Irritable bowel syndrome (IBS) is a chronic, functional gastrointestinal disorder characterized by recurrent abdominal pain and cramping, excessive bloating, constipation, and/or diarrhea. As many as 20 percent of the adult population, or one in five Americans, have symptoms of IBS, making it one of the most common disorders diagnosed by doctors. It occurs more often in women than in men, and it begins before the age of 35 in about 50 percent of people who suffer from it.[1]
Causes of IBS
IBS is poorly understood, and its causes remain unknown. Various theories exist, however, to explain why people develop IBS, including those pointing to stress, diet, and hormonal issues as triggers. In my experience, emotional stress is almost always a factor in the development of IBS.
Stress and Emotion: Recent epidemiological studies suggest that IBS is significantly associated with psychological stress[2] and mood disorders.[3] A well-known, close relationship, called the “brain-gut interaction,” exists between emotion and gastrointestinal function. Our brain and intestines are connected by the autonomic nervous system. When people become anxious or upset, the digestive tract is stimulated, causing spasms and the development of symptoms. Ironically, people can develop anxiety due to their unpleasant digestive symptoms, creating a vicious cycle that many chronic pain sufferers encounter: stress causes pain, and pain causes stress. It should be noted that a higher prevalence of IBS has been found among fibromyalgia[4] and chronic fatigue[5] sufferers. Both fibromyalgia and chronic fatigue are considered to be highly associated with stress and emotional disorders.
Diet: Both patients and primary care physicians relate IBS to food intolerance [6]; however, no correlation has been found between perceived food intolerance by patients and findings from common diagnostic tests for food intolerance.[7]
While certain diets may relieve or trigger IBS symptoms, some IBS sufferers also experience a complete resolution of symptoms during times of relaxation, such as while on vacation, even if their diets are “poor” and they are eating forbidden or unusual foods. On the other hand, at other (i.e., stressful) times, anything they put in their mouths (even plain water) may cause immediate abdominal bloating and trigger other IBS symptoms. The bottom line: diet is important, but whether or not certain diets help or aggravate could be influenced by other factors such as the individual’s emotional state during a particular time period. Addressing diet alone will most likely be insufficient to achieve long-term management of IBS. (Related Article: Is There an Ideal IBS Diet?)
Hormones: Many women with IBS experience intensified symptoms around the time of menstruation.[8] It is therefore believed that reproductive hormones play a role in IBS. This is possible, since the female hormonal system (HPG Axis) and stress hormones (HPA Axis) interact closely. In my opinion, however, some IBS symptoms are actually triggered by the intensified emotional symptoms associated with female conditions such as premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and dysmenorrhea (painful periods). It is important to address these female menstrual conditions when treating IBS patients. Acupuncture and moxibustion therapy can be used to manage the aforementioned gynecological conditions.
Current Evidence Regarding Conventional Drug Therapy and Acupuncture for the Management of IBS
Current drug therapy has been shown to be of limited benefit and to carry potential risks.[9, 10] In addition, a low level of patient satisfaction with care received from primary care physicians has been found among IBS patients.[11] Consequently, almost 50% of IBS patients turn to acupuncture and other complementary and alternative medicine (CAM) therapies.[12]
Acupuncture has traditionally been utilized for the treatment of a variety of digestive complaints. Research studies have suggested that acupuncture may be effective for certain cases of nausea, vomiting, gastroesophageal reflux disease, functional dyspepsia, bloating, abdominal pain, diarrhea, and constipation.[13, 14] Digestive symptoms could improve after acupuncture treatment partly because acupuncture affects the motility and perception of the digestive organs. Laboratory research using rats[15-19] and dogs[20] demonstrated that acupuncture stimulation significantly impacted gastrointestinal motility and visceral perception, both of which are closely associated with the development of IBS symptoms. Laboratory studies on rats also indicated that acupuncture stimulation on lower limbs (e.g., on the ST36 point) elicits gastric motility via vagal efferents, while acupuncture stimulation on the abdomen (e.g., on the ST25 point) inhibits gastric motility via sympathetic efferents.[18, 19, 21]
Clinical trials on IBS patients, however, have shown mixed results. The 2006 Cochrane Collaboration Systematic Review concluded that current evidence regarding the effectiveness of acupuncture for treating IBS is inconclusive.[22] Further rigorous clinical studies using adequate experimental design are certainly needed. However, compromised standardized acupuncture protocols that involve simply inserting needles into preselected points (often employed by previous clinical trials on acupuncture) are less likely to provide measurable benefits for the majority of IBS patients.
IBS is considered by gastroenterologists to be a “difficult” condition with significant psychological components.[23] Carefully designed, individualized, and comprehensive acupuncture programs will likely be needed to provide profound clinical benefits for many IBS patients.
Acupuncture Points Commonly Used for IBS and Other Digestive Conditions
Traditionally, a variety of acupuncture points have been utilized for gastrointestinal complaints.
Acupuncture Points Commonly Used for Digestive Complaints (Abdomen)
(CV12 Zhongwan, CV4, Guanyuan, SP14 Fujie, ST27 Daju)
Acupuncture Points Commonly Used for Digestive Complaints (Back)
(BL18 Ganshu, BL21 Weishu, BL23 Shenshu, BL27 Xiaochangshu, BL33 Zhongliao)
Note:
- The above-mentioned points are just a few examples of the acupuncture points that can be used to treat IBS patients. Many other important points exist on other parts of the body, including the upper and lower limbs. In clinical practice, acupuncture points will be selected based on each patient’s signs and symptoms as manifested on the day of the treatment.
- The location of the acupuncture points described in the figure and in textbooks should be considered rough locational guides. Experienced acupuncturists will locate effective points through palpitation.
- Both traditional theory and scientific research show that stimulating exactly the same acupuncture point can elicit entirely different responses at two different times. In other words, effective acupuncture treatment does not depend solely on the selection of acupuncture points, but equally or more so depends on how those acupuncture points are stimulated by using acupuncture and moxibustion.
It is important to receive treatments from qualified acupuncturists who have the knowledge and skills to locate effective meridian points and induce favorable physiological responses through acupuncture.
At our Toronto clinic, acupuncture and moxibustion have been used to treat a variety of digestive conditions for over 20 years.
Treatment consists primarily of stimulating acupoints traditionally known to restore digestive functions by using both acupuncture and moxibustion. It also includes acupuncture and moxibustion therapy for emotional health. Our comprehensive acupuncture protocol is typically administered in three different patient positions:
Supine (facing up): Acupuncture is administered in this position primarily to stimulate points located in the legs, arms, and abdomen using our Japanese superficial needling techniques.
Prone (facing down): Acupuncture stimulation is applied on selected points along the spine, with attention to nerve segmentations associated with digestive organs. Moxibustion is applied to warm up selected acupoints.
Seated: At the end of the session, the patient is asked to sit on the treatment table so that a gentle superficial tapping acupuncture treatment can be administered on a point near his/her wrist. Studies have suggested that this particular acupuncture technique enhances autonomic nervous system (ANS) function.[24, 25] Optimal functioning of both branches of the ANS (sympathetic and parasympathetic) is crucial for proper digestion.
In addition, most patients are treated with our innovative approach, the Acupuncture and Sound-Assisted Autonomic Modulation Technique[26, 27], which involves acupuncture and moxibustion in combination with a specific HRV biofeedback breathing exercise. This specialized technique further augments the modulation functioning of the autonomic nervous system. This particular breathing exercise is utilized during acupuncture sessions; in addition, we ask patients to practice it between treatments to maintain the therapeutic benefits. This combined acupuncture and HRV biofeedback approach is currently provided only at our Toronto acupuncture clinic.
In some cases, other forms of traditional East Asian medicine, such as Oriental dietary therapy and Kampo herbal formulas, are also recommended.
Updated on February 14, 2011
Tim H. Tanaka, PhD. is a Japanese licensed acupuncturist, certified herbalist, and board-certified biofeedback therapist. He is available for consultation and treatment at his acupuncture and alternative medicine clinic in Toronto.
- Related Article: Is There an Ideal IBS Diet?
References:
1. Talley NJ: Irritable bowel syndrome: definition, diagnosis and epidemiology. Bailliere’s Best Practice & Research 1999, 13(3):371-384.
2. Nam SY, Kim BC, Ryu KH, Park BJ: Prevalence and risk factors of irritable bowel syndrome in healthy screenee undergoing colonoscopy and laboratory tests. Journal of Neurogastroenterology and Motility, 16(1):47-51.
3. Mykletun A, Jacka F, Williams L, Pasco J, Henry M, Nicholson GC, Kotowicz MA, Berk M: Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterology, 10:88.
4. Kurland JE, Coyle WJ, Winkler A, Zable E: Prevalence of irritable bowel syndrome and depression in fibromyalgia. Digestive Diseases and Sciences 2006, 51(3):454-460.
5. Gomborone JE, Gorard DA, Dewsnap PA, Libby GW, Farthing MJ: Prevalence of irritable bowel syndrome in chronic fatigue. Journal of the Royal College of Physicians of London 1996, 30(6):512-513.
6. Bijkerk CJ, de Wit NJ, Stalman WA, Knottnerus JA, Hoes AW, Muris JW: Irritable bowel syndrome in primary care: the patients’ and doctors’ views on symptoms, etiology and management. Canadian Journal of Gastroenterology/Journal Canadien de Gastroenterologie 2003, 17(6):363-368; quiz 405-366.
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16. Iwa M, Nakade Y, Pappas TN, Takahashi T: Electroacupuncture elicits dual effects: stimulation of delayed gastric emptying and inhibition of accelerated colonic transit induced by restraint stress in rats. Digestive Diseases and Sciences 2006, 51(8):1493-1500.
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20. Iwa M, Strickland C, Nakade Y, Pappas TN, Takahashi T: Electroacupuncture reduces rectal distension-induced blood pressure changes in conscious dogs. Digestive Diseases and Sciences 2005, 50(7):1264-1270.
21. Iwa M, Tateiwa M, Sakita M, Fujimiya M, Takahashi T: Anatomical evidence of regional specific effects of acupuncture on gastric motor function in rats. Auton Neurosci 2007, 137(1-2):67-76.
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25. Tanaka TH: The possibilities for optimizing acupuncture treatment results through synchronization with somatic state: Examination of autonomic response to superficial needling during exhalation. American Journal of Acupuncture 1996, 24(4):233-239.
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