Irritable bowel syndrome is considered a diagnosis of exclusion. Individuals typically may suffer from chronic intermittent abdominal pain, bloating, and or altered bowel movements that can be mainly diarrhea, constipation, or alternate between the two. The length of time of symptoms also matters, and most individuals with IBS will have had these symptoms at least once weekly for 3 months or have had 3 months of symptoms within 6 months. IBS is 1.5 times more prevalent in women than men. Common age groups for IBS are 20-39 years old.
To be properly diagnosed with IBS, individuals will first undergo medical evaluation to rule out other causes such as metabolic disorders, bacterial, parasitic infections, and or other inflammatory bowel conditions. Most patients should have received conventional stool testing, blood testing that included (a thyroid function panel, complete blood count, liver function testing), and possibly a colonoscopy.
If results remain negative in a primary care or gastrointestinal office setting, a patient may be diagnosed with IBS. This leads to the question of what is causing the IBS symptoms. IBS is considered a disorder of altered brain-gut interactions. 30-40% of patients with IBS also suffer from depression and anxiety, and 15-38% have suffered from suicidal ideation.
Several nutritional, lifestyle, and stress management modifications are appropriate for IBS support, see our blog on the 5R approach for IBS. This article will focus mainly on the gut-brain connection via hypnosis.
Hypnosis is a therapeutic practice that involves teaching a patient how to enter a trance-like state through hypnotic suggestion. It typically involves a hypnotic induction through focused attention and relaxation and then a deepening technique. Hypnosis is considered an ultra-focused state of mind. Counter to what’s seen on TV shows or movies, individuals going under hypnosis are typically under complete control of their faculties and can voluntarily enter trance and self-induce trance with regular practice. They can also choose to move out of trance if they choose to at any time. It is during hypnotic trance that the hypnotist can help the individual work through an emotional or physical issue of their choosing, utilizing suggestion and or imagery.
Hypnosis provides access to the gut-brain interactions of unconscious stressors of the central nervous system and can influence the enteric nervous system. Hypnosis may help promote neuroplasticity of the brain recreating neuronal connections under hypnotic suggestion, altering pain sensation.
In a multi-center randomized control trial in the Netherlands, both group and individual hypnotherapy led to statistically significant improvement in IBS pain scores after six hour-long sessions over a 3 week period and results lasted for up to 9 months. Though there have not been findings of changes in the actual gut flora after hypnosis, gut-directed hypnotherapy has lowered IBS pain scores and symptomatology.
References:
Császár-Nagy N, Bókkon I. Hypnotherapy and IBS: Implicit, long-term stress memory in the ENS? Heliyon. 2022 Dec 30;9(1):e12751. doi: 10.1016/j.heliyon.2022.e12751. PMID: 36685398; PMCID: PMC9849985.
Flik CE, Laan W, Zuithoff NPA, van Rood YR, Smout AJPM, Weusten BLAM, Whorwell PJ, de Wit NJ. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2019 Jan;4(1):20-31. doi: 10.1016/S2468-1253(18)30310-8. Epub 2018 Nov 23. PMID: 30473202.
Whorwell PJ. Review article: The history of hypnotherapy and its role in the irritable bowel syndrome. Aliment Pharmacol Ther. 2005 Dec;22(11-12):1061-7. doi: 10.1111/j.1365-2036.2005.02697.x. PMID: 16305719.
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Written by: Dr. Zhiling Trowbridge
Dr. Zhiling Trowbridge, MD, is a family medicine physician with over 10 years of experience, treating patients of all ages using both traditional and integrative approaches. A second-generation Chinese Cambodian born in Michigan, she values culturally informed, holistic care. She specializes in chronic conditions, focusing on the mind-body-spirit connection through therapies like acupuncture, nutrition, meditation, and herbal medicine. Dr. Trowbridge is certified in medical acupuncture and plant-based nutrition, and is a Nutritarian Health Coach. She is also certified in Women’s Integrative and Functional Medicine. Her compassionate, whole-person approach is rooted in science, personal connection, and cultural sensitivity. Learn more about Dr. Zhiling Trowbridge.