Irritable Bowel Syndrome (IBS) and Painful Bladder Syndrome (Interstitial Cystitis)

By Kent Bassett

Like many other chronic pain syndromes, irritable bowel syndrome (IBS) is said to be incurable, and its cause is not well understood. According to the Cleveland Clinic, “Though there is no cure, you can control and improve symptoms through diet and lifestyle changes.” IBS is the most common diagnosis given by gastroenterologists (10-15% of Americans have IBS).

IBS is considered a “functional” somatic syndrome, which is a term doctors use when there is no organ disease or infection found. But for many with IBS, horrible dysfunctional symptoms persist nevertheless. And typical treatments are often not that effective.

Identifying “functional” syndromes should be good news for patients, because it means that organs are healthy and no identifiable infection is present. But this information is not usually delivered with the kind of joy one might expect, because doctors know IBS symptoms can persist indefinitely. Pain without disease is still pain; and the hurting, discomfort, and embarrassment is as real as for any disease process, but there’s no proven medication or surgery to fix it. And it’s scary to have a problem doctors struggle to understand or treat.

For patients with symptoms resembling IBS, it’s important to rule out structural problems like infections, tumors, inflammatory bowel disease (like Crohn’s and ulcerative colitis), celiac disease, and others diseases before arriving at a diagnosis of IBS, especially since the symptoms can be similar.

Our film This Might Hurt explores an evidence-based treatment for functional disorders and other non-structural problems that often perplex doctors. Doctors are trained to find and treat diseases, but when they don't find them, they can get stumped and offer “lifestyle changes.” Maybe you should eat better, sleep better, exercise, and adopt a mindfulness practice. Sure, but what if I do all those things, and I’m still in serious pain?

Watch the Live Seminar We Hosted with IBS Survivor and Coach, Michelle Wiegers, and podcast host, Chazmith Newton 👇

Tips from Michelle Wiegers

How To Re-introduce Foods Safely and Reclaim the Joy of Eating

a.k.a. the End of Food Elimination Diets…

👉 21:52 - Don’t start re-introducting the foods that cause you the most fear, start with the ones that are the least scary.

👉 Start with just using your imagination combined with messages of safety—if you get symptoms from imagining eating something, this is confirmation that the brain is generating the symptom.

👉 After using imagination, progress to eating trace amounts of the trigger food — so small they couldn’t possibly cause such a severe symptom, combined with reassuring messages that your body is safe and healthy.

👉 Then add a little more food, like a teaspoon, and so forth. Using this graded method, it’s possible to slowly recover the ability to eat foods while unlearning the symptoms. This is possible because the conditioned response to eating certain foods, which is a feedback loop driven by neuroplasticity, is highly reversible.

👉 As your adding foods back to your diet, repeat messages to yourself, “This food is safe,” “My body is safe and healthy,” “I’m not afraid of this food anymore.” These messages may need to be repeated 100s or 1000s of times over many weeks before they reach deeper levels of the brain and begin to rewire the threat detection system.

👉 Many people with IBS report that it takes them months or even years to unlearn the automatic fear response to certain foods, but it is possible. It’s best not to turn your recovery time into another thing to beat yourself up about. It takes as long as it takes—every individual’s recovery is unique.

👉 For maximum effect, it’s best to combine graded behavioral retraining like reintroducing foods with other methods (e.g. emotional and cognitive retraining) that help people unlearn stubborn symptoms. More details can be found on our 5-step process to unlearn pain page.

Most doctors are unaware of the new diagnosis and treatment paradigms like PRT (Pain Reprocessing Therapy) or EAET (Emotional Awareness and Expression Therapy) that are specifically tailored to identify, treat, and resolve functional disorders like IBS and irritable bladder syndrome (interstitial cystitis). These treatments help patients unlearn symptoms like pain, bloating, diarrhea, brain fog, and burning pain; they reduce fear that the body’s damaged; they take advantage of the latest neuroscience breakthroughs on predictive coding and the brain-body connection; and they can help patients dramatically reduce symptoms, and often make full recoveries.

The treatments usually begin with reassuring patients that symptoms of pain and digestive issues—in their case, after examination and reviewing scans for each individual—are not a sign of a damaged digestive system. Yes, there are alarming dysfunctional issues with digestion, but what’s the underlying cause? This question is explored in-depth, and people’s histories are taken with attention to when symptoms started, and whether anxiety can trigger their pain and dysfunction. Fear around eating and problems with bowel movements are addressed, and many of the same steps used for other chronic pain syndromes are customized to help unlearn IBS-specific symptoms.

The NEVER-ENDING TREADMILL of Food Elimination Diets

Restrictive diets like FODMAPs are typically not recommended by mind-body physicians because these changes can create a fear-avoidance feedback loop that exacerbate symptoms over the long-term, and reduce the joy of eating.

Of course, changing one’s diet may reduce symptoms in the short-term (which is oftentimes a result of the placebo effect), but in the long-term, avoiding food triggers can paradoxically make triggers more powerful through fear. (This is similar to the problem of triggers for people with migraines.)

Food intolerances can be slowly unlearned in the same way that primary pain symptoms are unlearned: carefully and with attention to unwinding the cause-and-effect spiral of fear, expectations, and symptoms.

In the interview below, Michelle Wiegers, a mind-body coach and advocate for chronic pain survivors, talks about how for her, it was actually more challenging to unlearn food triggers than it was to unlearn pain and fatigue.

The conditioned responses can create this vicious cycle: ingesting food -> unconsciously expecting symptoms -> getting brain-generated symptoms. This is another reason why food elimination diets are often counterproductive in the long-term.

Her whole story is amazing, but if you want to hear about the delicate art of unlearning food triggers and the joy of resuming a full diet without symptoms, you can skip to minute 55. ↓

You can find out more about the process here:

Can IBS Be Reduced by Changing Anxiety Pathways in the Body?

Allan Abbass, MD, a teacher of Experiential Dynamic Therapy, tells a case study of seeing a patient who was hospitalized for severe IBS who recovered by changing how they processed anxiety and emotions:

IBS is real, physical pain and it can be so severe it causes hospitalization. It’s not “all in the head,” or imagined, or made up. But if doctors cannot find a disease process, what’s an alternative explanation?

People with irritable bowel syndrome suffer from disruption of the unconscious process by which food is digested. We all know that the anxiety of anticipating public speaking can cause butterflies in the stomach, but can a stressful life be the cause of more serious abdominal symptoms long-term?

Psychologists who specialize in helping people process emotions and transform their unconconsious anxiety are accustomed to seeing patients channel their anxiety into “smooth muscles,” which can cause nausea, vomiting, diarrhea, and other bowel problems. Often when people become angry, instead of experiencing the difficult emotion, they become nauseous instead, which is a process that happens completely outside their scope of awareness. This is so common that therapists have a technical term for this, “unconscious anxiety channeled into the smooth muscles.” This is an autonomic nervous system dysfunction for a group of muscles involved in digestion that are outside our deliberate control. As these afflictive emotions are gently approached and integrated, anxiety goes down and when it arises it can be brought into conscious awareness more easily. This process of transforming anxiety prevents it from being channeled into the smooth muscles that control digestion.

According to Dr. Maury Joseph, “The smooth muscle systems of the body include the gastrointestinal system, the vascular system, the bronchi, and the urogenital system. There are also smooth muscles in our skin and eyes. The muscles are called smooth because they are made up of small, mushy, somewhat elastic cells. They differ from our skeletal muscles, which have long, striated fibers that are less flexible.”

“When our smooth muscles are functioning as they should, they regulate our blood pressure, digestion, sexual and excretory functions, and breathing—functions that are essential to human survival. However, the smooth muscles are linked to the emotional center of the brain by the nervous system, and they can be activated in response to anxiety. So what happens when anxiety impacts the smooth muscles? What symptoms are linked with dysregulation of the smooth muscle systems?”

Go here to read his whole piece: “Self-Criticism, Smooth Muscle Anxiety, and How ISTDP Helps” by Maury Joseph, PsyD, July 2016

Dr. Kristy Lamb, a practitioner of ISTDP therapy, lays out the three levels of anxiety. IBS is defined by changes to the second layer of anxiety, that is anxiety involuntary muscles in our guts:

Is there any peer-reviewed research for treating IBS as a primary pain condition?

Adults with IBS were randomized to receive EAET in a study funded in part by the NIH and published in a peer-reviewed journal. The full text is available online:

“Emotional Awareness and Expression Training Improves Irritable Bowel Syndrome: A Randomized Controlled Trial,” number of patients = 106, pulished in Neurogastroenterology & Motility, December 2018.

Another couple of studies examined a related emotion-focused treatment for functional abdominal symptoms. “Efficacy of Intensive Short-Term Dynamic Psychotherapy for Medically Unexplained Pain: A Pilot Three-Armed Randomized Controlled Trial Comparison with Mindfulness-Based Stress Reduction,”January 2016, Psychotherapy and Psychosomatics, Parvaneh Mohammadkhani.

In this study, short-term experiential dynamic therapy was compared to Mindfulness Based Stress Reduction. Patients randomly assigned to ISTDP for 8 sessions of therapy reduced their pain on average from 8.5 -> 3.5 on the 10 point pain scale. More than 50% reduction in pain.

“Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects” Journal of Psychosomatic Research, Allan Abbass, MD et al March 2021.

This recently published meta-analysis serves as a convenient summary and bibliography of recent studies on treating primary pain syndromes with the interventions you see in the film (ISTDP and EAET).

“A Randomized Controlled Trial of Psychotherapy in Patients with Refractory Irritable Bowel Syndrome,” E Guthrie, F Creed, D Dawson, B Tomenson, Number of patients=102, British Journal of Psychiatry, 1993

More research is needed.

Resources for Overcoming IBS and IC

Here’s a success story of someone with IBS-D and fibromyalgia telling his story of over-medicalizing IBS and then recovering using neuroplastic brain retraining popularized by Dr. John Sarno. It’s a long video, so this link takes you to the timecode where he discovers a way out of IBS pain:

(Whether someone has IBS-D, IBS-C, or both, neuroplastic brain retraining is helpful for all IBS manifestations.)

In our film This Might Hurt, one of the people has IBS symptoms re-emerge after doing emotional work around one of her other pain syndromes. She has a deep fear of embarrassing herself with an involuntary bowel problem.

As he describes in the film, Dr. Howard Schubiner also suffered from IBS during his first year as a doctor. You can view the trailer for This Might Hurt here:

“Let the Mind Help Tame an Irritable Bowel,” New York Times, 2008

David Clarke, MD, a gastroenterologist, wrote a book They Can’t Find Anything Wrong about IBS and other stress-induced illnesses.

The TMS-Wiki collects success stories from patients who recovered after just reading books by Dr. Sarno and Schubiner—this can give people with debilitating IBS some hope.

Nicole Sachs, LCSW podcast interview about overcoming Irritable Bowel Syndrome

Nicole Sachs, LCSW podcast interview about dealing with Interstitial Cystitis