Angela Harewood still cringes at the memory of the comments she used to get from strangers about her advanced pregnancy.
‘People would say things like “not long to go now” pointing to my swollen tummy,’ recalls Angela, 48, a company director from Abbots Langley, Hertfordshire.
‘It didn’t happen just once, but over and over again. the only trouble was, I wasn’t pregnant — just very badly constipated.’
All in the head? one way of treating IBS is ?hypnotising patients into a deeply relaxed state and asking them to place their hand on their ?stomach and ?generate feelings of warmth and comfort
Angela is one of the millions of Britons thought to suffer from Irritable Bowel ?Syndrome (IBS) — a problem with gut function which can cause symptoms such as constipation, diarrhoea, painful ?cramping, bloating and flatulence.
The symptoms can be so severe in some cases that sufferers have to give up work.
It is notoriously difficult to treat and, while the symptoms are undeniably real, tests often reveal no obvious physical cause, explains Dr Julian Stern, who treated Angela at the specialist bowel ?centre at St Mark’s ?Hospital, London.
For Angela, treatment at St Mark’s proved to be the turning point, thanks to a new approach that focuses on the link between the mind and bowel health.
Angela’s symptoms started after the birth of her son, Ashley, when she was 30.‘my constipation was awful: ?sometimes I couldn’t go to the loo for up to ten days and this caused my tummy to swell up like a ?balloon. I would bloat from a size ten to a size 14 in days; none of my clothes would fit. I suffered stomach cramps and acid reflux.‘I was a single parent and trying to do the best for Ashley on my own. I had a long commute into London and a stressful job as an executive for a charity. I was ?irritable and had a permanent frown on my face because of the stomach pain.’
For more than ten years, Angela’s GP tried a host of approaches: ?laxatives, ?painkillers and ?antacids for ?indigestion, diet advice and antidepressants — but nothing had any long-term effect.
‘Even if I drank gallons of water and ate lots of fruit and vegetables it didn’t make a difference. In fact, fibre seemed to make my symptoms worse. Eventually, I was ?having so much time off sick I had to give up work and survive on benefits, which meant I was under a ?lot of financial pressure.
‘I ended up throwing most of the drugs in the bin and was ?adamant I didn’t need ?antidepressants, as I had a physical ?illness not a mental one. I felt insulted that my doctor believed my problems were all in my head when I knew my symptoms were very real and physical.’
At one stage Angela was referred to a ?psychologist at her local ?hospital as tests — including MRI scans and an endoscopy, where a tiny ?camera is inserted into the bowel to check for signs of ?disease — did not reveal a physical ?reason for her symptoms.
‘I was defensive about being referred to mental health services — it seemed like they were saying I was making it all up,’ she says.
Eventually, Angela started to research ?specialist bowel ?hospitals on the internet and came across St Mark’s Hospital in North London, one of only two specialist tertiary referral bowel hospitals in the UK (this means that other hospitals can refer patients to their specialist care).
‘As my psychological health improved so did my gut ?problems. my constipation and bloating eased a lot and I felt able to go out and livea normal life again’
‘I went back to my GP and told him I was sick of being constantly fobbed off and needed help from the top experts at St Mark’s.
‘I felt that if anyone could solve my health problems it would be them and insisted he refer me there,’ says Angela.
A few months later, Angela was referred to St Mark’s ?Psychological Medicine Unit.
‘When I was told I was going to see a psychiatrist I felt slightly defensive again,’ says Angela.
‘but it was explained that no one was in any way doubting I had the physical gut symptoms — just that they had been ?unable to find a physical cause and that sometimes conditions such as stress and emotional trauma can affect the gut.
‘because I trusted the advice given at St Mark’s I decided to give it a chance — it helped that the Psychological Medicine Unit was within the hospital and not in a mental health unit.’
In fact, there is now a growing body of scientific evidence to show a link between psychological feelings such as stress and gut problems.
As Dr Julian Stern, the unit’s consultant psychiatrist in ?psychotherapy, explains: ?‘There is a significant link between the brain and gut impulses. this is known as the brain-gut axis.’
Indeed, the gut has its own ?neurological system — called the enteric nervous system — sometimes referred to as the second brain, as it is lined with hundreds of thousands of nerve cells which communicate with the central nervous system.
‘Some patients have gut ?problems that are not caused by a gut illness at all, but are a ?physical manifestation of their anxiety, says Dr Stern.
‘we are not saying that their problems are in their head, just that stress and other unresolved ?psychological issues may be a contributory factor. Dealing with those issues may improve some of the symptoms.’
The unit, which was set up in 2005, treats about 150 patients a year — about half of them have IBS symptoms, while others ?suffer from a variety of gut ?problems, including intestinal failure (where patients can no longer absorb food and need to be fed by an intravenous line) and Crohn’s ?disease — a chronic inflammatory bowel condition.
At Angela’s first consultation with Dr Stern they discussed the relationship between stress and the bowel. ‘It was a light bulb moment for me. I suddenly saw that my symptoms might be rooted in my stressful lifestyle and difficult childhood,’ she says.
Angela was referred on to ?consultant psychologist Dr Esther Serrano-Ikkos at St Mark’s for a form of therapy that tackles negative thoughts and memories. St Mark’s offers a range of ?treatments, including group ?therapy, psychotherapy and ?gut-directed hypnotherapy.
The latter was pioneered by IBS expert Peter Whorwell, ?professor of medicine and gastro?enterology at the ?University of ?Manchester. It’s not a cure, but eight out of ten patients say they feel 80 per cent better, and can control their symptoms more by using this technique to relax the muscles of the gut.
Patients are ?hypnotised into a deeply relaxed state and asked to place their hand on their ?stomach and ?generate feelings of warmth and comfort.
The therapist then ?suggests that patients use this action to create ?similar feelings of ?comfort when they feel symptoms coming on in the future.
Patients are given an audio recording to use daily to reinforce the positive suggestions.
The treatment she received was a huge help to Angela.
‘my self-confidence improved as Dr ?Serranos-Ikkos went through my progress results with me. I felt like the old me — happy and ?successful — was coming back.’
‘As my psychological health improved so did my gut ?problems. my constipation and bloating eased a lot and I felt able to go out and live a normal life again. I’ve started working for a housing company and doing voluntary work — something I’d never have dreamt of before the therapy.
‘I still get the odd flare-up due to stress, but I’m able to stay in control of my symptoms now.
‘Drugs and surgery are not the only way to heal physical ?problems.
‘More people should be told how ?psychological therapies can help, too.’