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I spent a lot of my time at the Bristol Royal Infirmary and University of Bristol working with people with these disorders. Many of the constipation patients were young women who had been threatened with a colectomy - removal of the large intestine (colon). Invariably this doesn't work producing diarrhoea and rarely getting rid of any pain component. I have many letters of thanks from patients who were spared this procedure as a result of the training.
Both these conditions are opposite sides of the same coin. Chronic constipation is a result of over-activation of the sympathetic nervous system (SNS). Diarrhoea type IBS, over-activation of the parasympathetic nervous system (PNS). Some sufferers of IBS have alternating bouts of each as the SNS and PNS flip flop. Which you get depends I suspect on your genetic makeup and, I'm beginning to believe, your mental processes.
Most often the two are stress induced. Stress and increased SNS activity produce a reduction in peristalsis (the movement of the intestines in pushing faeces along) and in consequence constipation. In susceptible individuals this is followed by an increase in PNS activity which increases peristalsis, perhaps even before constipation has set in, leading to diarrhoea.
It is not always a consequence of stressors and stress. In some individuals, especially where the problem is chronic, there may be no precursing stressor. Instead the symptoms are the result of a programmed in habit pattern. (I use the term dysponesis to cover this - it means faulty bracing but many just use this term to cover the bracing of striate muscle).
How do we sort it? The same way we do migraine and all the other problems, with the emphasis on reducing SNS activity. This, in relevant cases (i.e. IBS), consequentially reduces PNS activity, and stops any flip flopping there may be.
Thus, after helping the student to become more self-aware, training begins by looking at breathing patterns and teaching the student to change to slow, relaxed diaphragmatic breathing. We then go on to use myographic biofeedback (muscle) and finally temperature feedback of the hands and feet as an indicator of peripheral vasoconstriction/vasodilatation and SNS activity. All of these are augmented with general relaxation training, the biofeedback being used to check that quite specific criteria are being reached.
A self-help-training programme would include:
- Diaphragmatic breathing.
- Relaxing the striate muscles of the body.
- Learning to dilate the blood vessels in the hands and feet using mental techniques, as an indicator of a decrease in SNS activity.
- Looking at precursing thoughts and behaviours that might trigger the problem.
Theoretically the problem should resolve once we start the temperature training, but quite often, especially with regard to the pain element many IBS sufferers get, the diaphragmatic breathing seems to do the trick.
I did once have an IBS sufferer who got rid of the diarrhoea but still had tremendous pain in the abdominal region. On further inspection I decided that perhaps the pain was a result of something else so I sent her to a manipulative therapist friend of mine who gave her one yank on the leg and the pain never returned. It had nothing to do with IBS but was a back problem (sacroiliac). Don't try this yourself. Get a trained therapist to diagnose and manipulate.
By the way, I don't believe that diet is an important factor. I do believe that dehydration is. If you don't drink enough you will get constipated and so this was always a first consideration with my students. With regard to diet, although with some of them eating the wrong foods might trigger an IBS episode, I found that after training it was less likely to do so. Certainly eating too much fibre or taking "Fibregel" most of my students found unhelpful inspite of the insistence of their specialist that it was the answer.
Exercise is another matter. If you suffer from constipation and you get some exercise whilst practising diaphragmatic breathing - watch out. You could be caught short!
I've kept the above fairly brief and simple. If you'd like to know more ring or E-mail me.
For those of you who are working through this file, disorder by disorder, may I say that so far it's all pretty boring isn't it. The same basic training being used for all the disorders and just tweaked here and there.
In the next section we'll look at two problems where the biofeedback is used on its own - Incontinence and Constipation resulting from incorrect use of the anal sphincter resulting in obstructed defecation.
Although I promised this some time ago it still hasn't been written yet but hopefully I will get it out this autumn (no pun intended) together with Phobias, Skin Disorders, Allergies and some comments on assertively telling someone they smell, an item I was asked to do for the radio station GWR recently. Until then, Best wishes, Derek
DISORDER FILE PANIC ATTACKS
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Copyright © Derek Webster 2003 |
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