Yoga might be a feasible and safe adjunct treatment for irritable bowel syndrome (IBS), a systematic review shows in the December issue of Clinical Gastroenterology and Hepatology. The review found evidence for beneficial effects of yoga on gastrointestinal (GI) symptoms, quality of life, and anxiety, although further studies are needed.
IBS is characterized by abdominal pain, often in combination with constipation or diarrhea, bloating, and changes in stool appearance. Symptoms are frequently aggravated after meals, and can include nausea, belching, and pyrosis. The causes of IBS are not known, but symptoms reduce patients’ quality of life. The worldwide prevalence of IBS ranges from 9% to 23%; this disorder accounts for up to 12% of total visits to primary care providers. IBS is the most common disorder diagnosed by gastroenterologists.
Yoga is a part of the ancient Indian philosophy, dating back more than 5000 years. Yoga has been adapted as a method in complementary medicine and is practiced especially in terms of prevention and therapy of diseases. It traditionally consists of body postures (Sanskrit: asanas), breathing exercises (pranayama), and meditation (dyana). Yoga asanas aim to strengthen muscle tissues and the nervous system, and achieve a balance between body and mind.
IBS has been associated with visceral hypersensitivity and psychosocial factors (such as disturbed stress regulation), and autonomic nervous system dysfunction. Psychiatric comorbidities are common as well and need particular consideration, and altered signaling between the brain and the gut is believed to contribute to chronic abdominal pain syndromes such as IBS.
Yoga practice corrects underactivity of the parasympathetic nervous system induced by stress, and has been reported to reduce stress and psychological disorders in different populations of patients.
Dania Schumann et al performed a systematic review of the literature to examine the efficacy and safety of yoga as a treatment for patients with IBS.
They collected data from 6 randomized controlled trials (2 from India, 4 from North America), comprising 273 patients, that compared yoga with usual care or nonpharmacologic or pharmacologic interventions for patients with IBS.
In 1 trial, the yoga module was developed by research associates of Vivekananda Yoga Research Foundation; another trial used the principles of the Hatha Yoga Pradipika. A third trial did not follow a certain school, but selected the yoga exercises based on a review of different yoga literature. A fourth trial merged the Hatha and Iyengar yoga methods, and the remaining 2 trials based their intervention on Iyengar yoga.
All yoga programs included yoga postures. Breath control was instructed in 3 of the trials and meditation was an additional part of 1 trial. Program length and intensity varied, and asanas were taught by certified yoga teachers in 4 of the studies.
The primary outcomes of these studies included gastrointestinal symptoms, quality of life, and pain, with anxiety, mood, and safety as secondary outcomes.
Schumann et al found evidence for the beneficial effect of yoga over conventional treatments for IBS. Yoga provided significant decreases in patients’ bowel symptoms, disease severity, and anxiety. The exercise also led to significant improvements in patients’ quality of life and physical function, compared with no treatment. There were no group differences in depression or overall GI symptoms.
Adolescents who received the yoga intervention tended to report lower levels of functional disability and anxiety after yoga than adolescents in the control group.
A study that compared a walking program vs yoga found no significant group differences between the yoga and walking groups. Yoga reduced abdominal pain, overall GI symptoms, visceral sensitivity, and severity of somatic symptoms, whereas walking reduced overall GI symptoms, negative affect, and state anxiety. However, mean overall GI symptoms increased again after 6 months of follow up in the yoga group, whereas mean of overall GI symptoms continued to decrease after 6 months of walking.
Schumann et al found no difference between groups treated with yoga vs medical treatments that included including psyllium husk, propantheline, or diazepam. After 3 months of treatment, 3 of 5 patients on medical therapy and 4 of 5 on yoga had improvements of 50% or more in their symptoms.
One study that compared yoga with placebo found no difference between the groups. Three of 5 patients receiving yoga and 4 of 5 patients receiving placebo had improvements of 50% or more in their symptoms.
Two randomized controlled trials reported that that no adverse events occurred with yoga. Overall, risk of bias of the included studies was unclear.
The authors conclude that yoga might be a feasible and safe adjunctive treatment for people with IBS. However, they said that they cannot recommend yoga for the relief of IBS symptoms based on this review because of heterogeneity in the methodologies of the studies, and the unclear risk of bias.
Also, applicability is an important factor. In the case of Iyengar yoga, the help of props is often required and the emphasis lies on correct alignment, which usually requires supervision. And less focus is put on relaxation during classes vs home yoga.
However, yoga should not be discouraged for patients with IBS, especially for patients who believe that it benefits their health and quality of life. More research is needed with respect to a high-quality study design and consensus in clinical outcome measurements in IBS, say Schumann et al.