Irritable bowel syndrome: psychological treatment

  • Jul 26, 2021
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Irritable bowel syndrome: psychological treatment

The irritable bowel syndrome it's a common digestive picture of chronic course and recurrent, characterized by abdominal pain that is relieved with defecation or is associated with changes in bowel movements, presenting alterations in this regard.

In this PsychologyOnline article, we are going to talk in detail about this disease, what its symptoms are, its diagnosis and its psychological treatment.

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Index

  1. Symptoms of irritable bowel syndrome
  2. How is irritable bowel syndrome diagnosed?
  3. Irritable bowel syndrome treatment
  4. Diet and physical activity in case of irritable bowel
  5. Psychological treatment of irritable bowel syndrome
  6. Bibliography

Symptoms of irritable bowel syndrome.

Although traditionally to establish the diagnosis of irritable bowel it was necessary for the patient to present diarrhea, constipation or a combination of both, currently many professionals diagnose it without the need for this picture clinical. For example, it can be considered that

slow digestion, bloating, or excessive flatulence They may be due to suffering from this disease; instead of considering them as independent and isolated digestive problems (bloating, abdominal pain, etc.). The criteria to be followed to diagnose it in one way or another depends on the analysis that each case can produce.

It would be convenient to say that irritable bowel syndrome is not considered serious, although depending on its symptoms it can be more or less disabling. In relation to this, it can be said that there are more serious cases, in which the patient cannot lead a normal working and social life; even quite milder cases, in which the discomfort occurs more or less continuously but allow a normal life even with the discomfort that these discomforts can sometimes cause for the patient.

Considering that this disorder affects more than 20% of the population At some point in their life (without taking into account the cases that do not attend a medical consultation), this distinction is better understood in degrees of severity of symptoms. Cases with mild symptoms are widespread in the population. Symptoms can appear at any age, although more frequently in patients aged 20-30 years, and it occurs more frequently in women than in men.

Regarding its chronic nature, there are numerous cases in which patients with IBS are asymptomatic for long periods, although this improvement or relative cure of the syndrome is related to a generalized improvement of certain habits on the part of the patient (improved diet, stress reduction, regular physical activity, taking food and vitamin supplements, etc.).

Irritable Bowel Syndrome: Psychological Treatment - Symptoms of Irritable Bowel Syndrome

How irritable bowel syndrome is diagnosed.

To identify this pathology, it must be differentiated from other types of gastrointestinal disorders. Although IBS seems to present a great diversity of causes, symptoms and treatment, all cases have something in common: physical tests and clinical analyzes present a negative result, no organic or physical causes are found to explain the discomfort, but nevertheless the intestine "does not work well". This fact differentiates it from other gastrointestinal diseases such as Crohn's disease or ulcerative colitis (in which there is inflammation of the intestine).

This does not mean that the symptoms are fictitious or imaginary, but that cannot be linked to medical tests support it, but the symptoms are present in patients and are real. At this point, it seems convenient to point out that these patients should be differentiated from those with hypochondria, somatoform disorders, etc.

The irritable bowel diagnosisAs we have pointed out, it addresses various issues, and therefore all of them must be taken into account to establish the causes and possible treatment.

If a patient presents digestive discomfort, he will go to the consultation, and in it explain what symptoms you have and sometimes it will provide clues or directly explanations of why it thinks these are being given. The doctor will activate the appropriate protocol to know if it is IBS or if it is another type of pathology that presents similar or identical symptoms to IBS.

To do this, the patient will be instructed to perform a series of tests to rule out other types of pathologies (blood tests, food intolerance detection tests, X-rays, etc ...). All these tests will be destined to know if digestive discomfort are symptoms of anatomical abnormalities, intestinal flora regulation, vitamin deficiencies, food intolerances, etc. If so, the patient will find a marked improvement in the treatment indicated for these various disorders.

If the patient is negative in all these tests, there are no physical and biochemical differences with respect to normal subjects that can explain the discomfort, then IBS can be diagnosed. There is also the term functional dyspepsia, in it digestive complaints present high digestive symptoms (nausea, heartburn, reflux ,.). The difference from IBS is that it seems to be more associated with functional digestive discomfort of a low type (flatulence, constipation, diarrhea, bloating, etc.).

It is convenient to make this distinction because it supposes a more correct and exact diagnosis, since This differentiation may be useful for some points regarding the search for causes and treatment. However, many authors include all symptoms (high and low) under the label of IBS.

Treatment of irritable bowel syndrome.

Once the diagnosis has been established, the physician should attempt an approach to the case in which the more trouble spots that may be causing the disorder can be evaluated and treated correctly.

As there is no clear cause that explains this disorder, the doctor can indicate to the patient several courses of action with which to treat this condition and improve their quality of life. It is not about trying techniques and treatments in the patient without any sense, but about looking for certain remedies or adoption of habits that can substantially improve the prognosis of this disorder.

The approaches can be very different, but traditionally aspects such as the diet, drug administration that regulate the motility of the colon and psychiatric and psychological treatments that improve aspects related to stress, anxiety or other emotional aspects that negatively influence the course of the disease.

Referring to this last point, it has been shown that in practically all cases the psychological factor influences; has caused this disorder or functional problem one of the most covered topics within psychology Of the health.

The fact that one treatment is chosen does not mean that another is ruled out, indeed, in the case of this disorder the greatest guarantee of success seems to lie in a multiple approach, treating various factors.

A patient can take spasmolytics, avoid lactose and perform relaxation techniques, for example; Yes, this is the treatment that is most effective in your case. It is about normally taking care of your diet, being relaxed, but if there is a crisis; to be able to take a drug that helps to regain normalcy. A large part of patients report that their discomfort does not occur continuously, and that they only suffer from this problem sporadically. The continuous discomfort in many occasions is associated more with the anticipation of the symptoms, than with the suffering of them itself.

Therefore, when approaching the case, the patient must be made to see that it is possible to take care day by day without modifying your habits, which can have a normal life and that in cases of crisis you can take medications that can end it or at least make it more bearable. Make him see that the seizures are over and that the anticipation of the symptoms only causes a substantial worsening of the disorder.

Finally, say that for the patient control your anxiety (one of the fundamental axes of treatment), you can combine psychiatric and psychological treatment, they are not incompatible as long as you know how to use one and the other, and for what purpose.

Regarding the medication in this condition, the most commonly used drugs are those that regulate colon motility (spasmolytics, antidiarrheals.), drugs used to evacuate the colon (laxatives, enemas.), those intended to repair the intestinal flora (probiotics ...), antiflatulents (simethicone, clebopride), vitamin complexes, digestive enzymes, etc.

As psychiatric medication, they are often used anxiolytics and antidepressants. Very beneficial effects of both have been found, since if the first group manages to relax the individual; the second can be able to stimulate it emotionally, and secrete more serotonin (a neurotransmitter found in the colon and that can be affected by its regulation by IBS).

Irritable Bowel Syndrome: Psychological Treatment - Irritable Bowel Syndrome Treatment

Food and physical activity in case of irritable bowel.

As for food, it is usually recommended to keep a diary to see which foods usually trigger symptoms. Some foods are usually considered clear irritants of the colon, such as fried foods, industrial pastries, chocolate, dairy products, caffeine, sodas, etc.

Currently, a high correlation is being seen between certain lactose and gluten intolerances in cases that were considered IBS. Furthermore, this phenomenon is not only being observed in people in whom this intolerance is detected through tests (laboratory tests, duodenal biopsies, etc.); rather, it seems very common that these foods do not feel good even if they do not have a diagnosed intolerance.

It is not only the foods that are eaten that must be taken into account, but the adoption of certain habits to unseat others less beneficial. Among them would be eating slowly, chewing well, not eating standing up, not drinking a lot of fluids while eating, avoiding talking while eat, do not lie down immediately after eating, avoid large meals (especially dinners), eat several meals a day, etc.

The physical activity and sport They have also been shown to be very beneficial in the treatment of irritable bowel syndrome, especially the swimming and walking 1 or 2 hours a day.

Psychological treatment of irritable bowel syndrome.

Finally we will try to explain what the current psychological treatment of irritable bowel, see what treatment possibilities exist and what are your expectations of success. It is recalled that psychological treatment will be more successful with the adoption of other habits, but it is true that it is the most generalized and widespread treatment for any type of IBS.

There are other alternatives to treat IBS, but they are not fully validated, although positive results have been observed in some patients. In some cases these refer to food, such as the adoption of certain types of diets; or techniques in which remnants of dirt that may be stored in the colon are cleaned or evacuated.

Taking certain antibiotics, combined with taking probiotics, is also being investigated in order to balance a damaged intestinal flora, which is observed in many patients with IBS, or for example the application of psychological procedures such as biofeeback so that the individual knows how to regulate the motility of the colon. As we say, they are techniques that are under study and whose effectiveness in the population must continue to be demonstrated.

Irritable bowel: emotional meaning

They have been found to exist psychological factors that affect physical condition. The data show that this influence is bidirectional, that is, in the same way that a physical illness induces certain psychological states; Some psychological characteristics of people can induce or exacerbate certain physical illnesses.

It is necessary to differentiate, relative to this fact, that there are people who seem predisposed to disease (They have many negative emotional states that can lead to the onset of diseases), and people with predisposition to distress, which are characterized by tending to present health complaints without being supported by objective symptoms (this profile tends to coincide with certain hypochondriacal complaints).

Therefore, it is tremendously useful and positive, favoring certain attitudinal and behavioral states that favor to the correct physical / mental functioning of the individual and contribute to the maintenance of the state of "homeostasis".

The population that suffers from irritable bowel suffers from presenting more symptoms of anxiety and depression than the general population and other patients with organic digestive disease. In most cases of irritable bowel, nervousness, anxiety or obsessive thoughts are identified as clear triggers for the symptoms of the disease. Although a specific profile has not been found for these patients, they also tend to score high on scales such as hysteria, neuroticism, or hypochondriasis. In addition, a learned behavior of chronic disease characterized by continuous references to the disease and excessive medical visits has also been found.

What is unknown in many cases is the meaning of this relationship, that is; if depressive or anxious symptoms appear triggering the onset of the disease or if they appear as a direct consequence of it. What is recommended is to avoid previous judgments of the patient that may cause a negative bias in health professionals, with the consequent prejudice for their treatment.

Also, a higher index of anxiety with respect to patients with organic digestive pathology is due precisely to this condition, and also to the lack of sense of control and lack of information of patients regarding their symptoms.

There are few controlled and replicated studies on the psychological treatment of irritable bowel syndrome, although there are some that are pointed out as clearly probably effective treatments. Some of them are hypnosis, multicomponent-behavioral therapy for IBS, progressive muscle relaxation, exposure, systematic desensitization or contingency management.

It seems that cognitive behavioral therapy for IBS, aimed at coping with situations, has been shown to be effective for these patients as it includes many resources and techniques for dealing with situations, being considered very complete.

The progressive muscle relaxation has shown excellent results in the management of anxiety if practiced regularly, and therefore both with excellent results in patients with predominantly anxious IBS and anticipatory. It basically consists of the tension-distention of various parts of the body; It is intended that with the tension of the muscles and then relax them, the organism is aware of the difference in sensations, thus achieving general well-being in addition to reducing stress and nervousness.

The exhibition It is a highly validated and effective technique for various disorders, as is the case with the treatment of IBS. It is basically the extinction of stress and anxiety responses and digestive symptoms to specific situations identifiable, that IBS patients have identified (social gatherings, long trips, quiet places, etc.)

The contingency management It is used to reduce social reinforcement by showing symptoms and proposing activities that are incompatible with them. that is to say, that the complaints about their illness are attended and listened to, but not excessively reinforced. focus only on reporting your symptoms when they take up too much time in your behavioral repertoire, in relation to other more activities adaptive.

The irritable bowel syndrome treatmentcontinues in continuous study from its various approaches, and the main positive change seems to be the increase of information to the patients and a decrease in prejudices and negative labels traditionally associated with them patients.

This disorder can be treated and managed symptomatically As we have explained, all the relevant factors are taken into account, so that the patient knows better what is happening to him and, most importantly, how to approach it.

In this condition, with more evidence than in others if possible, understanding and providing information to the patient On the part of professionals, it can mean the change from suffering a chronic and annoying disorder, to a practically total remission of symptoms if all the necessary resources are carried out. You can change the absence of control of symptoms by acceptance and management of them.

Therefore, and by way of conclusion, the active role of the different professionals and of the subject himself, can transform a disease that in some cases it is highly disabling, in digestive complaints that appear with the same frequency in the population considered "normal".

Irritable bowel syndrome: psychological treatment - Psychological treatment of irritable bowel syndrome

Bibliography.

  • Rodríguez Marín, J. (1995). Social Psychology of Health. Madrid: Synthesis.
  • Gil Roales-Nieto, J. (2003). Health psychology historical and conceptual approach and applications. Pyramids: Madrid.
  • Schnake, Adriana (2007). Disease, Symptom and Character. Madrid: Four Winds.
  • Martí Esther (2004). Irritable colon, "A real case". Mandala Editions: Madrid.
  • Mearin F. Functional digestive disorders: from motility to sensitivity. Jano 2000; 5:14-18.
  • Drossman DA, Creed FH, Olden KW, Svedlund JToner BB, Whitehead WE. Psychosocial aspects of functional gastrointestinal disorders. Gut 1999; 45:28-34.
  • Moreno-Osset E, Antón Conejero MD, del Val Antoñana A. Treatment of irritable bowel syndrome. Med Clín Monogr (Barc) 2003; 4:41-7.
  • Rey Díaz-Rubio E. Therapeutic novelties in irritable bowel syndrome. Integrated Gastroenterology 2002; 3:98-104.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Irritable bowel syndrome: psychological treatment, we recommend that you enter our category of Clinical psychology.

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