Physical Therapy Treatments for Irritable Bowel Syndrome

What is Irritable Bowel Syndrome (IBS)?

Irritable Bowel Syndrome (IBS) is a functional bowel disorder in which chronic, recurrent abdominal pain or discomfort is associated with defecation or a change in bowel habit. There are three main types of IBS: Diarrhea Predominant or IBS-D, Constipation Dominant or IBS-C, and Mixed IBS-M. Individuals usually report frequent bloating, distension, and alternating episodes between diarrhea and constipation. Abnormalities in the way pain is perceived and psychosocial factors are also frequently seen in conjunction with the condition.

The total prevalence of IBS in the United States is estimated to be between 10.8 and 14.1%.1 Irritable bowel syndrome sufferers have more days off work (6.4 vs. 3.0) and days in bed, and reduced activities to a greater extent than non-sufferers. (1)

What can Physical Therapy do to help with IBS?

Physical therapy for IBS should usually include manual therapy, biofeedback and dietary management. The physical therapist will offer multiple options for treatment, each with their own risks and benefits, and work with the patient to create an individualized plan of care.

Biofeedback is a way to retrain the movement pattern of the abdominal and rectal muscles required to effectively and safely empty the bowels. There are many types of biofeedback, ranging from simple to complex. A physical therapist specially trained to treat defecation disorders, such as IBS, may recommend training of the muscles of the pelvic floor with use of a mirror or surface electromyography (sEMG) to provide visual feedback and assist with coordination training. sEMG is painless, and uses external electrodes or an internal rectal probe to sense changes in pelvic floor muscle activity to be displayed on a screen where the patient can visualize muscle activation and coordination for contraction and relaxation.

Physical Therapists are able to provide dietary recommendations that are often very helpful to assist with management of IBS, regardless of the type. These may include identification of certain food irritants or triggers, as well as appropriate fiber type to improve stool consistency. Along with this guidance, PTs can give education to promote normal bowel function including appropriate water intake, colon massage, toileting posture and the importance of mobility.

Balloon sensitization is another tool that may be applied in cases of External Anal Sphincter (EAS) deficiency, abnormal rectoanal inhibitory reflex (RAIR) or “sampling reflex”, rectal hypersensitivity, or dyssynergia (a coordination problem). With each of these issues, the therapist is able to insert a balloon into the rectum to assist with retraining of the movement patterns of the pelvic floor muscles required for improved ease of bowel emptying or defecation.

While these are some of the tools available to therapists to address these abnormal movement patterns, each patient is in control of their treatment.

Sources:

• Hungin AP, Chang L, Locke GR, Dennis EH, Barghout V. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther. 2005;21(11):1365-1375. doi:10.1111/j.1365-2036.2005.02463.x