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Yoga Therapy for Irritable Bowel Syndrome (2 CE Hours)

This course is approved for 2 hours of Continuing Education for Yoga Therapists and Yoga Teachers by the Yoga Alliance.

Learning Objectives: After reading this course, you will be able...

  1. to describe the pathophysiology of Irritable Bowel Syndrome and common digestive disorders.
  2. to describe the current medical intervention for Irritable Bowel Syndrome and common digestive disorders.
  3. to discuss the current research related to yoga for Irritable Bowel Syndrome and common digestive disorders.
  4. to list the benefits and risks of yoga therapy related to Irritable Bowel Syndrome and common digestive disorders.
  5. to practice specific yoga asanas designed to provide optimal benefit and minimal risk for people with Irritable Bowel Syndrome and common digestive disorders.
  6. to practice specific breathing and meditation techniques beneficial for people with digestive disorders.
  7. to provide a yoga practice designed for for a person with Irritable Bowel Syndrome.

Introduction to Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder. It is characterized by chronic abdominal pain or discomfort and altered bowel habits. The symptom-based criteria for the diagnosis of IBS comprise recurrent abdominal pain or discomfort, at least 3 days per month in the past 3 months, and at least 2 of the following:
• improvement of pain with defecation
• onset associated with a change in frequency of stool, or
• onset associated with a change in form (appearance) of stool.

With an estimated prevalence of 12% in the general population, IBS is a fairly common reason for seeking medical care. (1) Annual cost of IBS could be as high as $20 billion.(19)

Complex neurophysiological and psychological pathways underlie the experience of IBS. It is now generally recognized that intimate interconnections exist between the enteric motor system (smooth muscle of the gut) and the central nervous system, termed the brain-gut axis. These interconnections are involved in an altered perception of visceral events, the hallmark of IBS. Although small intestinal bacterial overgrowth has been implicated in alterations in brain-gut communication, visceral hyperalgesia (increased pain sensitivity) and gut motility remain the primary “biomarkers” for the condition. (20)

The current approach to treatment emphasizes education, dietary modification, stress management and medications. (2)

Current medication therapy is of limited benefit. Tricyclic antidepressants are supported by clinical evidence, but there is less solid evidence supporting the use of antispasmodics or selective serotonin reuptake inhibitor antidepressants. Agents targeting serotonin subtypes are not widely used due to the potential risks. (3)

Based on low levels of satisfaction both with the treatment they receive and their
overall care, up to 50% of IBS patients turn to complementary and alternative medicine (CAM) therapies. (4)

Complementary Althernative Therapies for Irritable Bowel Syndrome

Fiber

Usually the first recommendation given to people with IBS is to increase fiber in their diet. This complementary intervention was first introduced in 1977 when researchers demonstrated that it benefited 26 patients. (5) Since then, it has been shown to provide relief of IBS symptoms. Soluble fiber, usually administered as psyllium, forms a gel in water and ferments in the colon, which causes increased intestinal motility, decreased gut transit time and intracolonic pressure. Insoluble fiber, like wheat bran, retains water, which increases stool bulk and decreases gut transit time. (6) A number of studies have demonstrated that increasing dietary fiber improves global IBS symptoms, especially reducing constipation. (7)

Herbal Remedies

Peppermint oil has been used to treat stomach upset for thousands of years. Its mechanism of action appears to be relaxation of the intestinal smooth muscle. (8) Several studies have reported the benefits of peppermint oil for IBS symptom relief. Dosage of 3-6 enteric coated capsules of peppermint oil taken daily has been shown to relieve IBS symptoms, including abdominal pain. (9)

Other herbal remedies are commonly used to treat IBS symptoms. Tong xie yao fang is a Traditional Chinese Medicine (TCM) herbal formula that has been shown to have some therapeutic effect. (10)

A Tibetian herbal formula, Padma Lax, has been used in Europe for decades. It has also been shown to provide relief of IBS symptoms. (11)

Two other herbal formulas, STW 5 and STW 5-II, have demostrated decrease in abdominal pain and global IBS symptoms.

Overall, herbal remedies have demonstrated improvement in global IBS symptoms, including abdominal pain, and produce slight side-effects (like nausea) in only 3% of users. (12)

Probiotics

Probiotics are defined as live organisms that, when ingested in adequate amounts, exert a health benefit on the host. Probiotics may act in several ways that are not yet completely understood. They alter the chemical physiology inside the gut, producing beneficial short-chain fatty acids and deconjugating bile acids, and limit the growth of pathogenic bacteria by direct competition. They also exert potent anti-inflammatory effects, modulating cytokine expression by interacting with gut-associated lymphoid tissue. This immunomodulatory effect also decreases the visceral hypersensitivity characteristic of IBS.

A recent systematic review and meta-analysis of 23 trials involving 1404 patients found improvement in global IBS symptoms and abdominal pain compared with placebo. (13) This encouraging finding is somewhat limited by the heterogeneous
organisms, strains, and doses used. Strains of Lactobacillus or Bifidobacterium are more prevalent in research and in clinical practice, but there is insufficient
evidence to support the use of one strain over another. Patients should be encouraged to consume more probiotic-rich foods or supplementation with capsules or powders. It is difficult to advise patients about specific products, as commercial probiotics vary widely in terms of strains used, quality, and the ability to deliver adequate numbers of live bacteria to the colon. Daily oral doses of 10 to 100 billion bacteria are most common.

Mind-Body Therapies

Brain-gut interactions are increasingly recognized in the pathogenesis of IBS, and almost half of IBS patients have comorbid psychiatric disorders. This makes mind-body medicine an appealing approach to IBS treatment. A recent systematic review of psychological treatments included controlled trials of hypnotherapy, cognitive-behavioural therapy (CBT), biofeedback therapy, progressive muscle relaxation, relaxation, and stress management.52 Of these, hypnotherapy and CBT are supported by the strongest evidence.

Gut-directed hypnotherapy is a specific technique that combines suggestions related to emotional well-being and intestinal health. There is strong evidence supporting the use of hypnotherapy for the treatment of IBS. (15) It has also been shown to be safe and have potential long-term benefits. (16) It is reasonable to advise patients to consider a trial of hypnotherapy with a therapist trained in gut-directed hypnotherapy.

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