# Distention (Q for Mike)



## Ugh (Jan 30, 2001)

This question is for Mike, but anyone else is welcome to add their thoughts.I am wondering about distention and hypnotherapy. I'm not talking just about the bloated feeling but actual distention where my belly looks enormous and clothes no longer fit. This happens everyday and is easily measured as a gain of several inches on my waist. I haven't had a day without it, although the severity fluctuates slightly. It is not due to gas, because I have eliminated gas at times and I still get distended. As far as I can tell it isn't due to any external factor because it is always present. In the morning my stomach is flat, as the day goes on it gets progressively worse until it is putting pressure on my bladder and I'm urinating a lot. In short, it sucks.I'm wondering if you've ever had success with distention using hypnotherapy. I'm not talking about limiting the feeling of being bloated, but actually using hypnotherapy to reduce the size of the distention. I believe mine is due to spasms in the colon (that's my best guess). Theoretically, I would think if I could eliminate these spasms or dysmotility of my colon, it would immediately shrink. Obviously that's impossible, but the point being that I think it's a nerve problem of sorts. I don't believe relaxation alone can stop the distention, because I can be very relaxed, but still distended. Sorry to ramble on, but have you had any positive experiences with distention and hypnotherapy?


----------



## eric (Jul 8, 1999)

Ugh, Mike is away on holiday for the moment, but I wanted to point out this graph on hypnosis and distension for you on this website page. You are also right about distennsion not always caused by gas, even though it sometimes seems that way. For me it has helped this tremendously as well as being able to relax my entire digestive tract at will most of the time. Also, when your body is relaxed, the digestive system has a tendency to relax with the rest of your body. But, there is more to it then that with hypnosis.As you can see from this graph with this study it was signficantly reduced. However, everyone is different, but it has been shown in numerous studies to help with that symptom as well as the whole condition.Hope that helps. http://www.ibshypnosis.com/IBSresearch.html Also some info on distension for you.Am J Gastroenterol 2001 Apr;96(4):1139-42 Related Articles, Books Abdominal wall muscle activity in irritable bowel syndrome with bloating. McManis PG, Newall D, Talley NJ. Department of Medicine, University of Sydney, Nepean Hospital, NSW, Australia. OBJECTIVE: Recurrent episodes of bloating and visible abdominal distension are common and distressing in irritable bowel syndrome, but the mechanisms are unknown. Patients often note that the distension is most pronounced in the upright posture, suggesting that the bloating may be the result of a decrease or absence of the normal rise in electromyograph activity in the abdominal wall muscles when standing. There are no reports of noninvasive electromyograph recordings of abdominal wall muscles in irritable bowel syndrome. We examined the hypothesis that abdominal distension is the result of relaxation of anterior abdominal wall musculature. METHODS: Studies were performed on patients with irritable bowel syndrome and a history of visible distension (n = 11, mean age 48.6 yr, body mass index 24.8) and normal volunteers (n = 13, mean age 39.9 yr, body mass index 24.6). Surface recordings of muscle activity were made while subjects were lying, performing voluntary contraction of the abdominal wall, and standing. The examiners were blind as to the clinical status of the subjects. RESULTS: There were no differences in abdominal wall muscle activity (by electromyograph voltage) when comparing patients with irritable bowel syndrome to normal volunteers (e.g., relaxed lower abdomen supine mean electromyograph voltage in irritable bowel syndrome was 14.0 vs 14.6 in controls, p = 0.7, and relaxed lower abdomen standing in irritable bowel syndrome was 29.6 vs 25.2 in controls, p = 0.4). There was increased activity in both groups when contracting the muscles and when standing. CONCLUSIONS: Patterns of abdominal wall muscle activity do not differ between normal subjects and patients with irritable bowel syndrome. However, there is a clear increase in muscle activity in the standing position. Episodic distension is unlikely to be due to permanent anterior abdominal muscle weakness or a persistent inability of the muscles to activate with standing in irritable bowel syndrome. PMID: 11316160 [PubMed - in process] ------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


----------



## Ugh (Jan 30, 2001)

Eric, thanks for the graph, it looks promising. I'm very interested in reading more, could you post the study or a link to the study? I'd like to read this one "Whorwell PJ; Prior A; Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.The Lancet 1984, 2: 1232-4." if it's possible. I'm curious what the y axis in the graph is using as units for distention, that is if it's the patients feeling of distention or actual measured distention. Thanks again for the info. [This message has been edited by Ugh (edited 06-09-2001).]


----------



## eric (Jul 8, 1999)

ugh, I can't post the whole study. You have to pay for it online, and I had a full copy of it, but I sent it to someone and can't remember who at the moment. Although, even if I had it copyright on the whole study I would have to ask permission for. The abstrats you can get from pubmed though. Hope this helps and it really helps to study hypnotherapy for IBS in general to see all the ways it can help IBS.Here are some abstracts from Whorwell and there are others studying this.Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Whorwell PJ, Prior A, Faragher EB. 30 patients with severe refractory irritable-bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed.Gut 1987 Apr;28(4):423-5 Related Articles, Books, LinkOut Hypnotherapy in severe irritable bowel syndrome: further experience. Whorwell PJ, Prior A, Colgan SM. Fifteen patients with severe intractable irritable bowel syndrome previously reported as successfully treated with hypnotherapy, have now been followed up for a mean duration of 18 months. All patients remain in remission although two have experienced a single relapse overcome by an additional session of hypnotherapy. Experience with a further 35 patients is reported giving a total group of 50. This group was divided into classical cases, atypical cases and cases exhibiting significant psychopathology. The response rates were 95%, 43%, and 60% respectively. Patients over the age of 50 years responded very poorly (25%) whereas those below the age of 50 with classical irritable bowel syndrome exhibited a 100% response rate. This study confirms the successful effect of hypnotherapy in a larger series of patients with irritable bowel syndrome and defines some subgroup variations. PMID: 3583070 [PubMed - indexed for MEDLINE] Gut 1990 Aug;31(8):896-8 Related Articles, Books, LinkOut Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Prior A, Colgan SM, Whorwell PJ. Department of Medicine, University Hospital of South Manchester. Fifteen patients with the irritable bowel syndrome were studied to assess the effect of hypnotherapy on anorectal physiology. In comparison with a control group of 15 patients who received no hypnotherapy significant changes in rectal sensitivity were found in patients with diarrhoea-predominant irritable bowel syndrome both after a course of hypnotherapy and during a session of hypnosis (p less than 0.05). Although patient numbers were small, a trend towards normalisation of rectal sensitivity was also observed in patients with constipation-predominant irritable bowel syndrome. No changes in rectal compliance or distension-induced motor activity occurred in either subgroup nor were any changes in somatic pain thresholds observed. The results suggest that symptomatic improvement in irritable bowel syndrome after hypnotherapy may in part be due to changes in visceral sensitivity. PMID: 2387513 [PubMed - indexed for MEDLINE] Br J Hosp Med 1991 Jan;45(1):27-9  Related Articles, Books, LinkOut Use of hypnotherapy in gastrointestinal disease. Whorwell PJ. University Hospital of South Manchester, West Didsbury. Recent controlled studies in the field of gastroenterology have shown that hypnotherapy is unequivocally beneficial in conditions such as irritable bowel syndrome and peptic ulceration. There is also some evidence for influence on certain physiological functions. Further research should help to define more clearly the role of this controversial form of therapy. Publication Types: Clinical trial Randomized controlled trial PMID: 2009436 [PubMed - indexed for MEDLINE] Aliment Pharmacol Ther 1996 Feb;10(1):91-5 Related Articles, Books, LinkOut Symptomatology, quality of life and economic features of irritable bowel syndrome--the effect of hypnotherapy. Houghton LA, Heyman DJ, Whorwell PJ. Department of Medicine, University Hospital of South Manchester, UK. AIMS: The purposes of this study were to quantify the effects of severe irritable bowel syndrome on quality of life and economic functioning, and to assess the impact of hypnotherapy on these features. METHODS: A validated quality of life questionnaire including questions on symptoms, employment and health seeking behaviour was administered to 25 patients treated with hypnotherapy (aged 25-55 years; four male) and to 25 control irritable bowel syndrome patients of comparable severity (aged 21-58 years; two male). Visual analogue scales were used and scores derived to assess the patients' symptoms and satisfaction with each aspect of life. RESULTS: Patients treated with hypnotherapy reported less severe abdominal pain (P < 0.0001), bloating (P < 0.02), bowel habit (P < 0.0001), nausea (P < 0.05), flatulence (P < 0.05), urinary symptoms (P < 0.01), lethargy (P < 0.01), backache (P = 0.05) and dyspareunia (P = 0.05) compared with control patients. Quality of life, such as psychic well being (P < 0.0001), mood (P < 0.001), locus of control (P < 0.05), physical well being (P < 0.001) and work attitude (P < 0.001) were also favourably influenced by hypnotherapy. For those patients in employment, more of the controls were likely to take time off work (79% vs. 32%; p = 0.02) and visit their general practitioner ( 58% vs. 21%; P = 0.056) than those treated with hypnotherapy. Three of four hypnotherapy patients out of work prior to treatment resumed employment compared with none of the six in the control group. CONCLUSION: This study has shown that in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients' quality of life and reduces absenteeism from work. It therefore appears that, despite being relatively expensive to provide, it could well be a good long-term investment. PMID: 8871448 [PubMed - indexed for MEDLINE] He has done more studies, but not all of them are published in Pubmed. Also, like I said there are quite a few others doing research and studying this in clinical trials and very soon we will be doing this.







He has already done preliminary trials himself with his patients and the results have been very positive. These trials with involve his tapes in an American clinical research center on IBS. Palsson, is another major researcher on IBS and hypnotherapy so you know.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


----------



## Guest (Jun 14, 2001)

Hi Ugh,A quick answer it that I have not done specific work for distention out side of the IBS program, since these processes are usually quite effective.However it is a good thought and I will take some of this into account with my new group of IBS patients and monitor it to see if I can do a little work on it in the future.Thanks for the thought, but I realise my answer does not help you at this moment in time







Put in your diary to email me or post again in about 6 months and I will work on it in the meantime.Best RegardsMike


----------



## Ugh (Jan 30, 2001)

Mike, thanks for the response. However, I was really just wondering if you've had any success ever with distention. I understand that you haven't focused on it, but do you know if anyone using the current program has been able to decrease their distention? If not, do you believe it would be possible? I realize you may not be able to answer these questions, but I'm very curious.Eric posted a link to http://www.ibshypnosis.com/IBSresearch.html which has a graph from a study referring to abdominal distention and hypnosis. It is from the following article:Whorwell PJ; Prior A; Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.The Lancet 1984, 2: 1232-4. If you have seen that article, could you maybe comment on their findings? Any help is greatly appreciated.


----------



## eric (Jul 8, 1999)

Ugh, I think Mike was trying to say that yes he has had success with bloating and distension in IBS with his program. I believe some of the threads talk about this in them. Personally it helped me with it and I do not become as distented as I did before, I still do very rarely, but not as much as before.I don't thing you can make the bloating and distension go away forever,well maybe for some and not for some.People who don't have IBS bloat and distend, they just don't feel it as much as we do and because of that don't notice it as much.The distension problem itself is not well understood as to the mechanisms behind it completely. Also, many other factors play a part, especially for females, but there are other factors.A think you might also do is write Dr palsson at his website and ask him a short question about it. He may also be able to help.In Mike's in house trials they were asked to rate their symptoms and he followed through after a specific time after the treatment was over. I believe there were thirty some involved in that and bloating and distension among other symptoms were markedly improved in that group.On another note just the act of hypnosis for me at any rate when I feel bloated relaxes my gut muscles and the distension slowly subsides. I am just speaking from my personal experience, because that is the only experience I know for sure.Also, before hypnosis in order to relax my gut from this I had to lay down on my left side and wait for it to subside while trying to relax it.Hope this helps some.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


----------



## Ugh (Jan 30, 2001)

Thanks for the response eric.


> quoteeople who don't have IBS bloat and distend, they just don't feel it as much as we do and because of that don't notice it as much.


This is what doctors originally told me and I couldn't disagree more. Normal people don't gain 2-3 inches and have the distention I have. I agree that some people are more aware of a normal distention, but in my case it isn't a feeling or that I notice it more. It is measurable and apparent to other people. Doctors do this with gas to, where they just assume you are exaggerating or noticing it more or more aware of it, and assume you have normal amounts of gas because they have trouble explaining it if in fact you don't.


> quote:The distension problem itself is not well understood as to the mechanisms behind it completely.


 I'm aware of this.


> quote:A think you might also do is write Dr palsson


I did this the other day actually....great minds think alike









> quote:I believe there were thirty some involved in that and bloating and distension among other symptoms were markedly improved in that group.


This is why I'm interested in the other study with the graph. I agree with you that it is possible many people just feel or are aware of the distention more, and this is what could be happening here with Mike's patients. I'm trying to see if anyone has taken objective measurements of the distention, because in my case it isn't simply a feeling or awareness (although I don't discount those as factors) but it is easily measured and is far from minor.


----------



## JeanG (Oct 20, 1999)

Hi Ugh:The hypnotherapy has definitely helped me with the bloating and distension, which was a big problem for me previously. That, and gas. Generally by noontime my pants would be incredibly tight. Now that rarely happens.JeanG


----------



## eric (Jul 8, 1999)

Ugh, just so you know, when my gut distends it is very noticeable. I just want to make sure you know that and I am not saying it is just an all in the head thing. Something physical is happening. Each episode may or maynot be related to gas, although I believe its more not related, but another mechanism.I think you would have to be normal to know how a normal person reacts to it and I have never been normal that I can remember.LOLActually, with Mike's tapes both physical and a psychological change takes place.I am pretty sure he did not phyysically measure the distension and that is what he is implying here that he will take a look at it.I am sure our new clinical trials with them will also look at this.I look and feel pregant(LOL) when I am distended, I am with you in believing it is physical symptoms. I still have to mention though as IBSers it is more noticable to us as we have a tendency to focus on the gut more then normal people and because it can bring pain or discomfort, whereas a normal person would just slip into tight jeans and be on there way.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


----------



## eric (Jul 8, 1999)

Ugh, just so you know, when my gut distends it is very noticeable. I just want to make sure you know that and I am not saying it is just an all in the head thing. Something physical is happening. Each episode may or maynot be related to gas, although I believe its more not related, but another mechanism.I think you would have to be normal to know how a normal person reacts to it and I have never been normal that I can remember.LOLActually, with Mike's tapes both physical and a psychological change takes place.I am pretty sure he did not phyysically measure the distension and that is what he is implying here that he will take a look at it.I am sure our new clinical trials with them will also look at this.I look and feel pregant(LOL) when I am distended, I am with you in believing it is physical symptoms. I still have to mentionn though as IBSers it is more noticable to us as we have a tendency to focus on the gut more then normal people and because it can bring pain or discomfort, whereas a normal person wwould just slip into tight jeans and be on there way.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


----------



## Guest (Jun 17, 2001)

Hi Ugh,Distention can be helped by the IBS Program, quite a few people have mentioned its improvement. So yes I do think it is possible, since feedback shows that to be the case. My last research results showed a significant over all reduction in distention, in the third annual returns from patinets who had been in the research project.I also recieve letters and emails from patinets who they too have noticed changes.However some symptoms move quicker than others and certainly the improvements felt in the duration of the program are not the final improvements, since many report benfits continuing well after they have finished the program.The next trials I am involved in I will make sure this is measured and monitored.Best RegardsMike


----------



## Ugh (Jan 30, 2001)

> quote:A think you might also do is write Dr palsson at his website and ask him a short question about it.


I've tried this a couple of times and I don't get a response. Not sure what that means.


----------



## Ugh (Jan 30, 2001)

> quote:A quick answer it that I have not done specific work for distention out side of the IBS program, since these processes are usually quite effective.However it is a good thought and I will take some of this into account with my new group of IBS patients and monitor it to see if I can do a little work on it in the future.Thanks for the thought, but I realise my answer does not help you at this moment in time Put in your diary to email me or post again in about 6 months and I will work on it in the meantime.


I remembered! lol. Mike, I realize you may not have been able to do this, but I thought I'd check back with you just in case you have new information on hypno and distention.


----------



## Michael Mahoney (Oct 11, 2001)

Hi Ugh,I remembered too and your 6 days early







Since your last email I have looked more at the the distension while working with my clients in the practice. It is included also as a measured presentation in the project near completion now too.I will be able to post some information hopefully just before /or after Christmas on the patients feedback I have seen in my rooms, and approx Feb/March for the project patients.Thanks for your patience. I will post asap.Best RegardsMike


----------

