Diet changes, medications, and probiotics—often provide only partial relief, leaving patients searching for more effective solutions.
Published Oct 21, 2025 | 7:00 AM ⚊ Updated Oct 21, 2025 | 7:00 AM
IBS is a complex condition involving both the gut and the brain.
Synopsis: The brain-gut connection means that stress, anxiety, and emotions can directly affect digestive function. Signals constantly pass between the brain and the gut, shaping bowel movements, pain perception, and sensitivity. When these signals are amplified or misinterpreted, patients may experience discomfort even without a clear physical cause.
Irritable Bowel Syndrome (IBS), a disorder affecting millions worldwide, has long frustrated both patients and doctors. Characterised by recurring abdominal pain, bloating, and unpredictable bowel habits, IBS has no structural cause, making it notoriously difficult to treat.
Traditional interventions—diet changes, medications, and probiotics—often provide only partial relief, leaving patients searching for more effective solutions.
Recent research published in The Lancet Gastroenterology & Hepatology has brought hope, showing that behavioural therapies such as Cognitive Behavioural Therapy (CBT) and gut-directed hypnotherapy can significantly improve symptoms.
These therapies target the complex communication network between the brain and the gut, also called the brain-gut axis, which influences symptom severity and flare-ups.
The brain-gut connection means that stress, anxiety, and emotions can directly affect digestive function. Signals constantly pass between the brain and the gut, shaping bowel movements, pain perception, and sensitivity. When these signals are amplified or misinterpreted, patients may experience discomfort even without a clear physical cause.
“For decades, IBS was treated as a purely physical issue. Now, we’re realising it’s also about how the gut and brain communicate,” said Dr Dinesh Ramaswamy, Senior Surgical Gastroenterologist, SIMS Hospital, Chennai.
With this understanding, doctors are beginning to view the mind as a vital component in managing IBS, an approach that could reshape treatment strategies for millions of patients in India and beyond.
IBS is a complex condition involving both the gut and the brain. Unlike other digestive disorders, it does not have a structural cause, making it challenging to manage. Symptoms can vary widely, from diarrhoea and constipation to bloating and abdominal pain.
“The challenge with IBS is that it’s a functional disorder,” explained Dr. Ramaswamy. “There’s no structural abnormality, and the presentation is very varied. That’s why focusing on one treatment point rarely works for all patients.”
He added that the gut and brain communicate through pathways like the vagus nerve (the longest nerve of the autonomic nervous system), the enteric nervous system, and the autonomic nervous system. Changes in gut bacteria, or dysbiosis (imbalance of microorganisms in the body), can release chemicals that alter gut sensitivity and bowel habits.
Stress often plays a major role in triggering symptoms. “In my clinical practice, almost 60–70% of IBS patients have some form of stress or anxiety that can worsen their symptoms,” said Dr Ramaswamy. This can create a cycle where stress amplifies gut discomfort, and gut symptoms, in turn, increase anxiety.
Behavioural therapies are increasingly recognised as key tools for managing IBS. CBT, gut-directed hypnotherapy, and mindfulness-based stress reduction help patients manage how their brain interprets gut signals, easing pain, bloating, and irregular bowel habits.
Dr. Ramaswamy explained that these therapies work particularly well because they target stress and anxiety, major triggers of IBS symptoms. “By calming the mind, patients can prevent the amplification of gut signals that worsen discomfort,” he said.
Mindfulness exercises, guided imagery, and relaxation techniques teach patients to respond differently to gut sensations, breaking the cycle of stress and flare-ups. Digital or app-based CBT programmes are also being explored to reach patients who cannot attend in-person sessions.
Even simple lifestyle adjustments, suggested by Dr Ramaswamy—such as pursuing hobbies or stress-relieving activities—can complement formal therapy. These measures may not replace medication entirely but can significantly improve quality of life and reduce symptom severity.
In India, delayed referrals to specialists compound IBS management challenges. Many patients are initially treated symptomatically by general physicians without addressing the brain-gut interaction, leaving symptoms uncontrolled over time.
Even when patients reach gastroenterologists, counselling remains a crucial step. Dr Ramaswamy emphasised that reassurance about the gut’s health can reduce anxiety and, in some cases, improve symptoms. When medications alone are insufficient, cognitive behavioural therapy is recommended to manage stress, a common trigger of flare-ups.
Cultural factors also influence acceptance. Patients may hesitate to seek behavioural therapy due to mental health stigma. To ease this, Dr Ramaswamy advised complementary strategies like hobbies or stress-reducing activities to help manage symptoms while gradually introducing formal therapy.
The future of IBS management lies in an integrated approach that combines diet, medication, and mind-focused therapies. By treating both the gut and the brain, patients can achieve better symptom control and overall well-being.
Dr Ramaswamy noted that while behavioural therapies can be challenging to implement widely in India, they are essential for long-term management. “Educating patients about the brain–gut connection and reducing the stigma around stress-related interventions are key steps in improving care,” he said.
Even simple lifestyle practices, such as mindfulness, hobbies, or stress management, complement formal therapies. These strategies empower patients to take an active role in their care and help break the cycle of symptom flare-ups.
As awareness grows and more patients reach specialists, IBS care in India is set to evolve. By combining medical treatment with mind-focused interventions, doctors aim to move beyond symptom control toward truly enhancing patients’ quality of life.
(Edited by Majnu Babu).
