Understanding the Link Between Visceral Hypersensitivity and IBS: When Your Gut Feels Too Much

Have you ever experienced abdominal discomfort that seems out of proportion to what’s actually happening in your gut? Maybe you constantly experience crippling pain or spasms, even though all your investigations and tests are coming back normal? If so, you might be experiencing visceral hypersensitivity. This blog explores Visceral Hypersensitivity, its clinical significance to IBS and evidence-based management strategies to help combat it.

What is Visceral Hypersensitivity?

Visceral hypersensitivity, sometimes known as ‘Gut Sensitivity’ is a condition where the nerves in your gastrointestinal (GI) tract become overly sensitive, leading to amplified sensations of pain, discomfort, or even bloating. Normally, these nerves signal to the brain when there’s something going on in your gut, like digestion or stretching due to food intake. However, in people with visceral hypersensitivity, these nerves become hyperactive, leading to exaggerated sensations even in response to any stimuli - this means even normal digestive processes, might leave you in agony! Research indicates that alterations in the gut-brain communication, neuroimmune interactions, and abnormal processing of gut sensations within the central nervous system contribute to this phenomenon (Barbara & Cremon, 2015). Visceral hypersensitivity also extends its influence beyond gastrointestinal disorders, with emerging evidence linking it to conditions such as fibromyalgia, chronic pelvic pain, and functional dyspepsia.

Symptoms of Visceral Hypersensitivity

The symptoms of visceral hypersensitivity can vary from person to person but often include:

• Abdominal pain: This pain can range from mild discomfort to intense cramping and can occur anywhere in the abdomen.

• Bloating: Many people with visceral hypersensitivity report feeling bloated even when they haven’t eaten much.

• Nausea: Some individuals may experience feelings of nausea or even vomiting.

Understanding the link between Visceral Hypersensitivity and IBS:

Visceral Hypersensitivity is still a relatively new concept, and isn’t usually screened for or diagnosed. Its most commonly associated with IBS, and its thought that up to 40-60% of IBS sufferers have Visceral Hypersensitivity. Studies have demonstrated a clear association between visceral hypersensitivity and symptom severity in individuals with IBS, highlighting its role as a key mechanism (Mearin & Lacy, 2015). Its thought, any increase of fluid or gas in the gut triggers the nerves to send a signal to the brain saying there is pressure and our body then responds by telling us that we are experiencing gut symptoms or pain. 

Evidence-Based Management Strategies:

There is no consensus about what treatment is best to tackle Visceral Hypersensitivity, but generally with IBS we are moving to a more holistic approach that integrates several different evidence-based interventions. Dietary modifications, including the low FODMAP diet, has been shown to be effective in reducing symptoms associated with visceral hypersensitivity (Camilleri & Boeckxstaens, 2018). High FODMAP foods, are typically rapidly fermented in the gut; this increases gas production and draws large amount of water into the intestines. These digestive processes increase pressure on the gut walls, and can contribute to distension, bloating and abdominal pain in those with visceral hypersensitivity. Therefore, by temporarily following a low FODMAP diet, to identify symptom triggers, it can help manage sensation in the gut.

Pharmacological interventions targeting visceral pain perception, serotonin receptors, and gut motility may also be used in conjunction with lifestyle modifications for symptom management (Camilleri & Boeckxstaens, 2018). However, although medications may treat your symptoms, they don’t treat the underlying cause, like mind/body therapies such as Gut-Directed Hypnotherapy, Cognitive-Behavioural Therapy (CBT) or Mindfulness Practices. These interventions help to modulate the brain-gut axis and can help mitigate gut sensitivity (Moloney & Dinan, 2017). In other words, they take advantage of neuroplasticity, which is the ability of your nervous system and brain to learn new helpful connections and patterns.

Gut-Directed Hypnotherapy uses visualisation, imagery and gut-directed suggestions to address pain and specific symptoms, to reduce discomfort in the gut and reduce symptoms. Several studies have shown that gut-directed hypnotherapy provided by a trained hypnotherapist can help reduce abdominal pain caused by IBS.

CBT combined with hypnotherapy can be effective in managing symptoms of visceral hypersensitivity, by helping people recognise and unhelpful thought patterns related to their discomfort, and developing coping strategies to manage the symptoms.

Mindfulness practices like meditation, guided body scans and breathing exercises have also been shown to help people with IBS and visceral hypersensitivity. These practices help us cultivate non-reactivity to discomfort, which can decrease gut sensitivity and pain catastrophising. Brain scans show parts of the brain are activated that allow us to focus on letting sensations pass. Carving out time in your day for a dedicated mindfulness practice can be difficult, but there are lots of free online resources you go about your day. Mindfulness apps like Headspace or Calm can be quick and convenient to use, and I really recommend the following website for free mindfulness recordings:

Mindfulness Audio Downloads (bangor.ac.uk)

Closing words…

Living with visceral hypersensitivity can be excruciatingly painful and extremely frustrating, especially if not recognised by Healthcare Professionals. However, with the right treatment and lifestyle changes, many people find relief from their discomfort. Finding ways to manage stress and prioritise self-care can also make a significant difference in managing symptoms. I offer an integrated approach, which tackles diet, lifestyle, and wellbeing to address visceral hypersensitivity - I can work with you to develop a personalised treatment plan, which emphasises preventative measures and empowers you with tools to reduce your symptoms and improve your quality of life. Please reach out for support, I would be more than happy to support you!

References

• Barbara, G., & Cremon, C. (2015). Visceral hypersensitivity. Current opinion in gastroenterology, 31(1), 17–21.

• Camilleri, M., & Boeckxstaens, G. (2018). Dietary and pharmacological treatment of abdominal pain in IBS. Gut, 67(5), 966–974.

• Mearin, F., & Lacy, B. E. (2015). Mechanisms, diagnosis, and management of irritable bowel syndrome. BMJ (Clinical research ed.), 350, h1622.

• Miller, V. Carruthers, H.R., Morris, J. Hasan, S.S., Archbold, S., Whorwell, P.J. (2015) Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients. Aliment Pharmacol Therapy. 41(9):844-855.

• Moloney, R. D., & Dinan, T. G. (2017). Stress, visceral pain, and gut microbiota: unveiling the gut-brain axis. Inflammatory bowel diseases, 23(10), 1598–1609.