IBS and the Gut-Brain Connection
IBS is a complicated disease, and to understand it, we often need to look beyond the gut and investigate the effects of the gut-brain connection on symptoms.
What is the gut-brain connection?
Our brain and our gut are highly connected. Communication takes place between the central nervous system (the brain and the spinal cord) and the peripheral nervous system. The gut has its own nervous system, called the enteric nervous system. This nervous system is responsible for motility (movement of the muscles in the digestive tract), secretion of digestive fluids, and blood flow.
There's a "highway" running between the central nervous system and the enteric nervous system. Messages run back and forth between the brain and the gut all day long. It's thought that dysfunction of these pathways may contribute to common symptoms of IBS, like abdominal pain, constipation, and diarrhea.1
When they're functioning optimally, the brain and the gut cooperate with each other. However, in patients with IBS, the brain and the gut messages can be "misread."
For people with IBS, the nerves in the gut might also be extra sensitive. This is called "visceral hypersensitivity." Visceral hypersensitivity and the perception of normal digestion as painful changes the messages sent between the brain and the gut, leading to indigestion changes.2
IBS and stress
In this day and age, stress is a big factor in most of our lives. From working, commuting, and consuming social media, it's easy to become stressed. This stress puts our body into "fight or flight" mode, which can shift focus away from digestion. Stress can also affect different functions of the gastrointestinal tract, including gastric secretions, gut motility, gut permeability, gut barrier function, and visceral hypersensitivity.1
Stress also releases chemicals that promote inflammation, which can increase the level of inflammation in the gut. This can speed up or slow down gut motility, leading to symptoms like diarrhea or constipation. There is also evidence that stress can affect the composition and growth of the gut microbiota, implicated in the development of IBS.1
As you can see, stress can have a HUGE impact on the digestive system. So how can you manage stress as a way of potentially reducing IBS symptoms?
Managing the gut-brain connection
There are several methods of "retraining" the connection between the brain and the gut. Here are a few examples:
Mindfulness-based stress reduction
About 5-10 minutes of mindfulness practice per day can greatly impact how you perceive pain and digestive symptoms. Mindfulness practices also help activate the "rest and digest" mode, which may help relieve digestive symptoms. One study showed that an 8-week mindfulness course was associated with significant improvement in IBS-related quality of life.3
Gut-directed hypnotherapy is a special form of hypnosis designed to address the miscommunication between the brain and the gut. A trained therapist guides a person through different techniques, including suggestion, imagery, and relaxation.4 A randomized clinical trial showed that gut-directed hypnotherapy was just as effective as the low FODMAP diet for IBS treatment.5
Cognitive behavioral therapy
Cognitive-behavioral therapy is a type of therapeutic approach that focuses on changing behaviors and addressing dysfunctional thinking patterns to influence mood and physiological symptoms. For IBS, treatment involves educating on the connection between the brain and the gut, relaxation strategies (such as diaphragmatic breathing), cognitive restructuring (addressing fear related to IBS symptoms), and teaching problem-solving skills.6
Diaphragmatic breathing exercise
Breathing deep into your diaphragm can help shift your body into "rest and digest" mode and may help relieve IBS symptoms.
- To start, close your eyes (or if that doesn’t feel comfortable, look down the tip of your nose). Place one hand on your stomach and one hand on your chest. Start to become aware of your surroundings. What can you hear? Smell? Start to feel the air as it travels in and out of your nostrils.
- Take a long, slow deep breath inward for a count of 4. Bring the breath all the way into your belly. You should feel the hand over your stomach rising as you inhale.
- Next, exhale slowly through your mouth or nose for a count of 4. Feel your stomach "deflate" as the air leaves your lungs.
- Repeat this breathing exercise for 5 deep inhalations and exhalations. It can be helpful to do this exercise before a meal to help your body prepare for digestion.
The brain and the gut are highly connected, and it's thought that misreading the messages between the brain and the gut could contribute to IBS symptoms. Luckily, there are methods of calming the gut-brain connection, like mindfulness practices, gut-directed hypnotherapy, and cognitive behavioral therapy.
Have you ever had a public IBS accident?