In the world of pelvic rehabilitation, it is rare that we meet a patient who has an isolated issue. More often we hear complaints about not only bladder dysfunction, but also about bowel dysfunction, sexual health issues, and pain. Irritable bowel syndrome (IBS) is one diagnosis that shows up on many of our patient intake forms and will be identified as constipation-dominant, diarrhea-dominant, or as having both conditions. Much of the recent research regarding IBS reiterates the fact that the cause of IBS us unknown, that it is a functional gastrointestinal disorder, and that the diagnosis is made based on clinical symptoms rather than a test. Some patients have responded favorably to trials of certain antibiotics, but the medical community continues to struggle with a cure for this painful, distressing condition.
I was very pleased to see an article that proposes a biopsychosocial model for IBS. There is increasing interest in and awareness of the relationships between the brain and the gut. In this article, the authors discuss issues of life stress, history of abuse, parental patterns of "illness behavior", coping mechanisms, in addition to gut physiology. Although the authors do not recognize the role of physical therapy in treating IBS, it is stressed that providers must develop strong rapport with patients so that clear communication is available. It is then much easier for some of these challenging topics to be discussed and for strategies to be put in place. In addition to pharmacology, the authors suggest that psychotherapy may play a larger role in helping patients with IBS to heal.
Many of our patients do recognize that stress is a major factor that worsens pain and bowel dysfunction. Pelvic rehabilitation specialists are equipped with tools to help teach patients how to decrease the physiological sequelae of stress through skills such as breathing, contract-relax, physiologic quieting, and other means. If you are interesting in learning more about treatment of bowel conditions such as IBS, that information is covered in the Level 2A courses.