Irritable Bowel Syndrome: Yoga Therapy Case Study

Irritable Bowel Syndrome

Despite the relatively high incidence of IBS, it is still not well understood and difficult to diagnose.

For IBS to be diagnosed, the symptoms must have started 6 months prior and must have occurred at least 3 days per month for the previous 3 months. It is important that the client has an official diagnosis from a medical practitioner so that more serious diseases such as coeliac disease,inflammatory bowel disease and bowel cancer can be ruled out. Although IBS can be very painful and debilitating, it does not actually damage the digestive system and does not lead to more sinister diseases such as cancer. It is important to note, as a yoga therapist, that blood in the stools, fever, anaemia or weight loss are not symptoms of IBS and if these are present to refer back to their medical practitioner.

From an yogic perspective, IBS is attributed to a disturbance in the flow of prana, otherwise known as life force or chi. Although the flow of prana in the body is quite complex, we can simplify by saying that there are 3 main forms: udana is the upward flow of energy; apana is the downward flow of energy and samana is the balancing movement around the navel. Depending on the symptoms of the IBS we would be looking at balancing this flow of prana with certain yogic exercises. So if diarrhoea were predominant we would be looking to reduce the release of apana. Symptoms of constipation however would require practices to increase the flow of apana. Alternating diarrhoea and constipation indicates a disturbance in samana which is the vital energy in the navel. Balancing samana aids digestion on all levels. Also, IBS would indicate tension or blockages in mooladhara chakra or manipura chakra. These centres relate to fear, anger and insecurity on an emotional level and to the adrenal glands on a physiological level. These emotions produce adrenaline which initiates the flight or fight response and increases sympathetic nervous system activity. This gives us energy to deal with stress but negatively impacts the functioning of the digestive system. Over time an imbalance can occur.

Fortunately studies are showing that the practice of yoga can help to relieve symptoms of IBS.

Through the practice of asana and pranayama we aim to calm the nervous system increasing parasympathetic nervous system activity and reducing sympathetic activity, allowing our digestive system to work more efficiently. Also through the postures we want to massage, stretch and tone the abdominal area to increase blood flow and help move gas and waste through the colon.

However, in the case of severe diarrhoea, we would avoid too much pressing and twisting initially so as not to aggravate the condition. To help alleviate the negative effects of chronic stress we would want to work with the adrenal glands and regulate cortisol levels. Plus yogic practices work on a more subtle level by releasing energy blockages in the abdominal area and as mentioned above, balancing the flow of prana.

Research and the literature shows that mindfulness based meditation and relaxation techniques such as yoga nidra can be useful in alleviating symptoms of IBS. Swami Satyananda Saraswati states that “yoga nidra therapy leads to conscious and subconscious recognition and analysis of underlying psychological factors and initiates the release of supressed conflicts”. Mindfulness training, where people are taught to focus their attention on sensations occurring in the moment and to avoid worrying about the meaning of those sensations, has proved to be beneficial in helping people to deal with pain associated with IBS and to minimise negative emotions.

IBS is a somewhat complex disorder which may require treatment on many levels – medical, herbal and dietary. However yoga asana, pranayama, relaxation and meditation are shown to have a beneficial effect, particularly in lowering levels of stress and anxiety which are associated with the condition. And yogic treatment can be complementary to other treatments and used alongside them, rather than as an alternative to them.

Irritable Bowel Syndrome Yoga program

Supine

1. Shavasana (corpse pose): gentle belly breathing 1- 2 minutes.

2. Circle knees over chest: bring both knees over the chest and use the hands to slowly circle the knees so the lower back makes a circle on the floor. 5 times in each direction.

3. Supta Pawanmuktasana (leg locked pose): slide one leg long and hold the other knee over the chest with both hands. As you breathe out draw the knee into the chest and roll the head up; inhale, rest the head and let the knee out. (Place a hand behind the head for neck problems). Repeat 5 times each side.

4. Variation Supta Pawanmuktasana (both knees to chest): Draw both knees over the chest. Exhale and use the hands to draw the knees in, roll the head up; inhale down. Repeat 5 times.

5. Setubandasana (shoulder bridge): Have your knees bent with your feet flat on the floor about hip width apart. Arms by your sides. Breathe in and lift the hips up; exhale down. When comfortable with that, hold 3-5 breaths.

6. Utthanpadasana (supine double leg lifts): Have the knees over the chest and arms by your sides. Exhale and straighten both legs up toward the ceiling; inhale down. If that’s easy then have the legs long and keep the legs straight as you lift them up and down. Repeat 10 times.

7. Shava Udarakarshanasana (supine spinal twist): Lie with the left leg long and the right knee over the chest. Have the right arm resting on the floor in line with the shoulder. Place the left hand on the right knee and as you breathe out, slowly take the knee over to the left as the head turns to the right; return to the centre as you breathe in. Repeat a few more times and if comfortable hold for a couple of breaths. Swap sides.

8. Shavasana: rest and belly breathe. 1 minute.

Standing

9. Sideways bend: Stand with your feet about hip width apart and arms by your sides. Breathe in and float the right arm up toward the ceiling; breathe out as you slowly lean to the left, sliding the left hand down the left leg. Inhale to the centre and swap sides. Repeat 5 times on each side.

10. Trikonasana (triangle pose): Hold each side 3 breaths.

All fours

Marjariasana (cat/cow pose): exhale as you tuck the tailbone under, roll the head down and round the spine; inhale and arch the spine the other way. 5 times each way.

Prone

Bhujangasana (cobra pose): 3 breaths.

Shalabasana (locust pose): 3 breaths.

Dhanurasana (bow pose): 3 breaths.

Balasana (child position): 3 breaths.

Seated

Adhomukha Baddhakonasana (butterfly pose leaning forward): 3 breaths.

Pashimottanasana (seated forward bend): 3-5 breaths.

Ardha matsyendrasana (seated half spinal twist): 3 breaths each side.

Viparetta karani (1/2 shoulder stand or legs up the wall). Build up time slowly, starting with a couple of breaths and building up to 1-5 minutes.

Sitting in Vajrasana (kneeling) to practice Samana breath (centering breath): Imagine breathing in the energy of the universe through the navel; holding the breath in as you visualize the digestive fire blazing up; breathing out and imagine sending the breath to nourish all the tissues and cells of your body.

Shavasana: rest and breathe comfortably. 1-5 minutes.

Yoga Nidra – listen to recording after yoga practice if time permits or at another time in the day or evening.

Mindfulness meditation: After some months of the above practice I would suggest the client commences a mindfulness meditation practice.

Notes: the client would be instructed on each pose and easier options given where appropriate. It would be explained that the number of repetitions and length of holding are guides only and that listening to your body and not pushing into pain are more important.

Other holistic modalities, remedies and lifestyle tips

Probiotics

• Peppermint oil (relaxes the smooth muscle wall of the bowel)
• Avoid artificial sweeteners, MSG and caffeine.
• Avoid foods high in fat.
• Avoid gas producing food such as cabbage and broccoli.
• Establish a regular eating routine, prepare smaller meals and eat slowly.
• Increase soluble fibre gradually and drink plenty of fluid.
• Acupuncture and Chinese herbs (TMC).
• Ayurvedic treatment.