IBS: The Gut-Brain Connection

So, you've been diagnosed with irritable bowel syndrome (IBS), now what? If you are one of the large number of people in the US (upwards of 50 million by some reports and most of them women) who suffer from IBS, the first order of business is to make sure the diagnosis is correct.

Posted on | Robynne K. Chutkan, MD, FASGE | Comments ()
IBS: The Gut-Brain Connection
IBS: The Gut-Brain Connection

So, you've been diagnosed with irritable bowel syndrome (IBS), now what? If you are one of the large number of people in the US (upwards of 50 million by some reports and most of them women) who suffer from IBS, the first order of business is to make sure the diagnosis is correct.

What else could this be? Maybe you have undiagnosed celiac disease or gluten sensitivity, or simmering Crohn's disease that has been misdiagnosed as IBS, or lactose intolerance, diverticulosis, gallbladder dysfunction, small intestinal bacterial overgrowth, microscopic colitis or a host of other gastrointestinal disorders with overlapping non-specific symptoms. Part of making a diagnosis of IBS means excluding other conditions. For some patients, that may mean endoscopy and/or colonoscopy with biopsies, X-rays, blood tests, gallbladder scans, hydrogen breath tests and lots of other poking around in your nooks and crannies. The symptoms of these various conditions may be non-specific and overlapping but the treatment will vary dramatically based on what the cause is.

Before making a self-diagnosis of IBS, particularly if you have "alarm symptoms" of blood in the stool or anemia, unexplained weight loss or significant abdominal pain, consider getting some expert help to be sure you are on the right track.

Once the "what" is confirmed and other conditions have been excluded, an important question to ask is "why?" Common triggers for IBS include food, particularly caffeine, high fat foods, artificial sweeteners and processed foods – but even relatively healthy foods when the portion is too large can cause a flare-up of symptoms. One of the characteristics of IBS is something called visceral hypersensitivity. This has been illustrated in experiments where a balloon is inflated in the colon; the IBS patient becomes uncomfortable at much lower volumes of inflation than someone without IBS. For many people with IBS, the gut is happiest when it is empty, either before eating or after a bowel movement. Eating small frequent meals is a good tactic, as is making sure you have regular bowel movements if you have constipation-predominant IBS.

We know that stress is a factor in almost every chronic medical condition and IBS is no exception – in fact, it may be the poster child. But what does it mean to "reduce stress"? For most people, the common stressors of work, relationships, family and health concerns are not so easily cast aside.

Biofeedback is a well studied and effective method of improving symptoms in a number of conditions, including IBS, high blood pressure, fibromyalgia, migraines, and many others disorders by reinforcing the mind-body connection. It can reduce stress and symptoms of IBS through abdominal breathing techniques, muscular relaxation, guided imagery and cognitive strategies designed to result in a more balanced state. The biofeedback equipment, sensors that detect heart rate, breathing patterns, body temperature and blood flow, allow for more effective monitoring of the body's responses which ultimately results in a more coherent, smoothly functioning state within the body. Early symptom identification through biofeedback allows people with IBS to intervene before their nervous system has a chance to negatively impact their gastrointestinal function.

Biofeedback, meditation, yoga, regular exercise, massage and acupuncture have all been shown to be helpful tools in tackling IBS and may be complementary to dietary modification and/or medication in getting symptoms under control.

When we are able to shift our thoughts, emotions and physiology toward a more balanced state, not only are IBS symptoms improved, but so is our overall health.

Blog written by Robynne K. Chutkan, MD, FASGE
Dr. Robynne Chutkan is a Board Certified Gastroenterologist and an Assistant Professor in the Division of Gastroenterology at...