More than 120,000 Canadians are diagnosed with IBS (irritable bowel syndrome) each year. (1) Could osteopathy offer help for IBS?
Even though more than 14% of Canada’s population suffers from IBS, only 40% of them will seek medical attention. The estimated cost to the Canadian healthcare system for IBS alone exceeds $6.5 billion each year. IBS is also a frequent cause of work and school absenteeism.
This doesn’t even take into account the toll it takes on Canadians suffering from this syndrome. The pain, bloating and even anxiety causes Canadians suffering from IBS to miss (on average) thirteen days of work each year, representing another $8 billion of lost productivity. (2)
To further complicate the IBS picture, conventional treatment has low success rates. General practitioners prescribe antidiarrheals, laxatives, or antidepressants. However, all of these ignore the underlying or root cause. That’s why finding a long-term solution to IBS is so important.
Enter osteopathy. Through creating an environment where the affected organs are able to heal naturally, Osteopathy is a cost-effective, gentle technique that offers help for IBS.
What is Irritable Bowel Syndrome?
IBS is a chronic disorder that can involve the small and/or large intestines (colon) of the digestive tract. More specifically, it affects how the bowel moves contents through our intestines. The bowel can move either too fast (diarrhea/loose stools), too slow (constipation), or a combination of the two. In addition, irritable bowel syndrome affects how your brain interprets signals from the nerves in the bowel. This can result in abdominal pain, bloating, and even anxiety.
IBS is only diagnosed by eliminating all other diseases, such as ulcerative colitis and Crohn’s. At the time of this writing, the gold standard for diagnosing IBS is the Rome IV. (3) The Rome IV criteria include:
- Recurrent abdominal pain/discomfort occurring at least 3 days/month for the last 3 months. The abdominal pain must be accompanied by two or more of the following:
- Improvement with defecation
- Onset associated with a change in frequency of stool
- Onset associated with a change in form (appearance) of stool
- These symptoms must be ongoing for at least 6 months.
IBS is a syndrome, not a disease. Diseases have known causes. IBS is a collection of symptoms. Therefore, it is classified as a syndrome. The general symptoms of IBS include: (4)
- Feeling of incomplete emptying of the bowels
- Diarrhea (passing three or more stools per day, and/or urgent need to have a bowel movement)
- Constipation (passing three or fewer stools in a week or passing hard, dry stools and/or straining during a bowel movement)
- Abdominal pain and/or cramping
IBS is generally classified into one of three categories based on the predominant symptom.
- IBS-C – characterized by constipation.
- IBS-D – characterized by loose stools or diarrhea.
- IBS-M – characterized by alternating or mixed loose stools and constipation.
What causes IBS?
The exact cause of IBS remains a mystery. With that said, irritable bowel is often (but not always) triggered by: (4)
- A gut infection
- A course of antibiotics
- Food poisoning
- Food allergies
- Chronic stress (this may predispose one to IBS as well as exacerbate its symptoms) (5)
- Artificial sweeteners (6)
How should IBS be treated?
Conventional treatment for IBS depends on the main symptom. For those suffering from IBS-C, stool softeners and laxatives are often prescribed. Antidiarrheals are prescribed for IBS-D. Medications used to ease muscle spasms (antispasmodics) will often be recommended for abdominal discomfort. While there is not a lot of evidence that they work, low doses of antidepressants are also sometimes prescribed. (7)
Conventional treatment of IBS does not generally seek out the root cause and instead treats the symptoms.
Because of this, and because so many of the available drugs for IBS aren’t overly effective, patients have an increasing interest in alternative therapies. (8)
Stress & IBS
IBS is a biopsychosocial disorder. Meaning that its symptoms come about through a combination of genetics, behavior/personality, and cultural/socioeconomic factors. (11) When this complex balance is thrown off, the nervous system is deregulated. This change in the nervous system then affects the performance of the intestines. This is the gut-brain axis in action.
People with IBS are more likely to also suffer from a psychiatric mood disorder. (12) To further complicate matters, the communication between the nervous system and the gut is a two-way street. This means that pain sensations, mood, and behaviour can influence and be influenced by the gut. IBS treatments aimed solely at the gut ignore the influence of the nervous system. Treatments focused solely on the nervous system neglect the gut. For a treatment to be effective it needs to address both the nervous system and the gut.
Studies have shown that the nervous system plays a pivotal role in responding to stress. (13) Neurons not only receive and process information from the environment but also actively respond to various stresses to promote survival. These stresses can be external (think, seeing a bear) or internal (think, a bacterial infection in the gut). Both internal and external stresses have a tremendous impact on our neurons which in turn may affect IBS.
Can osteopathy help IBS?
Osteopathy is a hands-on therapy which aims to restore the function of the body by treating the cause of the imbalance. The philosophy of osteopathy is the belief that the body is naturally capable of healing itself. Practitioners manipulate the tissues to enhance this natural ability to self-regulate and heal. (14) When treating IBS, osteopathy aims to provide an environment that restores and maintains proper communication between the gut and brain.
Osteopathic techniques can be highly effective in the treatment of IBS symptoms. A small study involving 40 recently diagnosed IBS patients set out to see if osteopathic treatment were effective and if the effects were maintained. The patients received either conventional or osteopathic treatment. Osteopathic treatment was found to be effective in both the short and long-term, and it was found to be significantly more effective than standard treatments. (15)
In another study, one set of IBS patients underwent joint manipulations and soft tissue treatment while the other received placebo care – soft massage to the same areas. Those that received the manipulations reported a 25% improvement in the severity of IBS symptoms. There was also an improvement in the quality of life, psychological factors, and bowel habits. (16)
Yet another study showed an overall improvement in 68% of IBS patients who received osteopathic treatments vs 18% of IBS patients receiving conventional care. This improvement was still evident up to 6 months after treatment. (17)
The research clearly illustrates the success osteopathy can have on IBS. Unfortunately, it also shows how conventional health care is failing to properly manage it.
Osteopathy should be considered as a go-to therapy for those with IBS. There are specific osteopathic techniques that have been shown to work better than others. Below, I explore the most effective osteopathic techniques for overcoming IBS.
How does osteopathy help IBS?
Visceral or abdominal adhesions are fibrous bands that can form between abdominal tissues and internal organs due to abdominal or pelvic infections, surgery, or serious injury. Given the firm and fibrotic nature of adhesive bands, they may interfere with the normal functioning of the intestine. Should this occur, these adhesions can create abdominal pain, bloating, bowel obstruction, and changes in both small and large bowel motility. (18)
Adhesions can be a primary cause of SIBO. And SIBO is often the underlying, or, root cause of IBS. In fact, some forms of SIBO specifically require physical therapy or osteopathy to address the adhesions and remedy the condition. (19) You can read more here about SIBO and how it relates to irritable bowel syndrome.
While not commonly cited in the medical literature, adhesions can be a primary cause for IBS. Almost all patients develop adhesions after abdominal surgery, although not all have symptoms. Adhesions occur when the fascial tissues heal improperly.
Adhesions can form between every organ and damaged tissue layer. However, they most commonly occur between the omentum and the incision/wound. (23) Adhesions can also develop during the inflammation that is caused by infections. Unfortunately, the traditional treatment for adhesions is surgery – the very thing that likely caused the adhesions in the first place. Fortunately, osteopathy is well positioned to offer a non-surgical approach to removing adhesions.
How osteopathy helps adhesions
Osteopathic manipulation may decrease the formation of adhesions because it disrupts the cells that form adhesions (fibrins) from going to the injured area. Additionally, osteopathic manipulations increase fluid movement and may even break down clots (fibrinolysis). (24)
Osteopathic manipulation has also been shown to increase the range of motion in the pelvis and trunk. This helps decrease volatility of the gut. Which should also lead to an improvement in many IBS symptoms. (25)
Due to all of this, osteopathic intervention is critical to assess for any adhesive obstructions in the abdomen, to avoid misdiagnosis, and to prevent unnecessary surgeries.
Tests and imaging that can precisely diagnose adhesions can be difficult and expensive. A better option is seeing a well trained osteopathic practitioner who will combine a thorough patient history with an abdominal physical exam.
In the case of IBS, one study showed that the body’s ability to heal adhesions can be interrupted by this chronic inflammatory state. In this situation, the immune system actually supports the adhesion instead of dissolving the dense connective tissue.
Remember, those with IBS have chronic inflammation. And one cause of chronic inflammation is elevated long-term stress levels. This causes high levels of cortisol. Therefore, effective treatment must always include stress-reduction techniques. (26)
Osteopathy can help irritable bowel syndrome by manipulating the affected area through the abdominal wall. These techniques create improved blood flow and nerve activity to the gut. Mobilization of the spine can also help to improve the function of the nerves which supply the intestine. This can lead to calming the nerves and relaxing the smooth muscle of the gut.
The nerve supply to the abdomen is important to an osteopathic practitioner as visceral dysfunction can cause a cascade of symptoms throughout the body known as viscerosomatic reflexes. A viscerosomatic reflex is a relationship between any organ (viscera) and a closely related part of the body’s structure (soma). Why does your left arm hurt during a heart attack? That’s a viscerosomatic reflex.
Consider the low back pain commonly experienced by women during their menstrual cycle. The uterus releases impulses that are transmitted to the spinal cord. Therefore the pain experienced in the uterus can cause pain in muscles located away from the uterus itself. This commonly occurs in the low back. It follows that for the treatment to be effective the focus should be on the uterus, not the muscles in the lower back.
In the case of irritable bowel, a similar reflex can take place. Irritation in the small intestine could be the root cause of lower back pain. And as nerves are a two-way street, it is also possible that low back pain could affect the small or large intestine (colon). This might result in irritable bowel syndrome.
While this theory is unproven, if true it may help many who suffer from irritable bowel syndrome.
Is osteopathy a cure for irritable bowel syndrome?
Not at all. Irritable bowel is a complex, multi-system disorder. However, osteopathy can help with a piece of the puzzle. But keep in mind it is not a replacement for dietary or lifestyle alterations changes. Dietary changes are the single most important aspect of treating irritable bowel syndrome. For more information on the best diet for irritable bowel syndrome, click here.
Once dietary changes are in place, osteopathy can be essential detecting and treating abdominal adhesions, identifying and treating viscerosomatic reflexes, and calming the nervous system. As such, it should be an integral part of a treatment plan. Especially if the practitioner has background knowledge in functional medicine.
Do you need help overcoming IBS? We have all the info you’ll need here.
Now, I want to hear from you!
How has osteopathy helped your gut?