New research shows that talk therapy helps women with irritable bowel syndrome
By Jan Matthews
First published in Chatelaine's January 1999 issue.
© Jan Matthews

Unpredictable abdominal pain, diarrhea and constipation. They all come with irritable bowel syndrome (IBS)--the problem with a name, but no simple medical reason and no cure.

Almost one in every 10 people--the majority of them women--live with these intestinal troubles. In fact, IBS counts as the second most common cause of absenteeism, after the common cold. But researchers have finally found something that may help. Apparently, stress doesn't cause IBS, but it plays a major role in aggravating the gut, and psychotherapy can help manage both stress and IBS symptoms.

Most of us feel a pit in our stomach or get butterflies when we feel scared. The gut and brain communicate via a nerve pathway and chemical transmissions, so stress affects virtually everyone's bowels, according to psychologist Brenda Toner of the Centre for Research in Women's Health, which is connected to Women's College Hospital and the University of Toronto. Yet those with IBS have a hypersensitive gut, and a variety of dietary, hormonal or environmental stressors can aggravate the disorder, giving them a bout of diarrhea or abdominal pains. Dr. Toner is working with a research team at the universities of North Carolina and Toronto on a five-year study that compares psychological treatment with pain medication and education.

IBS patients don't recognize what causes them stress, according to team psychologist Shelagh Emmott at the Centre for Addiction and Mental Health, Clarke division. Although the women in the study do not consciously experience job change, divorce, death of friends or parents as overwhelmingly stressful, their guts still react with nasty symptoms.

Women in the IBS study learn how to recognize their stressors using cognitive-behavioural therapy techniques, such as learning to avoid jumping to conclusions, perfectionism and seeing problems as catastrophes. Then Dr. Emmott coaches them to understand what they do that makes the stress worse. Women often discover they've been saying things to themselves such as, "If I'm late, people will hate me" and "I have to give 120 percent or I'm a bad person." Dr. Emmott teaches participants to have more realistic expectations of themselves, to manage their perfectionism and to do something that gives them pleasure. They also learn different ways to respond to stressful events. That might mean saying no or asking or help.

Gender roles also play a big part in the stress that causes IBS symptoms. Women are socialized to be warm and giving, says Dr. Emmott, and often end up taking care of everyone except themselves. Dr. Toner believes that working women experience a serious conflict. "Society gives women mixed messages," she says. "Be focused and competitive but take care of others without complaint. That's unhealthy." Dr. Toner advises women to become aware of the gender trap--of what society expects. In addition, Dr. Toner also encourages women with IBS to take good care of themselves--eat well and get sufficient rest--and not feel guilty about taking time out for themselves.

Many women participating in a prior study by Dr. Toner have used what they've learned in therapy to manage symptoms. For a few, it's changed their lives. One woman felt so inhibited by IBS and the possibility of having to flee to the washroom constantly that she hadn't been to a movie in 15 years. But after four months of therapy, she attended a festival and saw 16 films in 10 days.