Treating Irritable Bowel Syndrome (IBS) – Feeling Right

by Dr. Simcha Sheldon

This article appeared in “Connections” magazine,Israel. January 26, 2007.

With the sufganyot/latke-eating season  behind us and mishloach and Pesach on the horizon, let’s take a look at finding relief from a common medical condition related to food and eating – Irritable Bowel Syndrome (IBS). It is estimated that as many as one in five people in the United States and in the United Kingdom suffer at one time or other from IBS, and according to the Mayo Clinic, two to three times as many men as women are affected. However, since many people feel embarrassed about talking about this disorder, little is said, and unfortunately, more than half of IBS sufferers do not seek medical or psychological help. Symptoms can vary and change in quality and intensity over time. The common symptoms of IBS include: cramping, bloating, gas, diarrhea, constipation, mucus in the stool, swollen or bloated abdomen, the feeling that you have not completed the bowel movement, uncontrollable urgency to defecate, and pain.

IBS is not a disease; it is a functional disorder, meaning certain parts or the body as a whole is not functioning properly. Sometimes cramping and pain occur due to nerves which are overly sensitive to the stretching of the bowel caused by gas. Cramping and diarrhea can occur, during or shortly after a meal, due to muscles which contract too much during eating. Constipation can occur from muscles not contracting enough. Symptoms of IBS arise when the muscles of the colon, sphincters, and pelvis do not contract in the right way, thereby impeding the proper flow of stool.

Researchers are uncertain as to the cause of IBS. However, it appears that about half the IBS patients relate their onset of symptoms to a highly stressful life event, such as a serious infection, major surgery, deep depression, change of job, house, bereavement, etc. Acute gastroenteritis is reported to initiate onset of IBS for between 10%-20% of IBS patients. It can also be as a result of intentionally ignoring the body’s natural healthy communication as to when it needs to relieve itself, forcefully holding in, often for hours, and then finally trying to relieve oneself. This causes the muscles to malfunction and even lose their ability to function properly when the person wants to listen to his/her body’s messages. To alleviate this problem, hypnosis and biofeedback can be very helpful; however, the full discussion of this kind of treatment is better left for its own article.

Regardless of the causes of IBS, a variety of mental, emotional, and physical occurrences such as stress, conflict or emotional upsets; particular foods; caffeinated beverages, certain medicines, and large meals can exacerbate the IBS symptoms (NIH).

Many medical specialists agree on a holistic mind/body approach such as diet, medication, stress management, psychological counseling, behavioral therapy, cognitive therapy, guided imagery, biofeedback, meditation, exercise, counseling, hypnosis and self-hypnosis. This kind of treatment can help alleviate the distressing cycle which often arises in which the digestive system can cause pain or discomfort or other annoying symptoms, which in turn creates, increases, or contributes to the patient’s anxiety and/or depression, which then causes the physical symptoms to get more intense and more difficult to deal with, and so the cycle begins again.

Many people feel “butterflies” in their stomach before an exam, public speaking, or some other activity that is psychologically or emotionally challenging, scary, or stressful. This is the mind-body connection. A person’s negative psycho-emotional response to a real or imagined life circumstance can affect his or her physiology. It is interesting to note that some people somatize, that is, direct their psycho-emotional responses/reactions/experiences into physiological ones in different ways so pain can be exhibited in any part of the body. If an individual’s response to stress is to tighten their neck muscles, eventually they will have muscle pain or spasm in their neck. If a person tightens his/her sphincter muscles or rectum, eventually spastic colon can occur. These responses to stress are usually unconscious, and that is why mind/body self-awareness and self-mastery are so important for physical and psycho-emotional health. (Yoga, meditation, self-hypnosis are very helpful in acquiring these skills.)

In order to alleviate the symptoms, it is important for the individual who has IBS to recognize, identify, understand and decrease both the physiological and the psycho-emotional stimulus which cause the digestive system to malfunction, and instead, to create a positive, curative, and healthy mind/body environment and reality for the patient’s daily life. A nutrition specialist should be consulted regarding food and eating considerations. Of course, the IBS sufferer needs to be ready and willing to eat properly in order not to aggravate the normal functioning of the digestive system. Unfortunately, many sufferers choose to continue suffering than give up their french fries and salsa. A physician can be consulted for possible medications which can help. However, it should be noted, that many medications have undesirable side effects, and that medication does not cure IBS.

The U.S. government NIH states regarding IBS, that “doctors have found that psychological treatments like hypnosis, relaxation training or psychotherapy provide the same amount of relief — or even more — than drug therapy”. A study done by the University of Albany (New York) states, “‘Gut-directed’ hypnotherapy has a very positive impact on health-related quality of life with improvements in psychological well-being and physical symptoms.”

There are a few basic goals for psycho-therapeutic intervention. First, to learn how to create a mind-body state that allows the digestive system to be relaxed, calm, and available for normal healthy functioning. Second, to identify the triggers which cause stress, and learn how to cope with them differently, so as not to allow psycho-emotional-social difficulties to be somatocized. Third, to increase the awareness and motivation needed to eat properly and to recognize and satisfy the body’s healthy needs. Fourth, to heal any past traumas or find solutions to present life situations which are causing the body to malfunction. Fifth, to identify any ulterior motivation or benefit which may contribute to the continuation of behaviors which aggravate the IBS. Sixth, to examine the role social and familial relationships may be playing in the cycle of IBS, and to make any necessary interventions and changes in such relationship so that they do not “feed into” the problem. Seventh, to help the patient create and maintain healthy psycho-emotional-physical day-to-day life functioning.

A few important points regarding the above goals: Many of us have grown up in families or communities where eating was done in an unhealthy way. Post-Holocaust frantic ‘fressing’…unconscious eating while talking…swallowing without chewing …finishing everything on your plate no matter what… eating to receive or give love … anxiety around food… steady high fat high salt chulent, ‘yeshiva bocher’ stomach, etc.  Some use IBS symptoms to manipulate their environment, gain attention, have an excuse for not taking care of responsibilities, or being on time. Most of us have to recondition ourselves to be able to do ‘mindful eating’, and have a conscious and positive relationship with our bodies, as the Rambam prescribes.

Hypnosis is particularly helpful for retraining the muscles to perform properly. It can be used to identify stressors and triggers, change negative reactions into positive ones, identify and heal past traumas, and identify unconscious destructive motivations and create positive mind-body sets. Self-hypnosis is an effective tool for IBS patients to improve their eating habits, relationship to food, reduce stress, actually improve their digestive tract’s functionality, and eliminate destructive thought patterns. Although some choose physical pain over emotional awareness of painful aspects of their lives, those who are brave and hopeful, with the proper guidance, can lessen the physical pain and improve their lives.

As we say in Birkat Hamazon, “and you shall eat, and be satisfied, and bless…”, I believe that this bracha is not just about having the food, but it is about being able to eat in a way that we can truly feel satisfied, then we can eat healthfully and have much to thank Hashem for. Our bodies are considered a kli of our neshama. As we continue to remember our celebrations of Chanuka, may we rededicate our bodies to maintaining a healthy lifestyle. Betayavon!

Dr. Simcha Sheldon is a U.S. Licensed & Israeli Certified Marriage, Family, and Child Therapist, an Israeli licensed Clinical Psychologist, Medical Psychologist, and Hypnotherapist, and Clinical Member of the Israeli Society for Sexual Medicine, Israel Medical Association. Dr. Sheldon practices in Hashmonaim and Modiin. (08-976-1056). www.drsimcha.com

Please feel welcome to call me regarding any questions that you may have or to schedule an appointment.

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Important for you to know

Winning the struggle with eating and food can be relatively easy if you go about the right way.

The way that I help people does not require a “die-et” – in fact you don’t need to feel that you are giving up anything important.

In fact you will gain – self-esteem, self-mastery, increased health, enhanced appearance and extra social benefits.

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