Treatment for Visceral Hypersensitivity in IBS

Visceral hypersensitivity means a general increase in pain sensation experienced in internal organs. It is common in IBS sufferers. If you suffer from this, an internal stimulus which would normally not be noticed will register to you as pain. And if you have a stimulus that non-sufferers would feel as mild discomfort, you might suffer from severe pain.

For example, patients with IBS describe rectal stimulation as much more painful or uncomfortable than equivalent stimulation in a healthy individual.

The gut has a very extensive ‘enteric’ nervous system – almost as big as the brain itself. It is therefore not surprising that things can go wrong here. Although it is thought that psychological factors may play a role in hypersensitivity, there may be local problems in the gut nerves themselves or in the connections between the gut and brain but actually no problem in the brain itself.

In addition, visceral hypersensitivity may provide an explanation for the link between stress, anxiety and depression and IBS, which is widely recognised. It is important to stress though, that not all people with this problem have any mental problems at all.

Medical Treatments

One of the first lines of treatment for visceral hypersensitivity in IBS is the prescription of drugs that affect the function of the nerves in the gut. The aim is to decrease the irritability of these nerves. The types of drugs used are exactly the same ones that are more commonly used in brain nerve disorders such as depression. But the dose needed to treat gut problems is generally much lower.

The drugs usually used include:

• tricyclic drugs such as amitriptyline or trimipramine
• selective serotonin reuptake inhibitors (SSRI) such as citalopram
• selective noradrenaline and serotonin inhibitors (SNRI) such as duloxetine

These drugs are prescribed at a much lower dose than for depression, but they still block some of the pain signals sent from the bowel to the brain, dampening down the heightened pain responses you may feel.

Complementary non-medical therapies

Some complementary therapies have also been shown to be effective in treating visceral hypersensitivity, such as hypnotherapy or cognitive behavioural therapy. These therapies are thought to relieve stress and anxiety, which can be the main triggers of many of the symptoms of IBS, especially hypersensitivity.

A large body of work has been carried out around the value of ‘gut related self-hypnosis’. This was pioneered in Manchester in the 1990s and is very successful. People undergo a 6-12 week course where they learn to self-hypnotise very easily. This enables them to reduce the pain when it comes.

We are able to recommend practitioners of this therapy if we think it is appropriate for you and you would like to try it.

In addition to relieving the pain associated with IBS, acupuncture is also thought to reduce visceral hypersensitivity by reducing pain signals sent from the bowel to the spinal cord. In fact the use of acupuncture to treat this condition has recently been published in scientific journals. If you choose to investigate this option, ensure you go to a reputable, knowledgeable acupuncturist.