The IBS/SIBO-Psoas Connection and Why It’s Important for Highly Sensitive People
Note to the reader – this is one motherload of an article. Grab some coffee and a low-fodmap cookie and let’s dive in.
In my personal experience with SIBO (small intestine bacterial overgrowth), back and hip injury, and with my experience working with highly sensitive people (HSP) with similar issues, a pattern has emerged that feels much too important not to talk about. So far, I haven’t really seen anyone having this conversation (not to say that it isn’t happening, I just haven’t come across it yet) so here I go, in hopes of starting one.
My lens as both an Ayurvedic health counselor and an energy medicine practitioner is one of seeing the body holistically, of noticing how different parts of the physical body interact, how different parts of the subtle body interact, and how the physical and subtle bodies interact. When working with digestive issues like IBS and SIBO, taking a big picture look at how the systems of the body interact is important. Through my lens as a highly sensitive person I have come to see the nervous system and subtle body as the center of the highly sensitive world – the central point which governs everything and through which all issues or discomforts must be addressed.
Other HSP experts have noticed common physical issues that HSP’s, as a group, tend to share. These include things like connective tissue disorders, scoliosis and other spinal issues, pelvic issues (bowel, bladder, menstrual, low back), digestive issues (IBS, SIBO, food sensitivities, leaky gut), and gut flora imbalances. Because the nervous system is the main focus with high sensitivity, we must start here when seeing how these issues may be linked for the HSP. The nervous system is incredibly complex and literally connects everything in the body together through a system of communication. It is also through the nervous system that us HSP’s take in sensory information and process it. Deeply. This very strong microphone of a nervous system, which connects to everything in the body, must be considered a central anchor in regards to physical and subtle issues in the HSP body.
If we think of the nervous system as the network of information that connects the body together, similar to our global information system, then we can start to see how the infrastructure through which the nervous system operates is important for the function of the whole system. Having a blocked infrastructure can cause problems with communication. Conversely, too much communication in the system (additional stress in the nervous system, for example) can short-circuit the infrastructure (kind of like running too much power through an energy circuit – you can flip a breaker). Consider using this metaphor as we look at the ways in which our muscle, connective tissue and digestive distresses are linked and how this can be a bigger problem for HSP’s.
In my Sensitive Self Intelligence course (soon being renamed as Flight School), we cover a lot of these connections. Here, I’ll mostly just be talking about the connections between IBS/SIBO and the Psoas.
Getting to Know the Psoas/Illiopsoas Complex
Two muscles, the psoas major and the illacus, together make up what is known as the illiopsoas complex or simply, the psoas. This muscle group is one of the most important in the entire body, and especially so for the HSP body. Because of its location, it is one of the major muscles that allows us to stand upright, connecting our spine to our legs from the front. The psoas begins at the long head of the femur (thigh) bone and wraps up over the front of the pelvis. The illiacus then attaches to the inside of the pelvis, while the psoas major draws back and connects to the sides of our lumbar vertebrae. Functionally, this is the muscle that pulls our knees towards our chest. It is also one of the main core muscles involved in body’s “fight, flight or fetal” response. (*Note – this response is called the “Red Light Reflex” in the study of Somatics. I highly recommend reading Somatics by Tommas Hannah for more information).
Our body has a physical response to stress that prepares the body to fight, flee or go fetal – curl into the fetal position. The psoas is the muscle responsible for all three – readying our body in a fighting stance, driving our body forward in a run, or curling us into a tight ball.
Additionally, large nerve bundles (transmission lines) that supply the digestive system with nerve impulses (communication/information) must pass through the psoas muscle, giving it an even more important job – messenger muscle, or, referring to our metaphor – an environment through which our transmission lines run. Liz Koch, an expert in pelvic wellness, says:
Although the psoas has been thought to serve the spine as a guide wire creating stabilization, its main job is to message subtle changes in weight, location, and safety. The psoas bridges the belly enteric brain, central, and autonomic nervous systems. The large nerve ganglion located within the belly core going to the digestive and reproductive organs passes over, embeds into, and through the psoas. Serving as messenger of the core our psoas translates and transmits all expressions of safety, harmony, and integrity; signaling whether or not we are centered and congruent or encumbered and vulnerable.i
When the psoas muscle is constantly charged with feelings of fear, or it’s holding a past trauma, it may become chronically short, tight and dry. It can also react this way when there is dysfunction in the pelvis – the psoas will react to take up any slack in pelvic stability. So if the pelvis is weak from inactivity, singular repetitive movements or trauma, the psoas will step in and do the job of stabilization, while continuing its more primitive and important work as messenger.
Many HSP’s suffer from low back pain, scoliosis and other spinal problems. While there is no major research on the link between HSP back pain and the psoas, I see more HSP clients with psoas issues than any other sub group of yoga students.
Stress affects the psoas, shortening it and pulling the body forward. The psoas provides the basket in which the digestive organs sit.vIf you think of the psoas as the bowl in which our softest most primal organs sit, you can see that it forms a sort of foundational layer within our body. This foundation, related in energy medicine to our first, second and third chakras, are often the areas that HSP’s struggle with most – issues with survival and money, trouble in identifying like-minded tribe or family, in relating with others and in self empowerment. Physically, a tight psoas can affect how well we digest food, the comfort of our menstrual cycle and how well we eliminate and remove waste from the body. When looking at issues in the gut, including IBS/SIBO, I think the psoas may be a big contributor.
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A bit about Connective Tissue HSP’s tend to have more connective tissue disorders, or problems with the fascia, than hardy people. Fascia is a type of connective tissue that acts like a spiderweb or network in the body. Fascia surrounds all of our organs and covers all of our muscles, effectively connecting our innards together in a web-like sheath, kind of like plastic wrap. But different from plastic wrap is the way that fascia acts like a network of information, relaying nerve impulses and reacting to stress and tension in the body. When flexible, our fascia is healthy and unrestricted. When unhealthy, the fascia becomes restricted and sticky.
Mainstream medicine still considers fascia a relative mystery, and largely ignores it in treatments for physical pain. What is known, but not really understood, is that within the body, fascia has a slippery quality, holding the organs but allowing them to glide over one another – allowing what visceral manipulation practitioners call “mobility” of organs. When fascia is unhealthy, largely due to inflammation or injury, it becomes sticky and can form adhesions – areas of drier tissue, causing tension that you can imagine by stretching plastic wrap tight around an object, then pinching it on one side – it stretches and gets tighter in some areas to account for the pinch.
Many sources cause the inflammation that leads to adhesions, the most obvious being direct injury or trauma. Other factors include infection, repetitive movement, poor diet, toxins, poor posture and emotional stress. Because fascia provides the atmosphere through which nerve interactions happen, it responds to stress and tension. Additionally, during an injury, it’s common for fascia to constrict around the injury in order to provide structured protection, tightening the whole fascial system and potentially causing pain and discomfort in an area of the body not associated with the injury.
For HSP’s with digestive and/or other pelvic imbalances, considering inflammation or stress-induced adhesions may be an important factor for treatment and relief. As we’ll see as we look at IBS and SIBO specifically, the small intestine is really long and loops its way through the abdomen, connected to our insides through several connection points. There are many opportunities for small adhesions to bind up the small intestine and inhibit motility and mobility. For example, the right sacro-illiac joint is the attachment point for the end of the small intestine. When the sacrum is out of place, the end of the small intestine can’t empty properly into the colon – and this works both ways. Disruptions in the psoas can cause inflammation, leading to small internal adhesions anywhere in the gut, and likely in some of the meters of small intestine. This sticky connective tissue can pull on the side of the sacro-illiac joint, internally causing rotation.
The Digestive System-Nervous System Connection
Remember that we are using the nervous system as an anchor or lens through which to link the psoas and digestive disturbances. I believe that a huge part of the reason HSP’s experience increased digestive discomfort (like IBS) is because of how the nervous system and gut communicate and because of the environment through which the transmission wires reach the digestive system. As stated earlier, the nervous system rules the roost; it plays a huge role in several digestive system processes. Some of the control the nervous system has over digestion comes from links between the digestive system and the central nervous system (CNS), however, the digestive system also has its own, local nervous system. This is called the enteric or intrinsic nervous system. We are only beginning to understand the complexity and magnitude of this immense nervous system – but we do know that it contains as many neurons as the spinal chord.ii
The enteric nervous system is part of the autonomic nervous system, along with the sympathetic and parasympathetic nervous systems. The enteric nervous system has two main networks of neurons (transmissions) embedded into the wall of the digestive tract from esophagus to anus. These exert control over the motility of the digestive tract (how well each organ moves of its own accord – primarily the act of pushing food and digestive juices through it) and in sensing the system environment in order to regulate blood flow and control cell function.
Within these plexuses are several types of neurons (communication centers) which receive sensory information from the mucosa and the muscle and respond both to the internal, chemical stimuli like digestive fluids and muscular stimuli like stress and tension. Other neurons respond to the motility and secretion of the digestive organs, and others integrate this information.
The enteric nervous system functions autonomously (without us thinking about it), but requires communication between this system and the CNS through sympathetic and parasympathetic fibers connecting the two (transmission wires). Through these links, the two systems can speak to each other. For example, when we see appealing food (sight is a sensory information coming in through the CNS), it signals the stomach to start secretions. Generally, sympathetic stimulation (usually a stress response, indicating activity) inhibits gastrointestinal secretions and causes the digestive tract to constrict or close down. Parasympathetic stimuli (our “rest and digest” system) stimulates digestive activities.
Stress and Digestion
What this tells us is that when we are chronically stressed, we don’t digest food as well. Additionally, because us HSP’s continuously take in sensory information, when we eat, we aren’t just digesting the food – we are digesting the entire atmosphere of the room, including conversation, emotions and the look and feel of our location. Eating in a stress-free environment is SO important for proper digestion and absorption of food, especially for HSP’s. The first and easiest thing can do to reduce gut disturbances is to learn how to manage stress and eat undistracted in a calm atmosphere.
When we experience chronic stress to the point that our fight, flight or fetal response is triggered, even at a low level, for long periods of time, the psoas muscle become short, dry and tight. Remember that the psoas is like the basket for our digestive organs and provides the atmosphere or environment through which our nerve transmissions run from our CNS to our enteric nervous system. If our psoas is short and tight, it signals to the CNS that we are somehow not safe, secure or calm. This information will be relayed to the enteric nervous system and be present as we eat. If we are continuously stressed or otherwise not managing our gift of high sensitivity well, our gut may be consistently receiving messages to shut the system down (so that we can run or fight or fetal).
IBS was once thought to be a diagnosis for gut disturbances that didn’t have any other cause. When flexible fiberoptic cameras became the rage in the endoscopy world, the whole practice shifted to focus on diseases that you could see with the naked eye. Patients whose problems couldn’t be identified via scope were often thought of as difficult because answers took effort and solutions were less lucrative; they were often diagnosed with IBS. Due to new research primarily being conducted by Dr. Mark Pimentel at the Cedars-Sinai Medical Center, we are now developing a new understanding of the causes of IBS.
Even though I just got done talking about digestion and stress, I want to clarify that I don’t believe that stress is the cause of IBS – in fact, it’s been proven not to be. However, especially for HSP’s, management of both the psoas muscle and stress-induced inflammation in connective tissue are a piece of the puzzle that remain important for healing and management, especially for those IBS sufferers who also deal with low back/hip/pelvis issues.
IBS is now thought to primarily be caused by bacterial overgrowth. The theory goes something like this: At some point, an otherwise healthy person gets food poisoning. Due to factors that are not yet understood (possibly genetics), the body does a poor job of completely eradicating the offending bacteria. This bacteria sticks around and its first order of business is to disrupt the cycle the regular cleansing waves of the digestive system. The digestive system must cleanse itself through peristalsis in order to move food through the system and repair. After these waves are disrupted (resulting in either too many or not enough), not only does food back up in the system but also the bacteria, colonizing in areas where few bacteria should live – namely, the small intestine (bacteria should primarily be found in the large intestine). Once bacteria have moved into the small intestine, they act as little thieves, stealing nutrients meant for the host and feeding on highly fermentable foods. Their by-product is methane. This whole process results in either too much or too little movement in the gut (diarrhea or constipation, or a combination of both) and severe bloating.
When people are diagnosed with SIBO, attention is usually put on the overgrowth of bacteria. While this is a problem, it’s not the main problem – the main problem is that the motility of the digestive organs is out of whack. The bacteria have messed with the nervous system impulses needed to keep the system moving. Yes, we must get rid of the bacteria, but only as a starting point. The real issue is in restoring motility so that the the whole problem doesn’t happen again.
In step one of SIBO treatment, an antibacterial drug or herbs are given. This is often the focus of treatment, but again, I want to reiterate that this is really just the starting point – this is how we wipe the slate clean in order to restore the system. Once the bacteria are gone, we can move into the important process of restoring proper digestion. This is where things like digestive enzymes, which work internally to restore proper digestive juices, come into play. One may also be prescribed an internal motility agent like small doses of erythromycin. This is also the phase of healing where management of stress as it pertains to the psoas and connective tissue comes into play.
Addressing Additional Causes of Poor MotilityWhile bacteria may have been the leading cause of poor motility within the system, there may be other factors. As HSP’s, there is a good chance that small adhesions within the fascia and/or a tight, dry psoas could be contributing to poor digestion and/or lack of motility. The primary ways I have found to address these is through regular (for me, this means monthly) trips to a good visceral manipulation therapist and through practicing constructive rest pose.
You can find a certified visceral manipulation therapist through the Barral Institute website. If you are in the Seattle area, I recommend Michael Hahn – he books out a month in advance but is well worth it.
Constructive Rest Pose
This position, coined by somatic educator Lulu Sweigard, is a position that uses gravity to release muscle tension in the psoas in order to support a neutral spine. Remember, tension in the psoas can build up over time and is often caused not just through physical activities, but through stress and feelings of tension, or lack of safety and security. Because of this, we are likely releasing tension that has been stored for a very long time.
CRP is done laying down with knees bent and feet on the floor. Place your hands just inside of your front hip bones to draw attention to the layers of muscle and tissue within the pelvis. If this is uncomfortable, place arms along your sides. If this position causes back pain, you may put your feet up on a chair or block, creating a 90 degree angle with your knees (not pictured). You may also put a small towel (no more than 1 ½ inches high) under the head.
Separate feet hip-width apart. Make sure your head is neutral and does not tip forward or back. Allow your eyes to gently close or remain soft but open. Rest for 10-20 minutes. As you rest, allow yourself to notice the sensations within the deeper layers of your tissue. Because the psoas will release excess primal energy, there is the potential for sensations of vulnerability, emotional pain or memory to flow through the body. Stay centered and allow for this release to happen. Notice what they are but do not become absorbed by them. Balance internal sensations by noticing sensations in your outer world, like air currents, warmth, comfort, sounds, smells, etc. Through moving between the inner releasing world and outer present-time world, you’ll create a balance of stimuli in the body.
If at any time your body spontaneously moves, flinches or changes positions, do not change it or tidy it up. Allow the muscles to guide their own release. You can do this pose any time. The best times are in the morning and before dinner, as it can help you release tension in the digestive system and energize you.
Congratulations, you made it all the way through is thesis of a blog post. Whew! You better stand up and stretch your psoas and thank your body for getting you through it! But in all seriousness, the connections that I have laid out here just scratch the surface of connections that can be made between the nervous system and high sensitivity, IBO/SIBO, the psoas and connective tissue and stress. There is so much information to learn and to put together. My hope with this article is that I have made connections for at least one person who might be struggling to find that missing, elusive piece to their recovery. I know that understanding this piece has been critical in my road to recovery and in my continued healing.
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iKoch, Liz. Psoas, Instinctive Responses & The Healthy Pelvis.1 November 2011 <wholewoman.com/blog/?p=931> 16 February 2015
iiBowen, R. The Enteric Nervous System. Control of Digestive System Function. <www.vivo.colostate.edu/hbooks/pathphys/digestion/basics/gi_nervous.html> June 24, 2006.