120,000 Canadians are diagnosed with irritable bowel syndrome each year. (1) Could osteopathy offer a solution?
Even though over 14% of Canada’s population suffers from IBS, only 40% of them will seek medical attention. (2) The estimated cost to the Canadian healthcare system for IBS alone exceeds $6.5 billion each year. (3) Irritable bowel syndrome is also a frequent cause of work and school absenteeism. Canadian’s suffering from IBS will miss (on average) thirteen days of work each year, representing another $8 billion of lost productivity. (4)
To further complicate the IBS picture, conventional treatment has low success rates. General practitioners prescribe antidiarrheals, laxatives, or antidepressants. All of which ignores the underlying or root cause. Finding a long-term solution to IBS is a worthy endeavor.
Osteopathy presents a cost-effective, gentle technique to assist those with IBS.
What is Irritable Bowel Syndrome?
IBS is a chronic disorder that can involve the small and/or large intestines of the digestive tract. More specifically, irritable bowel syndrome presents with motility problems (how the bowel moves contents through our intestines). Motility problems can be 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/or anxiety.
The diagnosis of IBS is typically one of exclusion. IBS is diagnosed when tests of other diseases, such as ulcerative colitis, Crohn’s, etc, are negative. At the time of this writing, the gold standard for diagnosing IBS is the Rome IV. (5) 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 associated with 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
- The above must be ongoing for at least 6 months.
IBS is known as 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: (6)
- 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?
This remains a mystery. As a medical community, we’re not entirely sure what the exact cause is. With that said, irritable bowel is often (but not always) triggered by: (7)
- 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) (8)
- Artificial sweeteners (9)
How should IBS be treated?
Conventional treatment for IBS is dependent on the predominant symptom. For IBS-C, stool softeners and laxatives are often prescribed. For IBS-D, antidiarrheals are prescribed. Medications used to ease muscle spasms (antispasmodics) will often be recommended for abdominal discomfort. While there is not a lot of evidence, low doses of antidepressants are also sometimes prescribed. (10)
Conventional treatment of irritable bowel syndrome does not address the root cause of the disease. When the root cause is alleviated, patients should no longer be dependent on continuous medical intervention. In light of the low efficacy of available drugs in treating IBS, patients have had a growing interest in alternative therapies. (11)
Stress & IBS
Stress has been shown to recreate symptoms in those with IBS. (12) To illustrate how connected the brain and gut are in IBS patients, consider that anxiety and depression are reported at much higher levels in IBS patients. (13)
IBS is considered a biopsychosocial disorder. Meaning that its symptoms come about through a combination of genetics, behavior/personality, and cultural/socioeconomic factors. (14) When this complex balance of our systems is interrupted, there is a deregulation of the nervous system. The change in the nervous system then affects intestinal motility and increases visceral sensitivity. This is the gut-brain axis in action.
It has been shown that the prevalence of psychiatric mood disorders is higher in those with IBS (15). To further complicate IBS conditions, the communication between the nervous system and the gut is a two-way street. Meaning that pain sensations, mood, and behavior can influence and be influenced by the gut. IBS treatments aimed solely at the gut miss the nervous system influence. Other treatments focused solely on the nervous system neglect the gut. Effective treatment 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. (16) Neurons not only receive and process information from the environment but also actively respond to various stresses to promote survival. This information can come from our external environment (think, seeing a bear) or, from our internal environment (think, a bacterial infection in the gut). Both intrinsic and extrinsic stresses have a tremendous impact on neuronal development and maintenance with implications in 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. Its philosophy was founded on the belief that the body is naturally capable of healing itself. Practitioners work through manipulations of the tissues to enhance this natural ability of self-regulation and healing. (17) In relation to IBS, the goal of an osteopathic treatment is to provide an environment in which proper communication between the gut and brain is both restored and maintained.
Osteopathic techniques have demonstrated highly effective results in treating IBS symptoms. A small study set out to establish if osteopathic treatment was effective in treating IBS in a hospital environment and if the effects were maintained. Forty IBS patients were diagnosed by a gastroenterologist and received either allopathic 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 allopathic treatment. (18)
In another study, a set of IBS patients underwent articular manipulations and soft tissue treatment versus placebo care – soft massage to the same areas. Those that underwent articular manipulations noted a 25% improvement in the severity of IBS symptoms. There was also an improvement in the quality of life, psychological factors, and bowel habits. (19)
Yet another study showed an overall improvement in 68% of IBS patients who received osteopathic treatments vs 18% of IBS patients receiving allopathic care up to 6-months after treatment. (20)
The research clearly illustrates the failing of conventional health care to properly manage IBS. Osteopathy presents successful treatment outcomes with minimal negative effects. Osteopathy should be considered as a go-to therapy for those with IBS. Specific osteopathic techniques 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 have the potential to interfere with normal intestinal motility and transit processes. Should this occur, visceral adhesions can create abdominal pain, bloating, bowel obstruction, and alteration in both small and large bowel motility. (21)
Visceral adhesions can be a primary cause of SIBO. And SIBO is often the underlying, or, root cause of irritable bowel syndrome. In fact, some forms of SIBO specifically require physical therapy or osteopathy to address the adhesions and remedy the condition. (22) For more information regarding SIBO and how it relates to irritable bowel syndrome, see this post.
While not commonly cited in the medical literature, visceral adhesions can be a primary cause for IBS. Almost all patients develop adhesions after abdominal surgery, although not all are necessarily symptomatic. They occur when the fascial tissues heal improperly.
Adhesions can form between every organ and damaged tissue layer. Though they most commonly occur between the omentum and the incision/wound. (23) Adhesions can also develop during inflammation as seen with infections. Unfortunately, the traditional treatment for visceral adhesions is surgery – the very thing that likely brought about the adhesions in the first place. Fortunately, osteopathy is well positioned to offer a non-surgical approach to removing visceral adhesions.
Visceral manipulation may decrease the formation of adhesions because it causes disruption of fibrin and inhibits fibroblast migration to the injured area. Additionally, the increase in fluid movement due to manipulation could cause an increase in metabolite exchange and, as a result, the break down of clots (fibrinolysis). (24)
Visceral 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 lead to an improvement in many IBS symptoms. (25) Osteopathic intervention is critical to assess for any adhesive obstructions in the abdomen, to avoid misdiagnosis, and to prevent unnecessary surgeries.
At the time of this writing, there are no diagnostic tests or imaging available to precisely diagnose visceral adhesions. Instead, well trained osteopathic practitioners will need to combine a thorough patient history with an abdominal physical exam.
In the case of irritable bowel syndrome, one study showed that the body’s ability to heal adhesions can be interrupted by a chronic inflammatory state. In these situations, the immune system actually maintains the adhesion instead of dissolving the dense connective tissue.
Remember, this chronic inflammatory state can be caused by elevated long-term stress levels. These states can cause elevated levels of cortisol. Those with irritable bowel syndrome are prone to this state. Thus, effective treatment must always include stress-reduction techniques. (26)
Visceral osteopathy can help irritable bowel syndrome by manipulating the bowel and the mesentery through the abdominal wall. These techniques create improved blood flow and nerve innervation to the gut by releasing the mesentery. 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 relaxation of the smooth muscle of the gut.
The nerve supply to the abdomen is of great importance to an osteopathic practitioner as visceral dysfunction can cause a cascade of symptoms throughout the body via viscerosomatic reflexes. A viscerosomatic reflex is that of an interrelationship 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 at work.
Consider low back pain commonly experienced by women during their menstrual cycle. The reflex is initiated by impulses from the uterus; these impulses are transmitted to the spinal cord, where they synapse with interconnecting neurons. In the example of the menstruating women, the pain experienced in the uterus could impart resulting changes in muscles located away from the uterus itself. This commonly occurs in the low back. Effective treatment would thus need to be focused on the uterus, not the musculature of the low back.
In the case of irritable bowel, a similar reflex can take place. The irritation of one’s small intestine could be the root cause of a viscerosomatic reflex that manifests as pain in the low back. As nerves are a two-way street, it is also possible that low back pain, causing alterations to the nerves, could affect the small or large intestine. Thus, creating irritable bowel syndrome.
While such a theory has not yet been proven, it may very well have the potential for helping many who suffer from irritable bowel syndrome.
Is osteopathy a panacea for irritable bowel syndrome?
Not at all. Irritable bowel is a complex, multi-system disorder. Osteopathy can help with a piece of the puzzle. 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/treating abdominal adhesions, identifying/treating viscerosomatic reflexes, and calming the nervous system. As such, it should be considered an integral part of one’s 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.
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How has osteopathy helped your gut?
Also published on Medium.