There is no doubt that both the bowel and brain mechanisms are at the helm of IBS.
Irritable Bowel Syndrome (IBS) has been called a functional gastrointestinal disorder for a very long time, but is now more commonly referred to as a gut-brain disorder. Affecting more people in the Western world than any other parts, IBS can be a terror on the quality of life to some sufferers and finding the answers to why it is happening to them is frustrating because the etiology is unknown.
The Role of the Gut in IBS
Since IBS is so common, it continues to be studied abundantly. There are several indications that bowel mechanisms play a part in IBS, including disordered motility as seen in IBS-C, IBS-D, IBS-M, and IBS-U. Additionally, pain thresholds are altered in gut sensitivity with IBS, even though this is not considered a diagnostic marker. Research has also noted the role of inflammation in the gut mucosa, bacterial overgrowth, and the role of infection as mechanisms for IBS potential.
Furthermore, the enteric nervous system (ENS) in your gut plays a role in the body by controlling digestion and if there is a disruption from the ENS nerve cells in your gastrointestinal tract to your brain, there can be signals sent to your central nervous system (CNS) that may trigger some serious emotional and mood changes. This ENS to CNS connection has been a centralized focus on many gut-directed psychotherapies and relaxation techniques to help reduce anxiety and depression in IBS sufferers.
The Role of the Brain in IBS
Multiple studies have reported that when IBS sufferers seek treatment, approximately 70% of them present with a psychiatric disorder such as depression, anxiety, or panic disorder. Other studies have reported increased cortisol levels in IBS sufferers, either at baseline or in response to stress, when compared to controls. Stress and anxiety/depression are associated with IBS symptoms and treatment related to these conditions should be sought to improve symptom management.
Environmental stressors play an important role in the development of IBS. These can include early life events such as prenatal malnutrition, early-life surgical events, or child abuse. Abuse in adulthood is also a risk factor for IBS. Moreover, it has been reported in the past that IBS sufferers have reported that a stressful event occurred before the onset of their condition in 51% of cases. Again, stress in IBS sufferers has been well-documented as being associated with increased symptom harshness and also impacts the immune system.
Putting it All Together
Knowing that there is an active role between the “gut brain” and the brain itself allows IBS sufferers and medical providers to understand the ENS to CNS connection better and to provide therapeutic options that address how both brains interact with each other. Gut-directed psychotherapies such as cognitive behavioral therapy (CBT) and gut-directed hypnotherapy can be helpful to improve the communication between the brains.
Antidepressants and other psychiatric medications may help with symptom management as well by easing the nerves in the ENS. The best thing is to be an advocate for your medical care and to continue to communicate with your healthcare team about your symptoms if they are not under control.