About IBS

Irritable Bowel Syndrome & Hypnotherapy
By Michael Mahoney, May 2001

Irritable Bowel Syndrome (IBS) is a heterogeneous condition with varying severity and symptomology. At least one in four of the general population is affected at some time in their lives (Jones 1992, Harvey 1983, Cook 1987). Despite the condition being classed as ‘non-serious’, it has serious cost implications to the UK National Health Service and Health Insurance Providers throughout the world, due to frequent presentations to general practitioners, hospital physicians and other specialist services (Talley 1995). The diagnosis is often reached by exclusion of diagnosable physical abnormalities and organic disease (Latimer 1983). But according the World Health Organization (1979), “health, which is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity, is a fundamental human right”

As a clinical hypnotherapist I have taken great interest in the management of this disorder as I have experienced the distress and frustration these client groups feel in the search for relief from symptoms which have a severe impact on their lifestyle. With conventional medical treatment being of little proven benefit (Houghton 1996) there is a need to look beyond treating the symptoms to addressing the cause. In the holistic view of illness, physical disease is only one of several manifestations of basic imbalance of the organism; other manifestations may take the form of psychological and social pathologies (Capra 1983 p131).

The fact is that holistic approach to medical and psychological care is required in the management of IBS, but that the psychological aspect is not universally accepted by the medical profession or the client group with clients feeling there is a stigma attached to this aspect of care. As a clinical Hypnotherapist I have an impact on these management issues as facilitator addressing the human response to this disorder, whereas physicians address the treatment of the disorder.

Etiology

IBS is an extremely common digestive disorder accounting for up to 50% of all cases seen by gastroenterologists (Harvey 1983). Of those that present in western society women outnumber men 4:1.

Pathogenesis

IBS is defined as a “functional bowel disorder in which abdominal pain is associated with defecation or change in bowel habit, and with features of disordered defecation and with distention (Thompson et al 1992). However there is multiple symptomology that is associated with this complex disorder which is not always mentioned in standard textbooks. Upper gastroenterology symptoms including nausea, vomiting, early satiety are common (Farthing 1995). Extra bowel manifestations include urological symptoms (Jones 1992), fatigue backache, headache and gynecological symptoms (Longstreth 1995) often precipitating multiple specialist referrals to exclude organic cause. Many women undergo diagnostic laparoscopy or even hysterectomy (Langstreth 1995). Inappropriate surgery in the form of cholecystectomy and appendectomy has also been reported.

Many suggestions are made as to onsetting causes of IBS such as stress factors, enteric infection or surgical intervention all of which have been found to increase visceral hypersensitivity. Even antibiotics, or trauma have been suggested as triggers.

The Uses of Hypnotherapy

The medical profession cannot be sure of the causes, nor have they suitable treatment for the condition, new drugs which may be effective in some individuals are mainly prohibitively expensive for sufferers. Hypnotherapy in the UK and elsewhere has been shown to help in the vast majority of cases of IBS sufferers. The writer is aware of at least one hospital gastroenterology department with its own hypnotherapy team alongside.

Hypnotherapy is non intrusive, safe, comfortable and a cost effective and complementary to use along side mainstream medicine, some in the profession would in this case argue ‘alternative’ since the medical profession are generally at a loss with this condition. Having conducted a private medical research project at the invitation of a medical center, and subsequently private patient trails in specifically designed hypnotherapy processes, the IBS Audio Program 100 is now use by sufferers in over 13 countries, our web site visited by surfers in over 40 different countries.

As a specialist in this area, the understanding that sufferers have the need for understanding, and an empathetic approach. Sufferers who consider hypnotherapy currently tend to do so as a ‘last resort’ rather than a first approach after diagnosis. The medical profession are becoming more aware of benefits of hypnotherapy from a specialist in the field. As a medical center based practitioner my hypnotherapy practices receives referrals from general practitioners, gastroenterologists and specialist gastro nurses.

Just dealing with the symptoms of IBS is not enough, the individual has to learn to rebuild internal energy, many sufferers feel drained emotionally, life issues and responsibilities continue to deplete inner emotional strength, leading in some cases to anxiety or even some forms of depression. Before the sufferer even thinks of working through the IBS, they invariably need an emotional ‘topup’, they need their batteries charged, after perhaps years of pain and discomfort, of being told by various medical professionals that there is nothing that can be done, even though intrusive and sometimes painful examinations have been undergone, many sufferers feel emotionally drained. Work and family relationships can be eroded and strained, social life and love life can be virtually non-existent, concentration and recall, may be almost impossible compared to how it used to be, confidence and self esteem of the individual is often very low, and the ability to see things in perspective is greatly reduced. Therefore to tell a sufferer that they must do this or that, without preparing for the journey is almost certain failure. Hypnotherapy, when conducted correctly can increase self-esteem, confidence, and allow the sufferer to begin a journey of self improvement and management, by changing their thoughts, changing negative thoughts and feelings for positive ones.. and thereby equip themselves emotionally to move away from the symptoms and ( familiarity ) thoughts of IBS and begin moving forward, a journey that many sufferers have or are taking at this moment, with positive changes.

Using Hypnotherapy in the Management of Irritable Bowel Syndrome

As a clinical Hypnotherapist, I have specilised  in treating IBS with specific hypnotherapy processes for over 8 years, with an expected improvement in symptoms and frequency of presentation of 80% plus over all variations of IBS.

However IBS is established, once established I believe three areas which compound the condition and create in the subconscious learning processes that develop negative belief systems, these lead to retention of the idea of having to live with the IBS condition – and the IBS condition being a normal part of life. The subconscious adjusts, the conscious doesn’t.

Firstly, Stress plays a part. Patients can be taught quite quickly that stress is not ‘out there’, stress develops when our own perceptions of external events ( real or perceived), outstrip internal resources.

Secondly: Food intolerance. Patients that have used hypnotherapy can reintroduce ‘forbidden foods’ if done gradually. Negative links to foods can be made by the subconscious when in an emotional state. For example, if one were to have a bout of vomiting after a night out, or eating a particular food – if during the process of vomiting thoughts of other foods were made or suggested, then the emotional link of the vomiting can be ‘anchored’ to the other food suggested, and the subconscious will very often react producing feelings of nausea when thinking about the suggested food.

Patients themselves will be able to eat one food one day and not the next. A state of mind perhaps rather than intolerance?

Thirdly and most importantly. There is a psychological element to IBS that my experience suggests is compounds the IBS thoughts. Every thought we have creates a physical reaction, all emotions start in the mind and then translate to physical feelings.

The IBS patient has ‘future fears’. The fact they might have ‘had an accident’ while shopping in the middle of a busy shopping centre creates thoughts that are deeply remembered. The next time the patient has to go shopping the memory returns, the associated feelings of embarrassment and others, and the patient will begin to find ways of justifying not going out, creating additional fears such as agoraphobia or social phobia.

Their fear is not what happened in the past, it is what might happen in the future. Patients that come to us will often have imagined their meeting 10, 20 times or more. They work themselves up, every thought remember creates a physical response.

Some may create delaying and frustrating routines, having to go to the bathroom, 3 or 4 times before leaving home, stopping at service stations, concerns about whether they will get to work before they need to the bathroom again. Will shops have toilets in? Most IBS sufferers, before they even open their eyes in the morning will run negative thoughts and images through their mind. To some extent is can become an almost self-fulfilling prophesy.

Many patients of course present with anxiety or various levels of depression. Anyone who had diahorrea like IBS patients, 3 or more times a day, often uncontrollable, and explosive, and having those symptoms for years, would be anxious or depressed.

I view myself as an educationalist as well as a Hypnotherapist. The majority of patients who come to me are there as a last resort, or by GP or Gastroenterologist referral.

Most will know nothing about the condition, a few will think they know everything. I find the first thing is to reduce their concerns about it being contagious, cancerous and the like. Remind them that no physical condition exists so there is nothing sinister to worry about. Explain what a functional disorder is and how the digestive system works in simple to understand language. When talking about the psychological elements to the IBS, most patients will weep, because they feel they are being finally understood. If there is any criticism of the medical profession as a whole, it is that no one has had the time to sit down to listen to them, and to explain things. They also invariably understand that time constraints prevent such educating.

IBS patients will often too have low confidence and self esteem, these affect the way they are able to see things in perspective. Their emotional ‘pot of energy’ is running on empty.

The first task for a Hypnotherapist with an IBS patient (once history and background have been taken) is to begin to ‘top-up’ that emotional pot of energy. Build up their confidence and self esteem again, this reduces stress and develops a stress hardiness for future use.
I generally see IBS patients 5 or 6 times over a structured period of 12-14 weeks. Each hypnotherapy process is different, each building on the proceeding one. The hypnotherapy sessions vary in duration, using direct suggestion and guided imagery.

The structure of the process is important too:

The first session builds confidence and self esteem, this reduces stress and as mentioned earlier begins the process of developing stress hardiness.

The second session uses imagery and guides the patient using methods to speed up or slow down the digestive motility, depending on presentation, also focuses on the lower part of the stomach.

The third session, again uses imagery to soothe and calm the entire digestive process, from ‘going in – to coming out’ re-enforcing previous sessions and using imagery to seek out areas of tightness, pain or discomfort.

Fourth Session, uses metaphor to take the Patient on a journey which parallels the journey of IBS. Encourages reflection of progress made in previous session, reminds them of the new feelings of comfort and well being. And encourages them to begin to write their own journey, effectively taking part in their own healing.

The Fifth session is usually the final one. Uses reminder cues from the previous sessions, allowing almost immediate positive responses to any old negative shadow fears.

The sixth ( rarely needed ), is used to help patients whose symptoms are more severe approaching and during the menstrual cycle. The previous sessions usually deal with these, but a process is available if needed.

Tried and test over years these processes are reliable, safe and widely effective. Hypnotherapy in the UK is the most researched complementary therapy in the UK. It is non intrusive, cost effective, prescribing budget friendly and totally safe. Any side effects are feeling of well being and calmness. It is not stage hypnosis.

Michael Mahoney is a medical centre based hypnotherapist in Warrington, Cheshire. He has been in practice for 13 years, specialising in IBS for 8 years His practice sponsors the The UK Register of IBS Therapists  www.ibs-register.co.uk

His hypnotherapy practice sponsored the UK’s first IBS Awareness evening at Liverpool University in 1997.
His IBS Audio Program was developed after years of research, and is favourably spoken about over the internet.
© PCSG 2002