By Rachael Freeland
Dear Dr Dan and Swami Sattva,

For the last few years I have been suffering from regular bouts of constipation, which occasionally turn into diarrhoea. My stomach fills like a balloon, and the cramps in my abdomen are horrendous. I’m sick and tired of feeling this way, of having no energy, and of not being able to do the things I want to do. I’ve had a myriad of tests but nothing ever shows up. I’ve been told it might be irritable bowel syndrome. Can you please tell me what is going on in my body? And what I can do about it?

Frustrated and Tired, Melbourne

Dr Dan: GP to the Masses’ Perspective

Dear F&T,
Whilst I am reticent to just assume you have Irritable Bowel Syndrome (IBS), the symptoms you have described certainly fit with this condition. If you’re confident you have been appropriately diagnosed with IBS, there are several key points that will aid your understanding and also your management of this syndrome.

1) You mentioned your predominant symptom is constipation. It would therefore be beneficial to increase your intake of fibrous foods. In particular soluble fibre foods (eg rice, pasta, oatmeal), as these foods regulate the digestive tract, and stabilise intestinal contractions. They do this by absorbing excess liquid in the colon to form a thick gel which the GI muscles can move quite easily. Try to avoid non-soluble fibre foods (eg seeds, nuts, whole wheat, beans, lentils, leafy greens…), as these foods require more digestion. Also, ensure you drink enough liquids, as this enables the muscles to move the waste along the tract. It is when the muscles struggle to move waste along the tract that the cramping and bloating you have described occur. I would encourage you to get to know the types of foods that trigger abdominal cramping and agitation in you, as everyone is different.

2) Whilst IBS is indeed a physiological disorder, the other important factor in reducing its symptoms, is stress management. Stress is an inescapable part of every-day life it keeps us alert to danger so we can keep ourselves safe. However, it is important to learn strategies to manage stress, so that it doesn’t build up, causing damage to our system.
A stressful event or experience stimulates the sympathetic nervous system, sending messages to our brain/spinal cord that we need to prepare for “fight or for flight.” Messages are then sent throughout your body. The adrenal glands begin to secrete adrenaline, readying your body for the perceived threat. You then become more alert, your breathing and heart rate increase, and blood is directed away from your organs to your muscles. Digestion, and all activity associated with it is stopped, because it is an unnecessary bodily function in the face of this danger. Once the stress passes, the body begins to relax, and messages are sent out in order to restore balance.
The unfortunate thing with stress is that, if your body is not given sufficient time to relax, stressors can just build, and your body doesn’t get a chance to slow down. This has a devastating effect on numerous systems, in particular the digestive system. If the sympathetic nervous system is active then the parasympathetic nervous system cannot stimulate digestion. Only one of these symptoms can be active at any one time. Thus the food you eat is not digested adequately and you begin to feel full, tired, nauseous, bloated and have no energy. The difficulty with IBS is that stress prevents digestion occurring properly, and the inability to digest produces more stress. Thus a vicious cycle is created.
Ultimately then, learning to relax your mind and body are essential allies here. Perhaps try exercising, to use up some of that adrenaline, and yoga to help you relax. Studies are showing yoga to be quite beneficial for reducing/managing IBS symptoms.

Good Luck.

Please Note: This was of course, not actually written by a GP and any recommendations should be explored in consultation with your medical practitioner.

Swami Sattva: a Yoga Therapy perspective

My learned friend, Dr Dan, has made some excellent points. The physical body is incredible in the way it regulates itself to maintain balance. But whilst Dr Dan, has described this process on a physical level, the yogic perspective can help us to explore this balance on increasingly subtle levels. From the yogic perspective, it is important to remember that what happens on a physical level (the body) creates blockages on other, subtler levels (including the mind), and vice versa. These subtler levels are non-physical parts that overlie our physical bodies. First we will explore some of these other levels so we can understand what might be going on in your body, then we’ll explore some options that will hopefully help you manage better.

Firstly, let’s look at the kosha’s. The kosha’s are sheaths encasing the physical body. There are 5 of these kosha’s:
• Annamaya kosha (Physical) which encompasses the physical body and its many different systems.
• Pranamaya kosha (Prana/Energy) which encompasses the movement and flow of prana, throughout our system.
• Manomaya kosha (Mental) which comprises our experiences with our lower mind, our senses, our reactions, our likes and dislikes,
• Vijnanamaya kosha (Wisdom) which is our intellect, our discernment and our wisdom, and,
• Anandamaya Kosha (Bliss) which is bliss, peace, contentment – (that which we all strive for!).

Much of what Dr Dan has described relates to Annamaya kosha. However, the improperly digested particles form a toxic substance known as Ama, which clogs all the channels in your body: both the physical (ie. The stomach and intestines) as well as the non-physical (ie. The nadis or energy/pranic channels) (Yoga Therapy Framework class notes, 2007). The nadis, or pranic channels exist in pranamaya kosha. Pranamaya kosha governs the vayus, and it is the vayus that are responsible for the flow of prana throughout the nadis. There are 5 types of vayu’s, each of which would be weakened by the distress in your system.
• Prana-vayu, is the forward moving vayu, it directs that which is coming into the body (i.e. food, breath).
• Apana-vayu is the downward moving vayu, it directs that which is leaving the body i.e. urine, faecal matter, flatulence etc.
• Udana-vayu is the upward moving vayu, it governs exhalation and speech.
• Samana-vayu is centred at the abdominal region; it balances what comes in, with what goes out.
• Vyana vayu is centred at the heart and is distributed throughout the entire body; it governs circulation, and the musculoskeletal system.

Your experience of constipation would create a block in apana vayu. The balance then, between what is coming into and what is leaving the body is lost, disrupting samana vayu. You might also begin to feel full, possibly nauseous, as it would be difficult for prana vayu to bring anything knew into the body. You would probably feel lethargic too, as Vyana vayu would also be weakened. The bouts of diarrhoea you describe would probably be apana vayu attempting to re-establish a balance in the system. Each of these systems exists in a harmonious balance, and when the balance shifts in one system, it is felt across them all.

Let’s look back again at the kosha’s. We have seen that your IBS symptoms have thrown your physical body (annamaya kosha), and your energetic body (pranamaya kosha) out of balance. We also know that these systems work in harmony together. So, as your awareness becomes fixated on the pressure in your system, you mind becomes focussed on these senses (i.e. the pain), on your emotions (i.e. the frustration), on your dislikes (i.e. IBS, possibly your body), and on your wants (i.e. to be able to process and eliminate food properly). These experiences keep you stuck in your experience and fixated in manomaya kosha. This makes it difficult, if not impossible for you to connect with your higher self (vijnanamaya kosha) - let alone contentment or peace (anandamaya kosha).

Now let’s look at the chakras. The chakras are wheel-like energy centres that interconnect and communicate with the kosha’s and the vayu’s. There are seven major chakras, which form a vertical pathway, called the sushumna (Anodea, 1999). The sushumna exists in line with the spinal column, and like the spinal column acts as a “super highway” through which energy and messages travel. Subsequently, as we have discussed earlier, the digestive disturbances you have described, although occurring at a physical level, are likely to be linked with disturbances at an energetic level. Of particular interest, are the following two chakras; Muladhara and Manipura.

Muladhara is the chakra found at the base of the spine. It is the foundation of our entire system – on both a physical and energetic level. At a physical level, it governs the foundation of our system, the solid parts of the body, including the bowel. The issues related to the functioning of Muladhara are feelings of grounded-ness, and of fear regarding security.
• Grounded-ness pertains to connecting with the earth, with the tangible things in your world. Feeling grounded strengthens Muladhara. Ask yourself whether you spend a lot of time in your head, thinking?
• Fear regarding security negatively impacts Muladhara. When we feel fear, we activate our fight or flight response, and so stimulate our adrenal glands. As Dr Dan explained, if you worry or feel stressed often, the constant stimulation of the adrenal glands may have a detrimental effect on your digestive system.

Manipura is the third chakra, and is found at the solar plexus, over the adrenal glands (Anodea, 1996). At a physiological level it rules over metabolism, of which the digestive system is an integral part. Imbalances in this chakra often manifest as digestive disorders (Anodea, 1999), like IBS. The central issue related to the functioning of Manipura is a sense of power. When people feel afraid, or powerless, they withdraw into themselves. This fear taps into Muladhara, and the self protective mechanisms people rely on to keep them safe. Sometimes people attempt to control what they say and do, so they fit with what is expected. This controlling and self-protection can create blockages in the flow of, or deplete a person’s pranic energy (this creates further disturbance in pranamaya kosha). Often this can result in feeling tired and lethargic – just as you have described F&T. Or it can manifest as a lack of strength, energy and/or will power to complete or achieve goals.

Whilst I’m sure I may have overwhelmed you with information F&T, let me reassure you that there is hope. Each of these energy centres, and subtle bodies can be cleared and balanced. Yoga practise can be invaluable in this process, as it can alleviate tension from and clear energy blocks in the body and mind (Bhumi, 2003). So speak to a teacher or yoga therapist about creating a practise to suit your needs. In the mean time, there are a number of things you can do to help manage your IBS symptoms, at the level of the body and the mind.

1) First we need to build Agni, or your digestive fire. For it is Agni which aids the processes needed to create energy and maintain and repair your body (Yoga Therapy framework class notes, 2007). This Agni, fuelled by Tejas (the subtle fire element) reduces Ama (the improperly digested toxic particles clogging the channels within your body), allowing Ojas to be created. The production of Ojas means your mind and body are not only receiving but also integrating the nourishment and vitality they need (Yoga therapy framework class notes, 2007). To build Agni; it is important to help your body regain its balance. You can start by trying to balance that which is coming into your body with that which is going out (ie. As simple as this may sound, try not to eat if you’re body doesn’t actually feel hungry. You might think eating will give you energy, but it will create further stress for your system). Try also perhaps to engage in some form of movement and activity (rajas), as this will begin to balance the stagnation and lethargy (tamas).
2) Dr Dan mentioned the increase in sympathetic nervous activity as a result of stress would of course result in a decrease in Parasympathetic nervous activity (the system which supports digestion) – as the two systems can not function concurrently. I talked briefly about sushumna nadi, which forms the vertical pathway of the 7 chakras. Weaving back and forth through each chakra are Ida and Pingala, two of the major nadis. These nadi’s are often linked to the nervous system: Ida, the cooling, restorative nadi to the parasympathetic nervous system and Pingala, the invigorating, heating nadi, to the sympathetic nervous system (class notes, 2007). By practising Nadi Shodhana, you help bring these 2 nadi’s and ultimately the two nervous systems back into a state of balance. Moreover, this breathing practise will also help you move through the kosha’s to realise greater clarity (vijnanamaya kosha) and connection (anandamaya kosha).
3) To begin to clear and balance Muladhara chakra, you might try bringing your awareness to and reconnecting with your body (through exercise, noticing the feeling of clothes on your skin, of the ground beneath your feet), and with the earth (by gardening, going for walks, spending time surrounded by nature). This can be a powerful means of reducing the mind/body split, and ultimately grounding yourself (which as we said before, certainly strengthens Muladhara).
4) To clear and balance Manipura chakra, begin nurturing yourself. This will introduce a level of relaxation into your life. Furthermore, by reconnecting with yourself (your body and mind) in a loving and accepting manner, you will begin to strengthen your self confidence, and help break the cycle of fear, withdrawal and the resulting loss of energy (If this is your experience). You may even want to begin exploring your relationship with power, how comfortable are you with it?

Take these suggestions as a guide, and explore those that resonate with you. - But have faith F&T; this is a process that may take some time. Perhaps begin by simply becoming mindful of and accepting your own processes, reactions and limitations. By exploring these, you may find you start making gradual shifts towards the life you want to be living. As Gandhi said; “be the change you wish to see.” Never be afraid to nurture yourself, and don’t be afraid to ask for help if you need it. There are many services available to you, for counselling, support, education, and health.

Good Luck and Take Care.

If you have any questions about this article or would like to consult with a Yoga Therapist about any conditions you may be experiencing, please don’t hesitate to contact Resonate Yoga’s own yoga therapist.

References

Anodea, J. (1996). Eastern Body Western Mind: Psychology and the Chakra System. Celestial Arts Publishing, USA.

Anodea, J. (1999). Wheels of Life: A user’s guide to the Chakra system. Llewellyn Publications, USA.

Bhumi. (2003). Asana to aid digestion. In ‘Australian Yoga Life’ (Issue 7). Australian Yoga Life, Australia.

Class Notes – May 2007.

Martini. (1998). Fundamentals of Anatomy and Physiology 4th ed. Prentice Hall: USA.

Yoga Therapy Framework - Class Notes, 2007.