First published in What Doctor’s Don’t Tell You Magazine.
Irritable Bowel Syndrome (IBS) is a debilitating and upsetting condition affecting 10-20% of the UK population at any time – probably more suffering who do not report to their GP. It is characterised by abdominal pain, bloating, altered bowel movements including diarrhoea and constipation – often with a see-saw between the two.
IBS is a problem of bowel function rather than structure and as a result, there is nothing abnormal to find during many medical investigations. Rather stress-related changes in the gut environment – altered probiotic bacteria and gut serotonin levels – are investigated by alternative practitioners and the smooth gut muscle seizure or spasms experienced seen to be a struggle to find ‘normal’. With many studies showing a physical yoga practice to help reduce stress (Yoga Therapy Today, 2006; 2:23–25), many are turning to this self-regulatory route for effective help.
In a culture where we can tend to live up in our heads, voices from our bellies often go unheard. Symptoms are often suppressed by medications or not viewed as relating to our lifestyles, yet we are subject to much psycho-social stress – from job, family and home worries and demands – which is felt and expressed in our physical body. If thinking rather than feeling runs the show, our mind-bodies’ needs often go unmet and we can readily see this manifesting in our gut.
Your gut feelings are true
Any discussion on gut health has to include the enteric nervous system, the independent ‘second brain’ that runs through our entire digestive tract and is about the size of a cat’s brain. There is immense communication between our gut and brains which we are only beginning to understand. Only 10% is actually from the brain-to-gut with much of this responding to outside stimulus and incoming food. The majority gut-to-brain signalling is much about digestive function, but is also reporting back on our ‘gut feelings’ – how we respond to the world around us in the same way our brains do, but on a visceral, intuitive level.
The gut and the brain form from the same piece of embryonic tissue; they even share similar 90 minute sleep cycle states, with the gut showing slow-wave followed by rapid contractions and those with disturbed REM sleep showing bowel disturbances. IBS has been described as a manifestation of “derailing of the brain-gut axis” (Gut, 1997; 390-3).
With IBS shown to be a condition of nervous system, many people are turning to practices that de-stress and also reconnect to the importance of fundamental needs like rest and self-compassion. Yoga has traditionally helped IBS by recognising that dropping beneath mind-fluctuations helps us release stagnant energy rising up from the lower body and the belly. When this is blocked, symptoms of anxiety and disturbance are held in the gut (Evidence Based Complementary and Alternative Medicine, 2015; Epub ahead of print).
Any moderate physical activity ranging from 20 to 60 minutes, three times a week, has shown to improve symptom severity of IBS compared to controls that did no physical exercise (American Journal of Gastroenterology, 2011; 915-22). Adding in the specific mindfulness, breathing and self-compassion that an embodied yoga practice can bring, can only enhance these effects on the nervous system and reducing IBS symptoms.
Although yoga studies showing reduced stress responses are many, those relating directly to IBS are few. A 2006 clinical trial (Pain Research and Management, 2006;217–224) studied the effects of yoga on IBS; although small at 25 participants, the results were promising. Over only four weeks with an hour’s weekly asana based class and a daily home video, those in the yoga group experienced less anxiety, avoidance behaviour and disability than those in the control group on a waiting list.
Another study focused on men with diarrhoea-predominant IBS with half receiving the medication lopermamide (Imodium) and the other half practising 12 yoga poses and a specific breathing practice twice a day for two months (Applied Psychophysiology and Biofeedback, 2004;9-33). Both groups showed a significant decrease in gastro-intestinal (GI) symptoms and anxiety, but whilst the lopermamide group displayed increased GI activity, the yoga group showed increased parasympathetic (calming) activity believed to be the cause of symptom relief and leading the researchers to conclude that yoga may be more the more beneficial treatment.
Modern postural habits
With so much information about our well-being travelling from gut to brain, any postural shifts that allow the digestion to function with less stress may have implications back to our ability to ‘still the mind’. Modern tendencies to hunch or slouch put pressure on the digestive organs with little opportunity for stretching or twisting them, which makes the digestive process physically more difficult.
Considerations for constipation
Bowel muscle needs toning as any other and sedentary habits and poor core muscle function and regulation can affect its motor ability and circulation, often one of the contributing factors to constipation. This is particularly true when the colon is routinely compressed from more sitting than standing, especially when seated positions are slumped.
Considerations for diarrhoea
Relieving chronic stress is one of the most important interventions in diarrhoea to help alleviate the autonomic reflex to defecate as part of the flight-flight-freeze response. We can see this in animals, which when frightened drop weight by emptying their bowels before running away.
Honouring your nervous system
Traditional yoga can include cleansing practices with strong abdominal breath work like kapalabhati, bastrika and nauli. These need to be taught and practised with sensitivity to postural and digestive issues and may be too strong for those with chronic stress whose digestive muscles may tend to seizure (constipation) and/or spasm (diarrhoea). If you attend classes where these are taught, talk to your teacher about their safety and how to moderate.
Stretching, compressing and twisting of the GI tract and viscera (organs) are a large part of supporting digestive health within yoga traditions. These are often related to specific asanas for the second chakra under the navel (svadisthana), represented by the colour orange and said to be the seat of emotion, where we can store feelings that have arisen from experiences. This correlates with neuroscientific research into how somatic markers (body state memories associated with previous feeling states) are set from positive or negative emotional responses being associated with gut reactions in similar situations. According to this theory, these body loops may play a part not only in how somebody feels at a given moment, but may also influence future planning and intuitive decision like whether we feel safe with particular people or suffer anxiety-related IBS at work (Nature Reviews Neuroscience, 2011;453-66). Safety via the belly is can break these cycles of stress reactive symptoms.
Specific practice for IBS support
Arrive on the ground
Supine (lying down) practices are always a great way to arrive in a practice as allow the whole body to be held by the ground, inviting release of habitual tensions we carry around holding ourselves up. They allow easy motion of the lower back to relieve core muscle tension that may be interfering with digestive muscular action. Lying also allows gravity to settle and reposition organs, often resulting in gurgling and more awareness of abdominal fluids, though may cause discomfort in those with reflux who may need to sit supported.
Spine undulations and fluidity around the sacrum
The calming parasympathetic branch of the nervous system feeds down to digestive organs via the base of the skull, an area where we can feel much tension from sitting hunched on chairs, so affecting our ability to calm and normalise contraction-release in the colon.
The practice within yoga of balancing cranio-sacral (gut to pelvis) via spine undulations such as cat/cow pose may help calming gut-brain feedback by reducing tension in the neck. These physical movements have long been associated with improving digestion in many cultural practices (eg belly dancing and kundalini yoga) and the exaggerated natural belly movement with the breath may help awareness and fluidity in the abdominal region. Daily lying spine undulations can have great benefit to those with IBS.
- Lying down, feet hip-width apart, allow the inhalation to arch your back and rise the belly, lifting the waist and moving the tailbone down towards the ground.
- With the exhalation, let the chest and belly drop as your lungs empty.
- As the motion becomes more organic and pelvic tilts send loosening waves up the whole body, allow the chin to move down the meet the chest as you breathe in and let it lift to the ceiling as you exhale.
- When this motion feels you are naturally following the movement behind each breath, you can add in some energy up from the ground by lifting the balls of the feet as you inhale and rocking on the feet to lifting the heels as you exhale.
- Continue this movement for as long as feels right, stopping to feel the ripples in the breaths that follow.
Other movements that create slide and glide around the digestive organs help to ameliorate lack of movement between organs and help soften any scar tissue. This motion also helps to loosen the hips to create more ease in the lower body.
- From seated either cross-legged or on a chair with knees apart, rotate your upper body, imaging the crown of your head drawing a circle.
- Keep your shoulders uninvolved and lift up through the spine, so the motion is directed into the hips, belly and lower back.
- Rotate in the opposite direction, noting this side may be going more ‘against the grain’ as you didn’t choose it first. Pay attention to how this feels in your belly and offer kindness there.
Stronger abdominal posture
Any stronger sequence where the feet hold up the body engage the abdominals as postural muscles with poses like downwards-facing dog (adho mukha svanasana), lunges, forward bends, wide-legged postures and twists all asking different muscle groups to lengthen and strengthen. It is crucial to focus on long and spacious breaths when postures get stronger so that the belly continues to receive the messages that strengthening doesn’t need to set off stress responses that add to IBS.
Squatting positions are natural for encouraging the muscular actions needed for bowel movements; engaging lower abdominal muscles massage the colon and remind it that it might like to get going where constipation an issue. We don’t tend to squat with modern furniture and digestion can suffer.
- Keep your heels on blocks unless you naturally squat on the floor without strain. Lift your chest to hands or reach forward to the floor if reaching your ribs through your inner thighs is difficult.
- If knee issues, sit on a chair and lift one leg at a time to emulate this motion.
Space in the front body
Back bends create space for digestion, particularly in the duodenum, the first part of the small intestine just below the breastbone where we can feel emotions intensely and the heat of heartburn. On the floor they also squeeze digestive organs for an inner massage as we breathe. Opening up the psoas muscle that connects the legs to the torso and runs through the inner thighs, hips and groin helps relieve compression in the colon and encourages lymphatic flow that helps elimination processes. Any focussed attention on individual organs and ‘gut feelings’ may help a mindful yoga practice to cultivate positive feedback loops from the gut to the brain.
- Find your arm position in cobra pose (bhujangasana), according to where your lower back feels comfortable. If elbows under shoulders creates pinching, move them further forward.
- An alternative for happy lower backs and staying to breathe into helpful pressure in the belly is folding the arms in front of you. Keep lifting the breastbone (not the chin) to lengthen the spine and let the belly go.
- Open the psoas muscle on each side in turn by coming to the ground and lifting each leg out to the side, feeling opening through the opposite front thigh and up into the belly.
- If you feel release into the groin, you may feel able to rise up onto your arms and stay with spacious breath that tells the body this is not a stressful place to be.
- You may have the room to open out the bent leg, having the option to bring chest to the floor if lifting it compresses the lower back.
- Come to the other side and end with bow pose (dhanurasana) to open the whole front body together, rocking across the belly with your breath.
Creating a ‘safe cave’ into your belly
Holding inversions and forward-bends helps reposition and compress the digestive organs to stimulate and modulate correct action.
- Come to downwards-facing dog to neutralise the spine after back bending.
- Using a bolster (or stack of folded blankets) raise just the pelvis up to create an inversion and bring the knees in towards the chest towards the armpits, allowing the tailbone to lift to create a cave into the belly. Breathe release into the jaw and base of the skull to invite full-body release.
- You can open up the legs into an inverted version of a forward bend (paschimottanasana) where the back body can be lengthened with less strain on the lower back.
Resetting the lower back
- Lay over your bolster or blankets to position them across your lower abdomen (between your hip bones) so that when you lay down, you allow the natural curve of your lower back and your sitting bones to lift and spread, opening and relaxing the pelvic floor; crucial to its ability to support pelvic and digestive organs without over-gripping.
- Rest with your head either side and then roll over into savasana (corpse pose) with bolster under your knees for full relaxation with softness in the lower back.
- Feel your breath creating subtle natural rises and falls in your belly and offer yourself compassion there, to your centre.
Need more guidance?
As a Nutritional Therapist, Charlotte offers one-on-one consultations. Offering guidance in sessions catered to your needs, Charlotte specialises in eating habits and IBS. Consultations may take place in person, on the phone, or over Skype. More information concerning consultations can be found here.
Charlotte also offers packages full of tips for a healthier lifestyle. Including e-books and audio books, exercise guides and meal plans, they are a perfect way to change your lifestyle in a comfortable, self-paced process. To view the range and price of Charlotte’s packages, click here.