A COURSE TO FACILITATE SELF HELP
The course outlined below has been designed to facilitate self management of IBS and will be available in designated locations in the UK from October 2016.
To express an interest, please send your contact details contact to The IBS Network (firstname.lastname@example.org).
Irritable Bowel Syndrome is a common illness of the gut with no clear pathology or cause and no agreed treatment. Instead, the manifestations of IBS seem to represent, to a large extent, the individuals response to their life style and situation. Effective treatments vary from person to person, and are probably best conducted in the first instance by patients themselves but facilitated by health care practitioners or expert patients/ self help group leaders, specifically trained to understand and manage IBS. This document outlines a model of training for self help group leaders or digestive health practitioners to facilitate IBS self care.
Aims and Objectives
The aim of this course is to provide people with the knowledge and confidence to manage their own condition in collaboration with their health care professionals. By the end of the programme, we would expect people with IBS to understand;
- The anatomy and physiology of the gut,
- The pathophysiology and causes of the common gut symptoms.
- The definition of IBS and the diagnostic criteria.
- What other conditions would need to be ruled out.
- The nature of IBS as an illness with no clear cause or pathology.
- The range and current understanding of unexplained illnesses (overlap with other illnesses).
- The nature and importance of gut sensitivity
- Suggested causes and triggers of IBS.
- The relevance of diet.
- The mechanism and effect of emotion.
- The role of infection and gut flora.
- The nature of healing and the relevance of complementary therapies.
- The medications available for IBS at your pharmacist.
This 13 week course is designed to be delivered to health care professionals or to he members of self help groups. It could be delivered by the group coordinator or prepared as a video or powerpoint presentation for showing at meetings.
1. Changing patterns of illness behaviour and encouraging people to take responsibility for their own illness.
IBS is an individual illness. Using case histories, narrative and examples from everyday life, this module will encourage people to understand their own illness, the factors that led to it, what makes it worse and what makes it better, and what treatments seem to help. Self management involves a major change in attitude from helplessness and dependence to responsibility and self confidence. It requires motivation and opportunity and a willingness to take control of their own condition, accepting the reality of the illness as a limitation and not a source of shame, adopting strategies to reduce the impact and avoid the triggers and explaining their needs to their doctor, their boss, their husband, parents or children with confidence.
This module will also discuss the personal attributes, skills and techniques that can help facilitate change in others. These include active listening, encouraging motivation, showing what might be possible but allowing space for the patient to find their way when the time is right, and taking it one step at a time, acceptance of the possibility before making change, consistency and empathy.
2. How your gut works.
This module includes an understanding of the anatomy and physiology of the gut, including the neurohumoral control of gut function, the role of colonic bacteria, the gut immune system, brain gut interactions and how emotions influence the gut.
3. Common gut symptoms
This module provides an explanation of the pathophysiology of common gut symptoms such as nausea, vomiting, heartburn, abdominal pain, bloating, constipation, diarrhea and urgency and include the causes and effects of changes in gut sensitivity. This module also includes a discussion of the pathology of other gastrointestinal diseases, which cause symptoms similar to IBS. These include coeliac disease, functional dyspepsia, gastro-oesophageal reflux, gallstones, colitis, Crohn’s Disease, diverticular disease and other disorders of defaecation.
4. What is IBS?
This module describes the nature and concept of IBS as an unexplained gastrointestinal illness that has no definitive pathology or no distinct cause and shows extensive overlap with other common unexplained illnesses like fibromyalgia, chronic fatigue syndrome and functional dyspepsia. It also includes the attempts of The Rome and NICE and other committees to define IBS, the utility and validity of ‘positive’ diagnostic criteria as opposed to a diagnosis of exclusion and historical and sociological perspectives on IBS. Finally it discusses different perspectives of IBS, such as a specific gut illness awaiting discovery of a cause, a resetting of gut brain sensitivity and reactivity or the visceral expression of a state of dysphoria involving the mind and the body?
5. What causes IBS
This module examines examine the evidence for the proposed causes of IBS. These include an infectious gastroenteritis, a traumatic life event affecting the gut, food allergy, a genetic disorder, an unidentified neuromuscular disorder, an environmental illness, a brain gut disease and a psychosomatic illness. It discusses visceral sensitivity as a diagnostic marker and distinguish between causes of visceral sensitivity and triggers that affect the sensitive gut to cause symptoms.
6. Diet and IBS
This module explains the distinction between food intolerance and food allergy and the relevance of each in IBS. Drawing on the concept of visceral sensitivity, it discusses the implications of the intolerant gut and the importance of fats, fibre, coffee, hot spice and Fermentable sugars (FODMAPS) as triggers of IBS symptoms and explains the principles of dietary management of IBS. It also explains how the context in which food is eaten, the memory and the meaning of specific foods can all affect the reaction to certain foods and the importance of allowing time to eat.
7. The Relevance of Colonic Bacteria and the Microbiome
This module explains the importance of colonic bacteria in salvaging unabsorbed nutrients and how this might affect gut symptoms, and the role of the colonic microflora in priming the gut immune system. It discusses the mechanism of post infectious IBS, the effects of our modern diet, lifestyle, drugs and illness in depleting the microbiome and the evidence for small intestinal bacterial overgrowth.
8. Stress and the effect of what has happened
This module reviews the evidence for how life situations and psychological distress can alter gut function and bring on the symptoms of IBS. It explains how the memory of a particular traumatic event that affects the gut can linger on, sensitizing the gut to further change, It discusses the concept of emotional immune system and what happens when trauma causes hyperactivity and disruption of the physiological mechanisms for bodily regulation and disconnects these from cognitive control. Finally it discusses the psychological treatments for IBS.
9. Decoding IBS.
The presentation of IBS is so variable, it may be regarded as an expression of the individual, their attitudes and life style. Using a combination of case histories and theory, this module will explore the symbolic nature and meaning of IBS symptoms and how such representations might come about.
10. How to help people manage their IBS.
This module focuses on facilitating self management of IBS, outlining the medical, social emotional elements and emphasizing support, information resources, customized advice, and working with the patient’s own belief system rather than imposing treatment and control. The importance of understanding the individual in the context of their life situation and lifestyle will be discussed alongside strategies for enabling self confidence. This module will also identify red flag symptoms and when it is necessary to see a doctor or get referred to a specialist.
11. Managing the symptoms of IBS.
Medical management of IBS is often a matter of treating the individual symptoms rather than the disease. This module will focus on the resources that are available to treat the main symptoms of IBS; constipation, diarrhea, bloating and abdominal pain, pointing out what can only be obtained from the doctor by prescription and referral and what can be obtained privately or from a pharmacist or health food store. It will also illustrate how treating one symptom may make other symptoms worse and how people with IBS are often very sensitive to the side effects of drugs.
12. Helping people deal with their emotions.
Fury, catastrophe, panic, despair and hopelessness are destructive emotions that have a major impact on bodily function and feeling, especially when they cannot be expressed. This module will explore how to help people reduce the impact of their IBS by providing the insights and techniques to helping them manage their emotions and understanding the situations that cause exacerbations of their illness. The role of antidepressants, counseling, mindfulness, cognitive behavioural therapy, and techniques for relaxation will be considered as well as how necessary it is to explore the background of any situations that may have instigated the illness.
13. Complementary therapies.
This module will discuss the nature of healing, why people need to identify with some credible belief structure, individual or technique to get better, and how to facilitate and encourage this while advising caution where adherence might be unsafe. It will explore the nature of belief, confidence and the healing or placebo effect and how to harness this for greater effectiveness. The module will also indicate how different complementary therapies recruit certain aspects of healing, belief, instilling confidence working with the body, and the use of touch.