Irritable Bowel Syndrome and Hypnosis
By Melissa J. Roth, CHt., DCH(c)

Irritable Bowel Syndrome, also known as spastic colon, colitis, spastic colitis or nervous stomach, are a baffling and complex set of gastrointestinal symptoms that affect 15% to 20% of the population (approximately 20 million people).  It is characterized by intermittent abdominal cramping, constipation, diarrhea, a combination of both constipation and diarrhea, pain and bloating.  Some IBS patients report having both constipation and diarrhea in the same day. Two thirds of the patients are women.  It is the second most cited reason for missed work days.
 
It accounts for approximately one half of all visits to gastroenterologists. The causes of IBS are unknown.  A diagnosis of IBS is actually a diagnosis of exclusion--you rule out everything else.  Since IBS symptoms overlap a number of other, potentially life threatening conditions, it is imperative that the person see his/her physician or a gastroenterologist, to receive a proper diagnosis.  While it isn't clear what causes it, we know that people with IBS have changes in the way sensations are perceived in the colon. And there are some anatomical changes in the lining of the colon and to the nervous system of the colon. What causes these changes is unknown. 

Symptoms range in severity from an occasional mild episode to a debilitating, life altering illness which prevents the individual from working or from normal functioning.  The symptoms are exacerbated by stress, changes in diet and changes in daily routine, among other things. Some people are so sensitive they must eat virtually the same foods, in the same proportions at the same times each day or suffer the consequences. Until recently, IBS was thought to be simply a "nervous" disorder and was not taken as seriously as it deserved to be. While IBS will not kill you, it is far more than just a nuisance.

Traditional treatment consists of fiber therapy, antispasmodic medications and antidepressants.  Fiber is added to the diet both through the use of bulking type laxatives.  These are just as important for those people whose chief complaint is diarrhea as it is for constipation.  Antispasmodic medications, such as Bentyl reduce the spasms in the gut. Antidepressants, in this case, actually function on the nervous system of the gut to reduce it's sensitivity to pain and to their sensations rather than acting as emotional antidepressants. 

Take, for example, Melinda S.  Melinda is a 35 year old special education teacher of gifted elementary children. When Melinda first came to my office, she had recently been released from the hospital for a particularly severe episode of uncontrolled diarrhea. She was on high dosages of multiple medications.  She reported that the medications had too many sideeffects and that in spite of them she had not seen any improvement in hersymptoms.  When asked to rank her symptoms on a scale of zero to ten, withten being the worst and zero indicating the absence of symptoms, she ranked them as follows:  diarrhea 5, abdominal pain 7, bloating 8, fatigue8.  At the beginning of the sixth and final session she ranked the samesymptoms as follows:  diarrhea 0, abdominal pain 0, bloating maybe 2, fatigue 0. She reported these results in symptom improvement in spite of the stress cause by the unexpected death of a close friend in an accident two days prior. 

Jackie B. characterized her symptoms as a "panic attack of the bowels."
After only two sessions, she reported that her symptoms had improved so much that she "actually got out with her family and went a few places" for the first time in over four years.  She can not remember when she didn't have the symptoms.  Now she reports that she "feels better upon awakeningthan I have in years." She no longer has abdominal pain upon awakening andeven though she had one period of diarrhea in a time of unduly high stress,she still had no pain associated with it.  Working in conjunction with her physician, Jackie has come off all the drugs she was on prior to starting the program and has not had a return of her symptoms even though her stresslevels remain high.

Susan W., a financial specialist, during her first visit characterized her symptoms as pain 10, gas 7, bloating 10, constipation 10, and diarrhea 2. By the middle of the program she reported her symptoms as follows:  Pain 0,gas 1, bloating 0, constipation 0-1, diarrhea 0.  By the end of theprogram she reported zeros in all categories.

Jerri W., an insurance underwriter, knew she had hit her glass ceiling at work, not because she was a woman, but because of her IBS symptoms, she could not do the travel that was part of her job description.  During thefirst visit she reported that she had not had a bowel movement in three weekseven though she was using bulking laxatives. She cited stress as thereason for her abdominal problems and could not ever remember not having GI problems in response to stress. After the second session and prior to thethird session, she reported having a bowel movement every day even though she was handling a highly stressful family problem and an overload at work.  After three months, even though she had done nothing constructive about handling her stress overload, she had not had a return of her IBS symptoms.

The common thread among these people is that they had unabated IBS symptoms which interfered with their daily living. Most of them did not believe hypnosis would work to alleviate their symptoms. However, they were so desperate for relief they were willing to try anything. They were desperate for hope, for an alternative to learning to live with debilitating symptoms.  Now, due to hypnosis treatment for their symptoms, they have been able to return to a much more normal lifestyle. 

The hypnotherapy program I used with these people was modified from the research done by Dr.Whorwell in Manchester, England and Dr.Olafur Palsson's research done at Eastern Virginia Medical Center.  The clients came for six to eight sessions spaced two weeks apart.  The hypnosis portion of their session was tape recorded and they were instructed to play the tape forthemselves daily until the next session. 

All suggestions and imagery was"gut specific" and incorporated information on how a normalgastrointestinal system functions.  Suggestions were made about the intestines being coated with a special protective coating to insulate it from irritants, etc.  At the last session, the subjects were taught selfhypnosis techniques and given instructions on how to formulate their ownself hypnotic suggestions.

In summary, I followed similar protocol guidelines as Drs. Whorwell and Palsson. My clients responded in almost the same percentages as theirs. However, my clients tended to report symptom improvements in much less timethan it took Dr. Palsson's to report symptom relief. That may be due tosome differences in suggestions. I used both gut specific direct suggestions and gut specific Ericsonian type metaphors. 

There is no doubt in the world literature that hypnosis is a valid and valuable therapy for IBS symptoms.  In today's climate of managed care, hypnosis represents a brief therapy which is benign, inexpensive and non-invasive. Since IBS symptoms fluctuate, you must evaluate the results over a long period of time. It appears that the greater number ofsessions, the longer lasting relief the client gets.

This represents a relatively new market for the hypnotherapist in the US, one in which everyone wins. The therapist has more clients to treat, the client gains relief from symptoms maybe for the first time and the insurance companies have a valid brief therapy.