Noba

The article has been published by the National Competence Service for Functional Gastrointestinal Diseases at Health Bergen in Norway. Through our collaboration, we pass on this article, as it is relevant to all Noba users.

IBS is a complex condition. Most people with IBS experience more problems than just digestive issues and abdominal pain. Multiple body systems, such as the nervous system, immune system, and hormonal system, are often affected, which often results in a variety of symptoms. This is why every IBS patient is DIFFERENT and thus UNIQUE. Consequently, it is very difficult to find a single solution or specific treatment that suits everyone.

This is frustrating for both patients and healthcare providers. Patients with IBS will find that their condition is influenced by many factors, not limited to biological and physical factors, but also social, psychological, cognitive, and environmental factors. All this means that in encounters with IBS patients, we often hear about a range of complaints and symptoms in the body beyond gastrointestinal issues:

• Fatigue
• Sleep disturbance (usually insomnia)
• Musculoskeletal pain (headache, neck/shoulder/arm pain, thoracic spine pain, lower back/pelvis/hip and leg pain)
• Circulatory disturbances (cold hands and feet)
• General hypersensitivity in the body (feeling tense, uneasy, restless, sensitive to light and sound, pain-affected, rapid pulse)
• Anxiety
• Fear avoidance behavior

Many of these symptoms are thought to be the result of the body's stress systems being turned on and the body's own preparedness being activated. Having bodily preparedness (often known as the fight-or-flight mechanism) is sensible in many situations if one is actually in danger.

However, it is inappropriate if such preparedness is turned on all the time and especially if one is in situations where there is no need for such preparedness. Our experience is that many IBS patients often feel such inappropriate preparedness manifesting in the symptoms listed above.

In managing IBS, stress management is therefore very useful. There are many ways to approach this, and in some cases, it may be appropriate to take a multidisciplinary approach with help from a doctor, physiotherapist, and psychologist. However, there are also relatively simple steps one can take on their own. Here are 3 tips for self-managing stress:

1. Our breath is not only essential for survival, but it is also perhaps the most effective way to quickly influence the level of preparedness in the body. When we are stressed, we often hold our breath by tensing our stomach and jaw. Think of expressions like "butterflies in the stomach", "bad gut feeling", "walking around with a lump in the stomach", and "clenching one’s teeth". This results in more shallow breathing while typically using more neck muscles rather than the diaphragm to breathe. To calm the body down, it is therefore important to focus on releasing tension in the jaw (not biting) and in the abdominal muscles. Imagine the chest moving outwards to the side and feel the stomach come out a bit when you breathe in and the chest lowering again when you breathe out. The most important part of the breathing cycle is the exhalation phase. Think of expressions like "breathe out" or "take a breath". We therefore recommend a 1:2 ratio of inhalation:exhalation when practicing this for relaxation (e.g., 2 seconds in and 4 seconds out). Make sure to breathe out completely before you breathe in.
2. Mindfulness training. This comes easily to some, while others find it too difficult and are unable to benefit from it, but it is usually a matter of practice. When one is strongly affected by symptoms, especially pain, it is often difficult to think of anything else, which means that we can lose focus on both what is happening around us and on the important things in life. Mindfulness training is simply about improving our ability to continuously shift focus to more easily not let our symptoms get in the way of living our lives in line with what is important, valuable, and meaningful. The point of mindfulness training is NOT to eliminate symptoms, but rather to be able to "carry" our ailments while doing what is important to us. This will reduce stress, which in turn often reduces the experience of the symptoms we have. There are many resources available without the need to seek professional help. A good example is a mindfulness app called "Headspace", which is available on both Apple App Store and Android.
3. Exercise. It is generally always a good idea to exercise, whether you have ailments or not. It is important to choose something that is feasible and sustainable over time. You do not necessarily have to exercise at a gym. Exercise can be done effectively both at home or outdoors without any equipment.
   
   Research has shown that aerobic exercise can be especially effective for patients with IBS. A good example of this is short-term intensive interval training. To get started properly with this, we recommend NTNU's 7-week training program (https://www.ntnu.no/cerg/treningsprogram)
   

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Source: Eirik Østvold, Manual Therapist/Specialist Physiotherapist