Some physical or somatic diseases are believed to have a psychological component derived from everyday stress. Common disorders are: Irritable bowel syndrome or IBS, migraines, asthma, and teeth-grinding (bruxism).
A very common and typical psychosomatic disorder is irritable bowel syndrome. Continue reading to find out more about its symptoms, cause and therapy.
An example of a psychosomatic disorder:
Irritable Bowel Syndrome (IBS)
Functional Gastrointestinal Disorders are Disorders of Gut Brain Interaction
We already know it from colloquial language that there is an interaction between the brain and the gut. For example, we say:
- She has butterflies in her stomach.
- That affects my stomach.
- I have a belly full of this.
- That upsets my stomach.
And many of us know this gut brain interaction from practical experience. Having to go to the bathroom urgently before an important exam? Or having abdominal pain after an angry outburst?
Research has supported this connection between emotional states and stress and the gut, and we call it the gut brain axis.
Stress can lead to the release of stress hormones (such as adrenaline and cortisol) and activate the autonomic nervous system, sending signals to the cells in the gastrointestinal tract.
On the other side there are also signals going up from the gut to the brain. Scientific research has found that the gut contains a significant number of nerve cells. This number of neurons is so high that we call it the brain-gut or the enteric nervous system. In healthy individuals, most of these input from the gut to the brain is not consciously perceived but in IBS patients this conscious perception of afferent information from the gut can occur in the form of discomfort or pain.
A person with a disorder of the gut brain interaction may experience problems with the following:
- Motility disturbance: The movement of food and waste through the GI tract
- Visceral hypersensitivity: Heightened experience of pain in the internal organs
- Altered mucosal and immune function: Changes in the gut’s immune defenses
- Altered gut microbiota: Changes in the community of bacteria in the gut (altered gut microbiota)
- Altered central nervous system processing: Changes in how the brain sends and receives from the gut
Overview of IBS
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by chronic abdominal pain or cramps, and altered bowel functioning (diarrhea and/or obstipation). Other gastrointestinal symptoms include bloating and gas.
It affects about 16% of the Malaysian population, and is twice as common in women as in men. Most of those suffering IBS have mild symptoms, but there is still a substantial number of patients with severe symptoms with considerable impairment of functioning in daily life, and loss of work and school days.
- chronic abdominal distress or pain
- altered bowel habits
- Urgency: need to rush to WC, often after eating
- feeling that rectum is still full after bowel movement
- bloating (flatulence, belching, excess gas)
- mucus in the stools
- sometimes nausea, reflux, pack pain
The cause of IBS is unknown and to date no specific abnormality or structural changes of the gut has been found in IBS patients. Although the pathophysiology is unclear, IBS may be explained by a combination of both physiological and psychological factors. Some of the factors involve the smooth muscles that contract to move food through the intestines, and others involve abnormalities in the nervous system regulating the digestion, such as an overreaction to the stretches of the gut caused by gas or stool.
There are several psychological factors that predict whether somebody will get IBS or not: Anxiety, depression, high levels of psychological distress, and sleep problems are risk factors for IBS. Stress and negative emotions might influence the functioning of the intestine. Scientific research has shown that stress can change the motility (movement of the intestine and the content within), sensitivity, and permeability of the intestine.
To diagnose IBS your doctor will take your complete medical history, do a physical exam and do additional tests to rule out other conditions (e. g. gluten intolerance). A set of commonly used diagnostic criteria for IBS are the Rome IV Criteria:
Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
- Related to defecation
- Associated with a change in frequency of stool
- Associated with a change in form (appearance) of stool.
Some additional imaging tests may be necessary to diagnose IBS, for example x-ray, gastroscopy, colonoscopy or a CT scan. Your doctor may also ask for laboratory tests such as lactose intolerance test or stool tests.
Finding ways to manage stress may help ease the symptoms of IBS. A general approach to treat IBS includes:
- Psychotherapy and counseling
- Medical hypnosis
- Relaxation techniques
- Change of diet: Avoid high-gas foods, gluten, FODMAPs
- Physical activity
- Medication based on your symptoms
Partially because the precise cause of IBS is not known, conventional treatment has proven difficult. Usually the initial therapy starts with education of the patient about the nature of IBS, reassurance that IBS is a benign condition, advice about diet (e.g. exclusion of gas-producing foods) and physical activity.
Medications target symptoms such as pain, bloating, diarrhea, and constipation but show little evidence of effectiveness for IBS therapy.
Psychological treatments have proven a promising alternative therapy compared to standard medical care for severe IBS. Of all the tested psychological therapies, cognitive-behavioural therapy and hypnotherapy have been best backed by scientific evidence.
There is a large body of scientific evidence that shows that medical hypnosis is effective in most IBS patients and reduces all of the central symptoms of IBS (pain, diarrhea, constipation, and bloating).
To know more about how medical hypnosis helps patients with irritable bowel syndrome, click here.