What is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome is a group of symptoms—including abdominal pain and changes in the pattern of bowel movements without any evidence of underlying damage.These symptoms occur over a long time, often years. It has been classified into four main types depending on whether diarrhea is common, constipation is common, both are common, or neither occurs very often.
The causes of IBS are not clear. Theories include combinations of gut–brain axis problems, gut motility disorders, pain sensitivity, infections including small intestinal bacterial overgrowth, neurotransmitters, genetic factors, and food sensitivity. Onset may be triggered by an intestinal infection, or stressful life event.
There is no cure for IBS. Treatment is carried out to improve symptoms.
What is Osteopathy?
Osteopathy is a manual therapy which places emphasis on normal mobility of tissues. For IBS, manual techniques are applied to the organs in the abdomenal cavity. There are various techniques that can be applied to the rectum and intestines to treat IBS. Osteopathic treatment of IBS is a promising therapy in the treatment of this frustrating problem (Hundscheid et al. 2007).
How can Osteopathy be applied to manage Irritable Bowel Syndrome?
Osteopathic treatment for IBS focuses on the nervous and circulatory systems, spine, viscera, and thoracic and pelvic diaphragms in order to restore homeostatic balance, normalize autonomic activity in the intestine, promote lymphatic flow, and address somatic dysfunction. Lymphatic and venous congestion are treated by the lymphatic pump techniques and stimulation of Chapman׳s reflex points (Collebrusco and Lombardini, 2014).
It respects the interrelationship of mind and body and recognizes that the human body functions as a dynamic unit. This fits perfectly with the concept of the biopsychosocial model and the brain-gut axis. It seems likely that the different osteopathic treatment modalities are able to intervene at different levels of this brain-gut axis. (Florance et al. 2012).
Is Osteopathy an Effective Treatment for Irritable Bowel Syndrome?
Visceral Osteopathy improves short-term and long-term abdominal distension and pain, and also decreases rectal sensitivity in IBS patients. The effectiveness of visceral osteopathy on treatment for two cardinal symptoms of IBS (bloating and abdominal pain) (Attali et al. 2013). Osteopathy improves the severity of IBS symptoms and its impact on quality of life (Florance et al. 2012).
What is the current evidence base for Irritable Bowel Syndrome treatment with Osteopathy?
Currently the evidence base is limited for this area of practice within osteopathy. Though one systematic review of 5 RCTs indicated favorable results for osteopathy compared with standard medical therapies or sham interventions in the management of IBS (Müller et al. 2014).
What dietary and lifestyle advice should I consider for Irritable Bowel Syndrome?
The other important considerations is changing your diet and lifestyle to reduce the severity of irritable bowel syndrome. The National Institute of Clinical Excellence (NICE, 2017) provides guidelines to achieve this:
People with IBS should be given information that explains the importance of self‑help in effectively managing their IBS. This should include information on general lifestyle, physical activity, diet and symptom‑targeted medication
Diet and nutrition should be assessed for people with IBS and the following general advice given.
- Have regular meals and take time to eat.
- Avoid missing meals or leaving long gaps between eating.
- Drink at least 8 cups of fluid per day, especially water or other non‑caffeinated drinks, for example herbal teas.
- Restrict tea and coffee to 3 cups per day.
- Reduce intake of alcohol and fizzy drinks.
- It may be helpful to limit intake of high‑fibre food (such as wholemeal or high‑fibre flour and breads, cereals high in bran, and whole grains such as brown rice).
- Reduce intake of ‘resistant starch’ (starch that resists digestion in the small intestine and reaches the colon intact), which is often found in processed or re‑cooked foods.
- Limit fresh fruit to 3 portions per day (a portion should be approximately 80 g).
- People with diarrhoea should avoid sorbitol, an artificial sweetener found in sugar‑free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
- People with wind and bloating may find it helpful to eat oats (such as oat‑based breakfast cereal or porridge) and linseeds (up to 1 tablespoon per day)
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Attali TV, Bouchoucha M, Benamouzig R (2013). Treatment of refractory irritable bowel syndrome with visceral osteopathy: short-term and long-term results of a randomized trial. J Dig Dis. 2013 Dec;14(12):654-61
Collebrusco L, Lombardini R (2014). What about OMT and nutrition for managing the irritable bowel syndrome? An overview and treatment plan. Explore (NY). Sep-Oct;10(5):309-18
Florance BM, Frin G, Dainese R, Nébot-Vivinus MH, Marine Barjoan E, Marjoux S, Laurens JP, Payrouse JL, Hébuterne X, Piche T (2012). Osteopathy improves the severity of irritable bowel syndrome: a pilot randomized sham-controlled study. Eur J Gastroenterol Hepatol. Aug;24(8):944-9
Hundscheid HW, Pepels MJ, Engels LG, Loffeld RJ (2007). Treatment of irritable bowel syndrome with osteopathy: results of a randomized controlled pilot study. J Gastroenterol Hepatol. Sep;22(9):1394-8
Müller A, Franke H, Resch KL, Fryer G (2014). Effectiveness of osteopathic manipulative therapy for managing symptoms of irritable bowel syndrome: a systematic review. J Am Osteopath Assoc. Jun;114(6):470-9
National Institute of Clinical Excellence (NICE, 2017). Irritable bowel syndrome in adults: diagnosis and management. NICE: London