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What is IBS Really?

April is Irritable Bowel Syndrome (IBS) Awareness Month.  I want to take some time to really look at what IBS is and how pelvic floor physical therapy can play a key role in treatment and management of this challenging diagnosis.

Rome III criteria (http://www.romecriteria.org/assets/pdf/20_RomeIII_apB_899-916.pdf) is a system that has been developed to help in the diagnosis and classification of gastrointestinal disorders.  According to the most recent criteria, IBS is defined as recurrent abdominal pain that improves with having a bowel movement, and a change in bowel movement frequency and/or change in the appearance of the stool.  There are not any tests that confirm IBS. IBS is a diagnosis of exclusion, meaning that the tests that are run will most likely come back as negative. There are many other diagnoses are ruled out before IBS is ruled in.  Other symptoms that are common with IBS included heartburn, early fullness with eating, nausea, bowel urgency, and bloating.  IBS often occurs in conjunction with other physical symptoms including low back pain, headaches, bladder pain, vaginal pain or vaginismus, and generalized muscle pain.

The gut is controlled by the enteric nervous system.  This part of the nervous system works fairly independently of the brain and central nervous system.  The enteric nervous system controls the motor function, blood flow, mucosal transport and secretion, and helps to modulate immune and endocrine functions in the gut itself (http://gut.bmj.com/content/47/suppl_4/iv15.full).  There has been significant research over the past 10 years indicating that the enteric nervous system is very much involved in the cause or at least the symptoms of many functional gastrointestinal disorders.  The enteric nervous system is sensitive to changes in stress and can slow or even stop digestion with a perceived threat.

This is where a pelvic floor physical therapist can play an important role in your management of IBS symptoms.  Many of the top GI clinics feel that pelvic floor physical therapy is an important part of their patients’ treatment team and incorporate PT throughout treatment.  A highly trained pelvic floor PT will look at you from a whole body point of view.  This includes how the pelvic floor muscles are relaxing and elongating with bearing down with both manual techniques and with biofeedback, how your diaphragm is working in coordination  with the pelvic floor muscles, and your hips, abdomen, and low back are moving.  Improved pelvic floor and diaphragm coordination aid in the improved muscle relaxation with the attempt to have a bowel movement and also with the calming of the enteric nervous system. 

Pelvic floor PT plays an important role in your road to recovery and management of your IBS symptoms. Take advantage of April and IBS awareness month to become more knowledgeable about your symptoms and the treatments that are available.  And remember the important role a good pelvic floor physical therapist can play in your symptoms management.

–Jennifer Cumming, MSPT, CLT, WCS

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates. 

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