure of your gut (for example, Inflammatory Bowel Disease (IBD) or Coeliac Disease) you will often be faced with a diagnosis explained thus: “don’t worry it is just IBS.” Whilst this statement is not strictly untrue, it promotes dismissal of what you experience to be a very real lack of order (disorder) within your own body. Since we now have gut doctors like myself who focus solely on disorders of the gut-brain axis like IBS – it can’t possibly be all in your head!
Why so sensitive?
As science continues to unravel the root causes of IBS (note: there is rarely a single cause and by extension, rarely a single solution) it also uncovers common themes. One theme is an altered or heightened sensitivity of your bowel to normal or low level sensations (so-called visceral hypersensitivity to use the medical term). Far from being a new discovery, this idea has been studied since the 1970’s when it was found that pumping gas into the bottom of IBS patients caused more complaints of bloating and pain compared to healthy people (3) – aren’t you glad you weren’t part of that study!
To keep things simple, it’s like your gut & brain are talking on loudspeaker and you have no volume control.
Studies have since confirmed the same volume of gas in an IBS bowel is less well tolerated by a healthy bowel - largely due to impaired movement of the IBS bowel rather than IBS patients simply producing more gas. (4). Furthermore, stretch in the bowel can lead to discomfort or pain and pain signals are amplified in IBS due to altered processing of your nervous system – your sensitivity threshold is lowered.
Even more interestingly, your sensitivity threshold can shift up or down with mental stress. This is true for everyone but IBS sufferers process this differently. One study tested this by blowing up a balloon into the bottom (rectum) of IBS patients versus healthy people before, during and after mental stress (5). Both groups showed lower thresholds to pain after the stressful event (i.e. more painful) but fascinatingly, only the healthy group were able to increase their threshold during the stressful event to tolerate the pain – whereas IBS patients were not. IBS patients also showed differences in their stress hormone response (cortisol levels) which contributes to heightened sensitivity.
This is of course, only part of the story. Why this occurs and how other aspects of the gut-brain interaction intertwine will be covered future articles. Yet in my mind, this information begs the question – can IBS sufferers relearn to tolerate more gas or increase their threshold of pain perception*? How do you get back the volume control?
*Note: pain is usually an alarm signal from the body to call your attention and let you know something is wrong. This is why any pain that is sudden onset, new for you (i.e. less than 6 weeks in duration) or different from your usual pain should be investigated by an appropriate medical doctor before concluding that you should be altering it in any way.
Retrain your attention
Paul Mckenna famously said “if I could only give one piece of advice to somebody, it would be that we get more of what we focus on”
Attention is our most powerful internal resource i.e. your ability to focus on an idea, feeling or activity of your choice, whilst filtering out unwanted distractions.
In today’s digital age this has become a dwindling ability, as rapidly advancing technology provides us with immediate gratification. Our brains become ‘hardwired’ to seek immediate gratification or we simply lose interest. Often, this is automatic– whereby we are pulled in the direction of our most dominant thought or idea.
We have lost our innate freedom to choose.
In our bodies, our attention gets pulled into - and stuck onto - feelings or symptoms that pose a threat to our survival. While this is helpful if we have an injury that needs emergency treatment, in the world of gut-brain disorders it only serves to (a) magnify threat (b) increase our stress response and (c) increase our sense of a focal, separate self.
In other words, explicit focus on your symptoms can lead to a perpetuating cycle of fear, anxiety and worry that makes your symptoms worse.
Yet you can rewire this process to support clear, calm & coherent gut -brain communication. The key technique therefore is learning to retrain your attention towards positive thoughts, emotions and sensations. This will reduce gut sensitivity because it reduces reinforcement along the signalling pathways up to the brain which are being reinforced by the attention you place on your symptoms.
“Attention is the key to transformation – and full attention also implies acceptance. Attention is like a beam of light – the focused power of your consciousness that transmutes everything into itself” – Eckhart Tolle
Cognitive Behavioural Hypnotherapy (CBH)
This simple idea has been extensively researched in the landscape of biology & psychology. Our thoughts, emotions and behaviours have a direct influence on the way we process & perceive our physical sensations. CBH is a combination of techniques designed to enable you to develop a highly focused and relaxed state of attention, in which positive suggestions can be fully realised. You can take back the volume control and take one step forward on your journey with IBS.