By Professor Peter J Whorwell
Irritable bowel Syndrome (IBS) does not have a single cause and results from a number of factors acting in combination to bring about symptoms. These include abnormal muscular activity of the gut, increased sensitivity of the lining of the bowel, imbalance of the gut bacteria, psychological issues and food intolerances.
At present, we do not have a single treatment that controls all these different factors and consequently, different symptoms often require different treatment approaches. In addition, combinations of treatment are often required such as dietary modification, anti-spasm drugs for pain and laxatives for constipation or anti-diarrhoea drugs for diarrhoea. In some patients antidepressants can be very effective and new medications are being developed which hopefully will give us even better control over IBS in the future. Fortunately, the majority of patients respond to these conventional approaches to managing IBS and don’t require any further help with their symptoms.
However, a small proportion of patients do not respond to conventional treatment and often gradually get worse as time goes by. It is for this group of sufferers that, many years ago, we developed gut focused hypnotherapy. We all know, from personal experience, that there is a strong link between our brain and our gut. For instance, butterflies in the tummy when we are nervous. The idea behind gut focused hypnotherapy is that instead of this connection between brain and gut usually being negative we exploit it in a positive way and enable the patient to exert control over our gut in order to make it work more normally.
Hypnosis is a technique for producing a state of deep relaxation to the extent that a person can develop the ability to control bodily functions which we are not usually able control. For instance, people can learn to control blood pressure or pain and, with respect to treating IBS, the function of their gastrointestinal system. Over the years, we and others have shown that with the use of hypnosis people can learn to control the amount of acid made by the stomach, the muscular contractions of the bowel, the sensitivity of the gut and even the way the brain processes pain signals from the body. In addition, hypnosis has the advantage that it can also reduce stress and anxiety which, although not the cause of IBS, can certainly make it worse.
Over the years, we have shown that gut focused hypnotherapy can improve the symptoms of IBS in approximately 70% of IBS patients who have not responded to any other previous treatment. In addition, it helps all the different symptoms from which many severe IBS patients suffer, such as back pain, constant tiredness and nausea. Fortunately, the benefits of hypnotherapy are long lasting and therefore patients don’t have to keep coming back for more treatment. Furthermore, hypnotherapy has absolutely no side effects. Interestingly, hypnotherapy is not quite so effective in milder patients probably because they can get their symptoms under control easily with medication and therefore their motivation is not so strong. Hypnotherapy is time consuming and needs a lot of practice, so the patients have to be strongly motivated and fully engaged in treatment. This is less likely to happen in those with milder symptoms or those who respond well to standard medication.
A typical session of hypnotherapy is performed on a ‘one to one’ basis and lasts approximately one hour with the patient siting in a comfortable chair opposite the therapist. Patients are taught how to control their gastrointestinal system in a variety of ways. For instance, they can use imagery such imagining their gut as a river and then learning to control the flow. Alternatively, they can use a tactile approach, such as placing their hand on their abdomen and feeling warmth, which rather like a hot water bottle, will relieve their pain. They may already have an image of their IBS in their ‘minds eye’ and we can teach them to modify that image in a positive way. Hypnosis is very good for stress and anxiety so if this is prominent that can also be dealt with. Patients are offered up to twelve sessions of treatment and are encouraged to practice the technique regularly with the help of audio recordings. Contrary to popular belief, people do not lose control when hypnotised and can’t be made to do anything against their will. At the end of the process we aim to have them more in control of their guts and their lives rather than under anybody else’s control. In addition, we don’t want them dependent on their therapist in any way and so learning self hypnosis with the aid of the recordings provided by the therapist is the key to becoming independent and self sufficient.
Patients are referred to our unit from all over the UK, so we have recently started using Skype to provide this form of treatment to save people having to travel long distances. In addition, it is useful for patients who find travelling difficult because of symptoms such as severe diarrhoea and incontinence.
A self help book which describes all the treatments available for IBS including hypnotherapy is available at: https://www.amazon.co.uk/Take-Control-your-IBS-Complete-ebook/dp/B01A7YX4HO
In conclusion, gut focused hypnotherapy offers new hope for IBS sufferers in whom conventional treatment has been a failure.
Peter J Whorwell
Professor of Medicine & Gastroenterology
Manchester M23 9LT