Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) describes a collection of symptoms, commonly including chronic abdominal pain, bloating, flatulence and altered bowel habits. It is a functional disorder of the intestines, occurring in the absence of visible structural abnormality.

IBS affects up to 22% of people in the UK (Maxwell 1997) and is the most common functional digestive disorder seen by GPs. Women are 2-3 times more likely to develop IBS, and often suffer more symptoms during their periods. The condition often begins in adolescence or early adulthood. Predisposing factors may include a low-fibre diet, emotional stress, use of laxatives or a bout of infectious diarrhoea. It is typically a chronic, recurrent disorder, associated with substantial health, social and economic costs. Pain and impairment from IBS can lead to frequent doctor visits, hospitalizations and workplace absenteeism, and can cause depression.

The cause of IBS is unclear, but it appears that sensory nerves in the bowel are hypersensitive in people with IBS and may overreact when the bowel wall stretches. Intestinal muscles can be hypo- or hyperactive, causing pain, cramping, flatulence, sudden bouts of diarrhea, and/or constipation. The symptoms are usually triggered by stress or eating. Systematic reviews of the research literature suggest that conventional medications are of limited benefit in IBS (Akehurst 2001).

References

Akehurst R, Kaltenthaler E. Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut. 2001 Feb;48(2):272-82.

Maxwell PR et al. Irritable bowel syndrome. Lancet. 1997 Dec 6;350(9092):1691-5.

How acupuncture can help

Research has shown that acupuncture treatment may benefit IBS symptoms by:

• Providing pain relief (Pomeranz 1987).
• Regulating the motility of the digestive tract (Yin 2010, Chen 2008).
• Raising the sensory threshold of the gut. Various possible mechanisms have been identified, involving spinal nerves and NMDA receptors and a range of neurotransmitters (Xu 2009, Ma 2009, Tian 2008, Tian 2006, Xing 2004). A lowered threshold to bowel pain and distention are hallmarks of IBS.
• Increasing parasympathetic tone (Schneider 2007b). Stress activates the sympathetic nervous system, which can stimulate colon spasms, resulting in abdominal discomfort. In people with IBS, the colon can be oversensitive to the smallest amount of conflict or stress. Acupuncture activates the opposing parasympathetic nervous system, which initiates the relaxation or ‘rest and digest’ response.
• Reducing anxiety and depression (Samuels 2008). The distress provoked by IBS symptoms can lead to a vicious cycle of anxiety-pain-anxiety, while the embarrassing nature of the condition can lead to feelings of depression. Acupuncture can alter the brain’s mood chemistry, increases production of serotonin and endorphins (Han 2004), helping to combat these negative affective states.

There is consistent evidence that a course of acupuncture improves IBS symptoms and general wellbeing (Anastasi 2009, Trujillo 2008, Reynolds 2008, Schneider 2007b, Xing 2004, Lu 2000), though there are arguments about the extent to which the effect is placebo-related (Lembo 2009, Schneider 2007a, Lim 2006, Forbes 2005). As yet there is no satisfactory placebo/sham intervention for acupuncture so this is still a matter for conjecture. There are plausible physiological explanations for acupuncture’s effects (see above) and it can promote mechanisms not seen with sham treatments (Schneider 2007b).

Acupuncture can be safely and effectively combined with Western biomedicine, and other treatments such as relaxation exercises, herbal medicine and psychotherapy. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be helpful in combating IBS symptoms. Working with a supportive therapist can also help people suffering from IBS to change their negative health beliefs and improve their coping mechanisms, which can have a positive influence on both mood and symptoms.

Full details of research studies into traditional acupuncture treatment for IBS can be found overleaf.