IBS and its physiology

Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine.
IBS is a mix of belly discomfort or pain and trouble with bowel habits: either going more or less often than normal
(diarrhea or constipation) or having a different kind of stool (thin, hard, or soft and liquid).Other names of IBS include:
Mucous colitis, Spastic colon or Nervous colon. There are four types of the condition:
1. IBS with constipation (IBS-C)
2. IBS with diarrhea (IBS-D)
3. Mixed IBS (IBS-M) alternates between constipation and diarrhea
4. Unsubtyped IBS (IBS-U) for people who don't fit into the above types
IBS isn’t life-threatening, but It is a chronic condition that you'll need to manage long term.

Symptoms
1. One of the most common symptoms is abdominal discomfort, cramping or pain. You may experience
stomach cramping after eating a meal and may get better after a bowel movement.
2. Bloating in your belly
3. Gas or flatulence: Certain foods and beverages can make symptoms worse.
4. There may be changes to your bowel habits and stool and appearance of mucus in your stool.
5. Constipation: Chronic constipation can lead to hemorrhoids or anal fissures
6. Diarrhea
7. Mucus: It is a clear liquid that protects and coats the tissues in your GI tract. With IBS, you may pass mucus
in your bowel movements, along with your stool.
8. Feeling like you still need to poop after you just did
9. Food intolerance
10. Tiredness
11. Anxiety/Depression
12. Heartburn and indigestion
13. Headaches
14. Frequent urination
15. Urinary symptoms or sexual problems.
The symptoms vary in severity and duration from person to person. However, they last at least three months for at
least three days per month. Stress can make these symptoms worse.

Causes
The precise cause of IBS isn't known. Factors that appear to play a role include:
1. Muscle contractions in the intestine: The walls of the intestines are lined with layers of muscle that contract
as they move food through your digestive tract. Contractions that are stronger and last longer than normal
can cause gas, bloating and diarrhea. Weak intestinal contractions can slow food passage and lead to hard,
dry stools. When the colon gets hypersensitive, overreacting to mild stimulation. Instead of slow, rhythmic
muscle movements, the bowel muscles spasm. That can cause diarrhea or constipation.
2. Nervous system: Abnormalities in the nerves in your digestive system may cause you to experience greater
than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between
the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive
process, resulting in pain, diarrhea or constipation. Emotional stress, anxiety, depression, and tension will
trigger IBS.
3. Severe infection: IBS can develop after a severe bout of diarrhea (gastroenteritis) caused by bacteria or a
virus.
4. Early life stress: People exposed to stressful events, especially in childhood, tend to have more symptoms of
IBS.
5. Changes in gut microbes.These include changes in bacteria, fungi and viruses, which normally reside in the
intestines and play a key role in health.
6. Because IBS happens in women much more often than in men, some believe hormones may play a role.
For e.g. symptoms are often more severe in women around the time of menstruation.
7. Diet
8. Genetic factors
Treatment
There is no cure for IBS. Treatment options for IBS aim to relieve symptoms and improve quality of life. If a person
with IBS avoids triggers, makes dietary adjustments, and follows their doctor’s advice, they can significantly reduce
the risk of flares and discomfort. In some cases, your doctor may also recommend medications, fiber supplements,
probiotic supplements, counseling, or other treatments.

Diet and Lifestyle

- Avoiding sugar alternatives in some chewing gums, diet foods, and sugar free sweets
- Not skipping meals / eating at the same time every day / Eating slowly
- Limiting alcohol intake
- Avoiding carbonated, sugary beverages, such as soda
- Limiting intake of certain fruits and vegetables that might make you gassy: beans, cabbage,citrus fruits etc
- Drinking at least 8 cups of fluid per day
- Avoiding dairy products and gluten can also reduce the risk of flares.
- Sometimes eating foods that are rich in fiber can also trigger flatulence. On the other hand, fiber can help
relieve some symptoms of IBS, including constipation. If your doctor encourages you to eat more fiber,
gradually increase your fiber intake.
- Work out: can help relieve stress and help with bowel discomfort by stimulating regular intestinal
contractions.

Medications
- Antispasmodic medications: These reduce abdominal cramping and pain by
relaxing the muscles in the gut.
- Bulk-forming laxatives: These can help a person relieve constipation.
- Antimotility medications: These can reduce diarrhea symptoms and slow down the contractions of the
intestinal muscles.

Psychological therapy: Useful in reducing IBS flares and the impact of symptoms:
- Hypnotherapy: This can help alter the way the unconscious mind responds to physical symptoms.
- Cognitive-behavioral therapy (CBT): This helps people develop strategies for reacting differently to the
condition through relaxation techniques and a positive attitude.

When to see a doctor

See your doctor if you have a persistent change in bowel habits or other signs or symptoms of IBS. They may
indicate a more serious condition, such as colon cancer. More-serious signs and symptoms include:
- Weight loss
- Diarrhea at night
- Rectal bleeding
- Iron deficiency anemia
- Unexplained vomiting
- Difficulty swallowing
- Persistent pain that isn't relieved by passing gas or a bowel movement
Yoga treatment for IBS
Yoga is an ancient technique that works on the physical as well as psychological level.Since IBS involves body-mind
imbalance, a regular yoga practice can not only help alleviate symptoms and pain relief, there is also a possibility of
managing it effectively long term.

1. Benefits
1. Studies have proven that stress is one of the most common triggers and yoga can help calm the nervous
system and lower the stress levels thus calming the irritated digestive system.
2. Specific asanas can help relieve certain symptoms of IBS like gas and bloating.
3. Yoga can also help you tolerate uncomfortable sensations.
4. Yoga increases your breath and body awareness. It will help you recognize the first signs of an episode and
make you vigilant for any change in sensation in your belly and gut. If you breathe and stay with the
sensation, your body learns to relax, even with intense feelings. This can profoundly change your
experience of the pain and keep a mild episode from becoming severe.
5. The relaxation poses at the beginning and end of the session, as well as pranayama, meditation and yoga
nidra will send a clear signal to your body and mind that it is time to slow down and shift gear towards the
healing state.
6. Yoga also affects the choices you make off the yoga mat. Developing stronger insights into what is healing,
and what is harmful to your body. You will find yourself wanting to do what is good for your body, and less
attracted to what makes your symptoms worse.
7. Not only do Asanas, Pranayamas and Meditation have a role to play, the Yamas and Niyamas also play a
role in keeping us balanced, live our life more in tune with who we are, in turn reducing conflicts, reducing
stress.

2. Different techniques: Lets see how each limb helps specifically with IBS symptoms
Asanas
Yoga asanas may help restore normal motility of the gut, improve circulation to the digestive organs and aid digestion.
Asanas also massage the different organs and strengthen them. They help regularize the organ's physical functions
and reduce effects of the disorder. When you have IBS, the contractions of your intestines may be slowed to the point
of constipation or spasming to the point of diarrhea. Some yoga poses like seated twists or prone backbends put
gentle pressure on the abdominal organs. Others, like side bends and reclining twists, release tension around the
abdomen. A well-sequenced yoga practice will send gentle pulses of compression and stretch to sensory receptors
along the digestive tract. This combination of pressure and release is believed to help balance the contractions of the
gut, whether getting things moving or slowing things down.

Pranayama
If your breathing is strained, it will reinforce your stress and symptoms. Anxiety intensifies IBS symptoms. Hence
make steady, smooth breathing the focus of your practice. Pranayamas like Deep breathing with both nostrils and
Right nostril Deep breathing is very useful for acute conditions. It will help lower your stress, relax you and right nostril
breathing will stimulate digestion.For mild IBS Bhastrika can be done. Bhastrika with Kumbhaka and right nostril
breathing with Kumbhaka to be added only when condition improves and under expert guidance. Nadi Shodhana and
Bhramari are very useful to calm the nervous system.

Mudras
Yoga Mudra and Sahaj Agnisar Mudra are both very good to circulate energy through the abdominal areas. It is highly
beneficial for all those suffering from abdominal discomfort like flatulence, constipation,nausea, etc.

Cleansing Practices/ Kriyas

Kapalbhati, Agnisar, Vaman, Lagoo Shankhaprakshalana are very useful practices to clean the colon, to stimulate
digestion and to improve gut motility. But these practices will have to be done only when the IBS is under control and
under expert guidance. During flare ups and acute IBS where the patient is weak, these cannot be performed.

Bandhas
Uddiyana bandha can be done once the aggravated IBS is under control. When there is no flare up, this can be
performed to stimulate peristalsis and to strengthen and tone the digestive organs and also to improve circulation in
the area and remove energy blocks in that area.

Yoga Nidra
Useful for physical as well as mental relaxation. Yoga nidra for stress/anxiety can be performed 3-4 times a day. IBS
specific sankalpa and visualization can go a long way in reducing discomfort and anxiety and make you positive,
facilitating healing.
Meditation
Meditation techniques will help reduce stress and induce calm. It will help tune out the clutter and distress. OM
chanting, Breath counting, Meditation on manipura chakra (OM-Ram) can be done.

Diet and Lifestyle

These play a major role in managing IBS symptoms and avoid triggers. In the acute condition, very light food (fruits,
vegetables and juices) that are very easy to digest is to be consumed.
On a regular basis, foods low in fats, low in carbs will be good. Avoid very high protein, very high fibre (some fibre is
useful), processed foods, spicy foods, junk food, fried foods, refined foods, non-vegetarian food.

3. Contraindications
Since IBS is a condition that can have acute symptoms, the patient has to proceed very cautiously step by step. In
asanas beginning only with basic movements and avoiding strong compression and twisting postures. The asanas
should be more to stimulate digestion and increase blood supply, and not to put more strain on them. Cleansing
practices should be avoided since the patient might be weak. Hence it should be included only under expert
guidance.
Food: hot, spicy, processed foods, stale food, non-vegetarian, stimulants, caffeine, alcohol etc should be avoided.

4. A general program for IBS patient (45-60 min practice)

Beginners: Only preparatory practices and basic movements to be performed initially. Pranayamas without kumbhaks
and Yoga Nidra to be done everyday.

Intermediate: Once the condition is less severe and the patient is stronger, cleansing practices as well as
pranayamas can be done with kumbhak can be done.

Preparatory Practices
Starting with Shavasana (3 mins)

Basic Movements:
Arm movements/leg movements/ joint freeing

Preparatory movements:
Single leg pavanmuktasana (dynamic - 3 rounds)
Uttanpad chakrasana (3 rounds)
Supta Udarakarshanasana (dynamic - 3 rounds)

Useful practices:
Supine:
Shava udarakarshanasana(1 min)
Pavanmuktasana both legs (2 min)
Prone:
Bhujangasana (1 min)
Shalabhasana ( 3 rounds)
Dhanurasana (30 seconds)
Makarasana (1 min)
Shashankasana (counter pose)
Sitting:
Udarasanchalanasana (3 rounds)
Akarna Dhanurasana (30 sec each side)
Paschimottanasana (1 min)
Ardha Matsyendrasana (2 mins each side)
Standing:
Trikonasana (1 min each side)
Veerasana (1 min each side)
Shavasana
Pranayama:
Deep Breathing/Suryabhedan - 5 mins
Nadi Shodhana - 5 mins
Cleansing Practices:
Kapalbhati - 5 rounds/100 per round (building it up slowly)
Agnisar - 3 to 4 rounds
Lagoo Shankhaprakshalana(1ce a week)
Optional Practices
Asanas: Uttanapadasana, Sarvangasana, Matsyasana, Vajrasana, Gomukhasana,Ushtrasana,
Marjariasana,Vakrasana, Tadasana, Kati chakrasana, Garudasana
Pranayama: Bhastrika
Cleansing practice: Neti, Vaman Dhouti

Walking -30-45 mins

Dietary recommendations to be followed

5. Yoga Nidra Sankalpa and Visualization

Sankalpa:
My body is in complete balance and harmony.My digestive system is strong and can easily digest food and emotions.

Visualization:
Bring your awareness to your abdomen. Pay attention to any sensations you feel in your abdomen. You might feel
pain, cramping or discomfort. Just breathe into the area and just soften the area. Visualize a white light coming down
from the top of your head, down the body and surrounding your abdomen. This white beam of light is filling your
abdomen with healing powers. Feel this light glowing and radiating to the surrounding muscles and organs. As you
inhale,feel the healing warmth spread and as you exhale feel the tightness in your stomach release. It is settling any
unpleasant sensations that you are feeling. Feel the space within your stomach expanding. If you have any pain,
direct this light to the area of discomfort and as you breathe out let the light absorb the pain.
Now bring your attention to your upper abdomen, the area just under the chest. This is the area where the stomach
lies. Feel the light completely relaxes the stomach. Thank and appreciate the stomach for all the work that it does in
breaking down the food that you eat. Notice a peaceful feeling in the upper abdomen. Now move your attention to the
area just above the belly button. Direct the healing light to this area. This is where the small and large intestine lies.
Feel any tension or tightness melt away under the warm light. Feel the relaxation in this area. Notice the difference
between the tension and the relaxation of your tummy. Thank the small intestine for absorbing the minerals and
nutrients in the food and keeping you healthy. Now direct the healing light to the large intestine. It has the important
job of absorbing water and removing waste from your body. The light is healing the walls of the large intestine. You
will no longer have uncomfortable sensations. You are feeling at ease.
Now feel the healing light move to the area below your navel, your lower abdomen. This is the area where the rectum
is located. Notice any sensations. Feel the healing light soothe this area. The bowels are reset to a regular pattern
and are functioning with ease.
Now feel full relaxation in your upper abdomen, mid abdomen and lower abdomen. Feel the muscles loosen and let it
all go. Feel all pain dissolved, all healed and functioning as it should.With relaxation everything flows more easily,
your breath, your digestive system, your circulation, your mental state, your thoughts, allowing your body and mind to
be free. Just exactly how you wanted to be. Imagine what it feels like to walk around with no symptoms. Picture
yourself free of all IBS symptoms. You feel healthy, happy, calm and relaxed. Feeling good that you have taken this
time to help your body heal. In this complete state of relaxation, you will repeat your sankalpa mentally, with full faith
and belief.

6. Available Research
Researches have shown that daily practice of basic yoga postures with mindful breathing can reduce both the
emotional and the physical symptoms of IBS.

Reference 1
Extensive research has been done and papers published on treatment of IBS using yogic techniques. Following is the
paper published by Vijaya Karuvi and Nagarathna Raghuram on “IBS: Yoga as a Remedial Therapy’
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438173/

As per this paper, there is evidence proving the role of stress in altering brain-gut interactions resulting in triggering
IBS. Key stressors (emotional or physical) triggers the ‘derailing of the brain gut axis. Exposure to stress affects the
Autonomic Nervous system (ANS) causing an imbalance, leading to disturbance in gut bacteria, leading to IBS.
Yogic concept of Pancha Kosha and Adhi/Vyadhi clearly explain the modern day psychosomatic disorders. Bad
lifestyle, emotional stresses, lack of exercise, addiction (smoking,alcohol) all can be traced to the mind (Manomaya
Kosha) which lead to Adhis(mental conflicts).Due to imbalance in vital life force due to these mental conflicts, there is
a disturbance in Samana and Apana energies (which are responsible for digestion and excretion). These Adhis then
lead to vyadhis(diseases) of these systems. Yoga can bring changes to Samanaya type of Adhis which are
mind-body diseases. By doing yogic practices, one can balance the disturbances of energies and help with
psychosomatic illnesses at all five levels of existence i.e. Pancha Kosha.

Reference 2
Publication by the Morarji Desai National Institute of yoga
http://www.yogamdniy.nic.in/WriteReadData/LINKS/13-Irritable%20Bowel%20Syndromeae1d7456-2fd0-458c-b09d-e
779b972afd2.pdf
Supporting the previous research, this paper also suggests that all gut functions are controlled by neural systems.Any
triggers to the nervous system (stress being one of the main) makes the nerves in the gut very sensitive and hence
triggers any/all symptoms of IBS. Since the causative factor is stress, every effort should be made to root out the
cause of stress.