IBS and Physio
In IBS and Physio Part 1 we discussed the peripheral (close to the outside :-)) aspects of bowel control. However the big dude in all of this is….the BRAIN!
As mentioned before, IBS is a functional gastrointestinal (GI) disorder; considered a disorder of ‘Gut-Brain’ interaction. This most important and fastest route between the gut and the brain is via the vagus nerve.
The vagus nerve runs from the brain, to the neck, the oesophagus, heart, between the lungs and through the diaphragm to the gut (Enders 2017). It is complex and fascinating beyond belief. Not to mention beyond the scope of this BLOG (and my mind), but I thought a brief intro necessary.
So, the vagus nerve tells the brain about things going on down in the gut that otherwise it would not have a clue about. It works via two-way communication. Meaning that messages come down from the brain that influence gut activity. And messages go up from the gut that influence the brain.
This process is responsible for that ‘gut feeling’ we get, ‘butterflies’ in your tummy, the pleasant feeling we get from a full stomach. As well as the unease we feel when we are hungry (or hangry!) and the grizzle we may feel if we have wind. If you consider those feelings carefully, you can see this is a very predominant communication system in babies, but it continues throughout adulthood.
Therefore the gut, with more than 100 million nerve cells, is known as the Second Brain for good reason. It is the message centre telling us about how our immune system is working, delivering information about chemicals or bacteria in our gut. These messages are what make us feel sick when we have ingested a contaminated food or bug.
Research is still in its infancy, but we are starting to understand how these changes in the gut can influence the mind. A diverse population of healthy gut bacteria is associated with increased wellbeing in some chronic conditions and has been shown to reduce stress hormones. Studies have shown that variations in gut bacteria can alter the area of the brain involved in pain perception and emotions. This all relates to why pre and probiotics have become popular.
The gut brain connection also appears to contribute to mood change. It has been shown that when a balloon is inflated in the gut of a person without a bowel condition, the person is not aware of this balloon. When the balloon was inflated in a person with IBS, there were emotional changes picked up via brain imaging and unpleasant feelings described in the subjects. As a result, it is hypothesised that an IBS flare can actually cause your mood to change and vice versa.
Working ‘vice versa’ ….. If you are experiencing anxiety/depression/low mood, these periods of stress can, via the vagus nerve, alter the bowel. As part of the stress response in the body blood supply is reduced and directed elsewhere, contributing to poor circulation in the area and less digestive juice production. If this continues over a long period of time it may contribute to weakening of the walls of the gut, increasing sensitivity and therefore IBS symptoms.
Research in mice has seen this go further with personality types changing depending on gut bacteria. In species of mice with 2 very different personalities, it was found that introducing the gut bacteria of one species into the other resulted in the mice demonstrating the personality traits of the other species. Similar has been shown to occur in mice with diabetes, depressive tendencies and obesity. AMAZING!
Why is this important to Physiotherapists?
So then, IBS and Physio, let’s get down to it.
Research indicates that in humans those with IBS have reduced vagal tone, or reduced function of the vagus nerve (Pellissier et al 2014). As we can see from above, if the vagus nerve isn’t functioning well, neither will the gut. The great news is we can influence the vagus nerve, stress response and therefore potentially the interaction with the gut.
We can improve vagal nerve function (or tone) with exercise; particularly interval training (Kai et al. 2016) , breathing exercises, relaxation and mindful practices (Mankas et al. 2013) . Even singing or laughing can help! You can also work towards calming the nervous system using hands on therapies like massage or reflexology. Acupuncture is also thought to be very effective in calming the mind and therefore the body.
As a specialist pelvic health physio I teach my patients specific vagal breathing exercises (deep and slow and from the belly). I encourage exercise using intervals/rest periods, of any type that the patient enjoys and can easily manage in order to stimulate the vagal nerve. This may just be a simple sit to stand exercise out of a chair, or it may be swimming, or walking, or cycling, or even dancing :). And I always include ‘brain physio’ (a blog for another time;) ) encouraging mindfulness to help manage stress. I personally enjoy using the ‘Headspace app’ and find it very helpful.
Manage Your Stress
Managing stress in our lives can have wide ranging benefits, not just on the bowel but on immune function, mood and sleep. This can have a positive effect on all pain conditions.
Whether it is IBS, or other chronic pelvic pain problems such as endometriosis, or bladder pain syndrome/interstitial cystitis, if you feel you would benefit from discussing your wellbeing needs, then contact me:
Via the website – https://www.georginabailey.co.uk/
Via facebook – https://www.facebook.com/georginabaileyphysio/
Or email me at – firstname.lastname@example.org
Specialist Pelvic Health Physiotherapist
If you would like an introduction to the gut with an easy, entertaining, informative read, I’d recommend:
‘Gut’ - the inside story of our body’s most under-rated organ, by Guilia Enders. Scribe. 2017.
Drossman DA, et al 2016. Rome IV, the functional gastrointestinal disorders. Gastroenterology; 150:1262–1279
Enders, G. 2017. Gut - the inside story of our body’s most under-rated organ. Scribe-London
Kai et al 2016. Effectiveness of Moderate Intensity Interval Training as an Index of Autonomic Nervous Activity. Rehabilitation Research and Practice. Article ID 6209671
Mankus AM, Aldao A, Kerns C, Mayville EW, Mennin DS 2013. Mindfulness and heart rate variability in individuals with high and low generalized anxiety symptoms. Behavioural Research and Therapy Journal;51:386-91.
Pellissier et al. 2014. Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative effects in Chrohns disease and irritable bowel syndrome. PLoS One; sep 10;9(9):e105328