Have you ever had nervousness manifest as butterflies in your stomach? Or described a scary experience as gut-wrenching? Turns out these aren't just expressions – the brain and the gut really are connected. In fact, irritable bowel syndrome (IBS) is just one of multiple GI disorders that stem from issues with the brain-belly connection.1 The good news? This connection also offers solutions for managing IBS symptoms – by harnessing the power of the mind.

The brain-gut connection

The nerve cells that line the walls of your entire digestive tract are referred to as the enteric nervous system (ENS). The ENS controls digestion – everything from the muscle contractions in your esophagus and intestines to the release of enzymes that help absorb nutrients. And the ENS operates in part from instructions from the brain, or central nervous system (CNS).2

This connection with the brain is why strong emotions like fear, anxiety, and stress can cause GI symptoms. Plus, the ENS also sends information back to the brain – for example, it signals the brain when you feel full at the end of a meal. And recent research suggests the ENS sends far more information to the brain than it receives.2

The relationship between mood (the brain) and IBS (the gut)

GI disorders – like IBS – are attributed to issues with the brain-gut connection.1 Although IBS is primarily characterized by abdominal pain and changes in bowel movements, individuals who have IBS are also more likely to report psychological symptoms like anxiety, depression, and sleep problems.1,3,4

Research suggests the correlation between psychological and IBS symptoms goes both ways. When you have feelings of stress, your brain sends signals to the digestive tract that trigger GI symptoms. But an irritated GI tract also sends signals back to the brain that trigger mood changes and sleep problems.4,5

Lifestyle changes for IBS: A two-pronged approach

What does this mean for managing IBS? In short, to help control IBS symptoms, lifestyle changes should address both gut health and mental health. In fact, IBS symptoms are more likely to improve in individuals who have taken steps to address their mental health than in individuals who don’t.6

Begin with a strong foundation of nutrition and exercise. Your health-care professional might recommend that you eat more fiber, avoid certain foods, and drink plenty of fluids.1,6,7 And regular physical activity will stimulate the intestines and boost mood. 1,6,7

The following techniques can help reduce stress and manage IBS symptoms.

1. Mindfulness training

Mindfulness is the act of paying attention to the present moment. During a mindfulness practice, you are encouraged to notice and accept your thoughts and feelings without trying to change them. Over time, mindfulness helps you reduce stress by improving your ability to accept change and let go of worries. Research indicates that mindfulness can prevent and ease IBS symptoms.7,8 

2. Cognitive behavioral therapy

Sessions with a trained counselor can help you learn to modify or change your responses to stress. Several studies suggest that cognitive behavioral therapy provides significant and long-lasting reduction of IBS symptoms.1,6-8 

3. Hypnotherapy

During sessions with a trained professional, you enter a relaxed state and are then guided through visualizations and suggestions designed to help you control your symptoms and calm your digestive tract. Several studies support the long-term effectiveness of hypnosis for IBS.1,6-8

4. Biofeedback

During these sessions, electrical sensors help you receive information (feedback) on your body's functions – heart rate, for example. The feedback helps you focus on making changes to manage stress and ease symptoms.7,8 

5. Progressive relaxation training

These exercises help you learn how to relax your muscles. For example, you might start by tightening the muscles in your feet, then slowly releasing that tension. Next, tighten and relax your calves. Continue up the body until all your muscles – including those in your face and head – are relaxed. This progressive tightening and relaxing of your muscles is typically coupled with breathing techniques – breathe in while tightening the muscle group, breathe out when relaxing the muscles.1,6,7 

6. Yoga

In a review of several studies, individuals with IBS who practice yoga experience fewer bowel symptoms, decreased IBS severity, and lower rates of anxiety compared with conventional treatment.9

References

  1. Irritable bowel syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome. [Accessed March 4, 2020]
  2. Rao M, Gershon M. The bowel and beyond: The enteric nervous system in neurological disorders. Nat Rev Gastroenterol Hepatol 2016;13(9):517-528.
  3. Fond G, Loundou A, Hamdani N, et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): A systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2014;264(8):651-660.
  4. Tu Q, Heitkemper M, Jarrett M, Buchanan D. Sleep disturbances in irritable bowel syndrome: a systematic review. Neurogastroenterol Motil 2017;29:e12946.
  5. Gracie D, Hamlin P, Ford A. The influence of the brain-gut axis in inflammatory bowel disease and possible implications for treatment. Lancet Gastroentrol Hepatol 2019;4;632-642.
  6. Ford A, Moayyedi P, Chey W, et al. American College of Gastroenterology monograph on management of irritable bowel syndrome. Am J Gastroenterol 2018;113:1-18.
  7. Irritable bowel syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064. [Accessed March 4, 2020]
  8. Thakur E, Shapiro J, Chan J, et al. A systematic review of the effectiveness of psychological treatments for IBS in gastroenterology settings: Promising but in need of further study. Dig Dis Sci 2018;63(9):2189-2201.
  9. Schumann D, Anheyer D, Lauche R, et al. Effect of yoga in the therapy of irritable bowel syndrome: A systematic review. Clin Gastroentrol Hepatol 2016;14(12):1720-1731.