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Treat your IBS with yoga

MagazineNovember 2015 (Vol. 26 Issue 8)Treat your IBS with yoga

In a culture where we tend to live in our heads, voices from our bellies often go unheard

In a culture where we tend to live in our heads, voices from our bellies often go unheard. Symptoms are often suppressed by medications or are considered unrelated to our lifestyles, yet we are subject to considerable psychosocial stress-from our work, family, or home worries and demands-which is felt and expressed in our physical body.

If thinking rather than feeling runs the show, our mind-body's needs will often go unmet, a situation that readily manifests in our gut with conditions like an 'irritable' bowel.

Irritable bowel syndrome (IBS), which affects 10-20 per cent of us, is characterized by abdominal pain, bloating and altered bowel movements-often see-sawing between diarrhoea and constipation.

It's a problem of bowel function, not structure, so there's nothing abnormal to find during a standard medical investigation. It's usually down to stress-related changes in the gut environment, like altered probiotic bacteria and gut serotonin levels, a situation more readily investigated by alternative practitioners.

Your gut feelings are true

The enteric nervous system-an independent 'second brain' that runs through the entire digestive tract-is about the size of a cat brain, and allows considerable communication between the gut and brain. But only 10 per cent is from the brain to the gut, usually in response to outside stimuli and incoming food. The majority of signals are from gut to brain, and they're not only about digestive function, but also to report on 'gut feelings'-our response to the world around us on a visceral, intuitive level.

The gut and brain develop from the same foetal tissue, and they even share similar 90-minute sleep cycle states, so disturbances of rapid eye movement (REM) sleep show up as bowel disorders. IBS has even been described as a manifestation of "derailing the brain-gut axis".1

Belly connection

As IBS is now considered a nervous-system condition, many people are turning to practices to help de-stress. Yoga has traditionally helped IBS by releasing the stagnant energy arising from the lower body and belly. When this is blocked, symptoms of anxiety and disturbance are held in the gut.2 Relieving chronic stress is an important intervention for diarrhoea, as it alleviates the autonomic reflex to defecate as part of the fight-or-flight response.

In traditional Ayurvedic medicine, postural yoga (asanas) is prescribed to treat disordered agni, the digestive fire believed to rise from the belly, using meditation and breathing practices (pranayama) to reduce stress-related root causes. The state of Grahani can be equated with IBS-a syndrome defined by chronically altered stools-and viewed as an overall imbalance that needs attention for a properly functioning mind-body.

In yoga traditions, stretching, compressing and twisting of the gastrointestinal (GI) tract and viscera (organs) all support digestive health. This is consistent with neurological research into how somatic markers (bodily memories associated with previous feelings) are set from both positive and negative emotional responses associated with gut reactions in certain situations.

By this theory, these 'feedback loops' not only play a part in how someone feels at any given moment, but may also influence future feelings and "intuitive decision-making".3 Feeling 'safe' in your belly can break these cycles of stress-reactive symptoms.

The science behind yoga

Although any moderate physical activity done for 20 to 60 minutes three times a week has been shown to improve IBS symptom severity,4 there hasn't been much research into yoga specifically. One 2006 randomized controlled trial studied the effects of yoga in 25 adolescents with IBS, and found that weekly hour-long yoga sessions led to less anxiety, functional disability and GI symptoms after four weeks.5

A study of men with IBS suffering from diarrhoea compared the effects of taking lopermamide (Imodium(R)) with practising 12 yoga poses and a specific breathing exercise twice a day for two months. While both groups showed significant decreases in GI symptoms and anxiety, the yoga group showed increased parasympathetic (calming) activity, thought to be the primary cause of the symptom relief, leading the authors to conclude that yoga was the more beneficial treatment.6

Modern postural habits

The tendency to hunch or slouch puts pressure on the digestive organs, which makes the digestive process physically more difficult. Bowel muscle needs toning just like other muscles, and sedentary habits and poor core muscle function and regulation can affect how bowel muscles move and work, so often contributing to constipation. This is particularly true when the colon is routinely compressed from more sitting than standing, especially when people slump while seated.

Honouring your nervous system

Traditional yoga includes cleansing practices with strong abdominal breath work like kapalabhati (abdominal flapping with sharp exhalations), bhastrika (rapid diaphragmatic breaths) and nauli (circular movements of the abdominal muscles), which work abdominal muscles as well as digestive organs and intestines. These exercises, though, may be too strong for those with chronic stress and digestive muscles that go into seizure (constipation) and/or spasm (diarrhoea), so talk to your teacher about how to modify them for safety.

Specific practices for IBS support

Lying down

Supine (lying down) practices allow the whole body to be supported by the floor, inviting total release of the habitual tensions we hold to stay upright. They allow easy motion of the lower back to relieve core muscle tension, which can interfere with digestive muscle activity. Lying down also allows gravity to settle and reposition organs, often resulting in gurgling and an awareness of abdominal fluids, although it may cause discomfort in those with reflux, who may need to sit supported.

Spinal undulations and sacral fluidity

The calming parasympathetic branch of the nervous system feeds the digestive organs through the base of the skull, where we can feel lots of tension from sitting hunched on chairs, so affecting our ability to calm and release contractions in the colon.

The practice of craniosacral (gut-to-pelvis) balancing is by spinal undulations such as the Cat/Cow Poses, which can help reduce neck tension. These poses have long been associated with improving digestion (like belly dancing and kundalini yoga), and the exaggerated belly movement with the breath can raise awareness and fluidity in the abdominal region. Daily supine spinal undulations can greatly benefit IBS.

Lying down with feet hip-width apart, on inhalation, arch the back, lifting the belly and waist, while pointing the tailbone down towards the floor.

On exhalation, let the chest and belly drop as your lungs empty. As the motion becomes more natural, these pelvic tilts will loosen the whole body. Place your chin down on your chest as you inhale, and let it point to the ceiling as you exhale.

When the motion is naturally following each breath, add energy by rocking your feet, lifting the balls of the feet while inhaling and lifting the heels while exhaling. Repeat the movement for as long as it feels right, then stop to feel the ripples in the breaths that follow.

Belly fluidity

Movements that allow the digestive organs to slide and glide around can improve the lack of movement between organs and soften any scar tissue. To loosen the hips and create more ease in the lower body: Sit either cross-legged or on a chair with knees apart and rotate your upper body, imagining drawing a circle with the crown of your head.

Keep your shoulders still while lifting up through the spine, directing the movement into the hips, belly and lower back. Rotate in the opposite direction, which may feel more 'against the grain' as you didn't choose it first. Pay attention to how this feels in your belly.

Stronger abdominal posture

Any sequence where the feet support the body engages the postural abdominal muscles, including poses like Downward-Facing Dog (Adho Mukha Svanasana), lunges, forward bends, wide-legged postures and twists, and all ask different muscle groups to lengthen and strengthen.

It is crucial to focus on long spacious breaths when postures are strong, so sending the belly the message that muscle tension from strengthening doesn't need to set off stress responses that add to IBS.

Natural postures

Squatting naturally encourages the muscle actions needed for bowel movements, and engaging the lower abdominal muscles massages the colon if constipation is an issue. As we don't squat in modern furniture, our digestion suffers.

Keep your heels on blocks unless you can squat naturally on the floor without strain. While lifting your chest, reach forward towards the floor if pressing your ribs against your inner thighs is difficult. If you have knee issues, sit on a chair and lift one leg at a time to emulate the movement.

Space in the front body

Back bends create space for digestion particularly in the duodenum, the first part of the small intestine just below the breastbone, where we can feel emotions intensely and the heat of heartburn. When lying down, they also give the digestive organs an inner massage with every breath.

Opening up the psoas muscle, which connects the legs to the torso and runs through the inner thighs, hips and groin, helps relieve compression in the colon and encourages lymphatic flow to help elimination. Focusing attention on individual organs and 'gut feelings' can help to cultivate positive feedback loops from the gut to the brain.

In Cobra Pose (Bhujangasana), the right arm position is where your lower back feels comfortable. If having elbows under shoulders pinches, move them further forward.

Alternatively, for a happy lower back while breathing helpful pressure into the belly, fold your arms in front of you, keeping the breastbone (not the chin) up to lengthen the spine and relax the belly.

Open the psoas muscle on each side by lifting each leg in turn out to the side, and feel it opening the opposite front thigh up to the belly.

If you feel a release in the groin, you may be able to straighten your arms while keeping a spacious breath to tell your body not to feel stressed.

You may even be able to straighten the bent leg and bring your chest to the floor, if lifting it compresses the lower back. Turn to the other side and end with the Bow Pose (Dhanurasana), rocking on the floor on your belly while breathing calmly.

Creating a 'safe cave' in your belly

Holding inversions and forward bends can help reposition and compress the digestive organs to stimulate and modulate their proper actions. Do Downward-Facing Dog to neutralize the spine after back-bending.

Using a bolster (or folded blankets), raise just your pelvis and bring your knees in towards the chest towards the armpits, allowing the tailbone to lift, creating a 'cave' in the belly. Breathe gently to release the jaw and base of the skull, inviting full-body release.

Straighten the legs for an inverted version of a forward bend (Paschimottanasana), which lengthens the back with less strain on the lower back.

Resetting the lower back

Lying down with a bolster or blankets across your lower abdomen (between your hip bones) allows your lower back to curve naturally and your sitting bones to lift and spread, opening and relaxing the pelvic floor, which is crucial for supporting the pelvic and digestive organs without overgripping.

Rest with your head turned to either side, then roll over into Savasana (Corpse Pose), bolster under tknees for full relaxation and softness in the lower back. Feel your breath creating subtle natural rises and falls in your belly, and offer yourself compassion there to your centre.

REFERENCES

1 Gut, 1997; 41: 390-3
2 Evid Based Complement Alternat Med, 2015; 2015: 398156
3 Nat Rev Neurosci, 2011; 12: 453-66
4 Am J Gastroenterol, 2011; 106: 915-22
5 Pain Res Manag, 2006; 11: 217-23
6 Appl Psychophysiol Biofeedback, 2004; 29: 19-33


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