The Irritable Bowel Syndrome (IBS): it used to be referred to as a spastic colon considering that it caused spasms or cramps in the bowel. Some people confuse it with Crohn's disease or with Colitis Ulcerosa, as the symptoms are very similar and can even overlap. The Belgian pharmaceutical firm Trenker organized a study day about the irritable bowel syndrome after the launch of their new probiotic "Cerevisia" next to their earlier product "Imutis". With this study day in mind, I would like to share some reflections.
Symptoms of the irritable bowel syndrome
The most common symptoms are bloating in the stomach and intestinal pain or stomach aches, sometimes including intestinal cramps or possibly diarrhea. For most patients, the complaints worsen in periods where they experience a lot of stress. That is why one could call this illness a psychosomatic disorder: an illness which has a physical cause, while often being triggered by psychological stress.
Irritable bowel syndrome: probiotic treatment
The study by Trenker shows that their probiotic Saccharomyces Cerevisiae CNCM I-3856, under the trade name "Cerevisia" can reduce the intestinal pain for a number of patients. The way in which it works seems to be that the type of bacteria stimulates the receptor PPAR in the intestinal wall by being present. This PPAR-receptor is active in pain relief in the bowel, as it responds to the body's own pain relieving "endorphins". Furthermore, the activation of this receptor lessens the susceptibility to irritation in general. A third effect of activating this receptor, is the decrease in infection reactions of the bowel. Such reactions to infection are namely often the cause of diarrhea. Endorphins are pain relieving chemicals which we produce ourselves. (Morphine is a chemical product which stimulates the same receptors but has many side effects as it is not as specific as our own internal regulation mechanism is). This study mainly found evidence in research done on mice, but there are indications that this should work in humans, too. This is therefore the first time that people gain insight in how probiotics could aid the recovery from the irritable bowel syndrome. A disadvantage of the probiotic treatment is that it only works for 7 days at a time, so if you do not supplement this treatment with other types of treatment, you will be dependent on probiotics for the rest of your life, which will become costly with time. As it is, the effect has only been studied and shown with Cerevisia, but this does not mean that other probiotics, kefir or yogurt cannot have similar effects in the future. Thus, if you want to play it safe, it is best to start with Cerevisia for the time being, but if your doctor agrees you could also experiment with other probiotics, or even yogurt or kefir.
Irritable bowel syndrome: stress management as treatment
Considering that stress can trigger or worsen dormant complaints, stress management is a very important part of IBS treatment. If you learn to form your life in such a way that your daily stress is reduced, the periods in which you suffer from the irritable bowel syndrome will reduce in frequency, as will the intensity of the complaints. If you want to know if stress management might be of help to you, we recommend you to take the online self-test on this website. If your score is in the red or orange alarm zone for tension and anxiety, it is extremely likely that stress support will help you to decrease your symptoms. We recommend you to, in that case, follow treatment until you manage to get a 'green' score for at least three consecutive months.
Irritable bowel syndrome: treatment with hypnotherapy
It has been known for years that hypnosis or hypnotherapy is one of the most successful treatment methods for the irritable bowel syndrome. In most cases, your hypnotherapist will combine hypnosis with teaching of self-hypnosis techniques. The exact mechanism making hypnosis effective in the treatment of irritable bowel syndrome has not yet become clear. We believe that there are two main mechanisms at play in treatment through hypnosis. First off, hypnosis and especially self-hypnosis helps to reduce your general stress level, in the same way that any other type of therapy, stress guidance or online self-help would. Secondly, there are suspicions that hypnosis can help produce endogenous "endorphins", meaning that it is possible that the same type of receptors as, for example, the abovementioned PPAR receptor, are activated. Of course, further research will be required to test whether or not this hypothesis is supported. The effect of hypnotherapy is present in a more long-term timeframe than the effect of probiotics.
Irritable bowel syndrome: treatment using online self-help programs
Good online self-help programs will teach you to reduce stress via the internet, so that you need not leave your house. This stress reduction will mean that the intestinal lining becomes less easily and/or less frequently irritated. Good self-help programs also teach you several self-hypnosis techniques, so if you have the discipline to spend fifteen minutes per day to work on yourself, this most definitely is a valuable way to get started. If you find that you need more help afterwards, you can always contact a hypnotherapist. Having the earlier experience with self-hypnosis techniques, the amount of hypnotherapy sessions needed will probably be lower than it would have been without prior experience.
To summarize: we can state that it is useful to start treatment with probiotics, combined with stress guidance in the form of online self-help or with the help of a doctor, psychotherapist or psychologist. If you notice after some time that this alone is not enough, hypnotherapy is recommended. When you have gained control over your symproms, you can speak to your doctor and evaluate whether you should reduce, stop taking, or keep taking the probiotics. By starting off with a combination of probiotics and stress guidance, you increase the chances that your intestinal lining will settle quickly. After it settles, you can decide with your doctor which treatment can be reduced.
Self-test for irritable bowel syndrome
Would you like to know whether stress, tension, anxiety, or even depressed feelings play a role in your irritable bowel syndrome? Then you can simply test this by filling out an easy test with 21 short questions.
Paul Koeck, MD