Irritable bowel syndrome:
Osteopathy and manual therapy to relieve digestive disorders
Irritable bowel syndrome: Causes and characteristics
Définition
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder affecting millions of people worldwide. It is classified as a functional disorder, as there is no visible lesion in the intestine, but rather abnormalities in its functioning. IBS is characterized by a complex interaction between the gut, the brain and the intestinal microbiota, and is influenced by psychological, nervous and environmental factors.
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Common symptoms of irritable bowel syndrome
Symptoms of IBS are varied and may differ from one individual to another, but they generally include:
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Abdominal pain: often cramps or discomfort that can be relieved after bowel movements.
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Intestinal transit disorders: alternating diarrhea and constipation or predominance of one of the two.
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Bloating and gas: a feeling of abdominal swelling that may be exacerbated by certain foods.
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Fatigue and headaches: less frequent symptoms, but may be present due to the general discomfort caused by IBS.
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​​These symptoms may appear in episodes or be constant, and are often aggravated by stress, certain foods or previous gastrointestinal infections.
Diagnosis of irritable bowel syndrome
IBS diagnosis is based on the Rome IV criterias, a set of diagnostic criteria for functional bowel disorders. These criterias include:
Recurrent abdominal pain at least once a week for the past three months, associated with at least two of the following features:
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The pain is related to bowel movements.
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A change in stool frequency or change in stool consistency.
Exclusion of other causes: doctors may carry out tests to rule out other conditions with similar symptoms, such as inflammatory bowel disease (Crohn's, ulcerative colitis), celiac disease or gastrointestinal infections.
Pathophysiological mechanisms
1. Link between emotional state and intestinal symptoms
IBS appears to be part of the ongoing response of the intestinal tract and central nervous system (CNS) to internal and external stimuli. Psychological factors, such as depression and anxiety, can influence communication between the CNS and the enteric nervous system, and appear to play a role in the manifestation of the syndrome as well as in response to treatment.
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2. Disruption of intestinal motility
Cells in the intestinal nervous system release serotonin (5-HT), which stimulates intestinal motility independently of afferent connections with the CNS. Patients with IBS have decreased expression of specific serotonin reuptake transporters (SERT), resulting in consistently high serotonin levels and dysregulation of intestinal motility.
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3. Visceral hypersensitivity
Patients with IBS have visceral hypersensitivity, in other words, increased perception of stimuli, which is likely a consequence of amplification of nociceptive signals in the CNS.
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4. Intestinal inflammation
Immunohistological studies suggest the hypothesis of an increased intestinal immune response with increased plasma levels of pro-inflammatory cytokines in people with IBS.
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5. Alteration of the intestinal flora
6. Genetic factors
Irritable Bowel Syndrome management modalities
There is currently no cure for IBS, but a number of strategies can reduce symptoms and improve patients' quality of life. Treatment is often multimodal and tailored to each individual's symptoms:
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Dietary modifications:
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Diet low in FODMAPs: these fermentable carbohydrates (such as fructans, galacto-oligosaccharides) are known to aggravate symptoms in some people. A diet low in FODMAPs can reduce bloating and abdominal discomfort.
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Fiber supplementation: soluble fibers (psyllium, for example) are recommended, especially in cases of constipation, to regulate transit.
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Medication treatments :
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Antispasmodics: used to reduce intestinal cramps and relieve abdominal pain.
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Laxatives or antidiarrheals: to help control stool frequency, depending on the predominant form of IBS.
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Probiotics: some probiotics show beneficial effects on the microbiota and can reduce symptoms, although results vary.
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Psychological therapies:
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Cognitive-behavioural therapy (CBT): as stress and anxiety often exacerbate symptoms, CBT helps patients manage these triggers.
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Hypnotherapy: some studies show that hypnotherapy can reduce visceral hypersensitivity and improve pain perception.
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Physical activity:
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Regular exercise is associated with improved intestinal motility and reduced stress, both of which can positively influence IBS symptoms.
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Osteopathy and Manual therapy ​
Osteopathy and manual therapy contribution to the treatment of IBS
Studies into the effect of osteopathic treatment on irritable bowel syndrome (IBS) show significant improvement: osteopathic treatment reduces symptoms such as abdominal pain and bloating, and improves patients' quality of life. Several studies show that visceral osteopathy, by working on visceral mobility, helps reduce spasms and improves intestinal motility. The soothing effects of osteopathy on the nervous system also help to relieve fatigue and anxiety, making this approach effective for the overall management of IBS. Research has shown that osteopathy is safe and free of side effects for patients. (Buffone et al., 2023; Hundscheid et al., 2007; Florance et al., 2013; Muller et al., 2014)
