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Irritable Bowel Syndrome: Summary of NICE Guidance

Working as a GP I always aim to use the best available evidence to treat my patients, as such I use the guideance produced by The National Institute for Health and Care Excellence (NICE) to guide my practice. NICE guidance is taken as the gold standard in the UK and is based on the best available evidence. Working as a Hypnotherapist at The Natural Practice I was already aware of the benefits of Hypnotherapy for patients with Irritable Bowel Syndrome (IBS) so when NICE updated it's guidance in 2015 I was pleased to see it included recommendations on using hypnotherapy in this common condition. This article gives a brief summary of the guidance which is hopefully a little easier to digest (no pun intended) than the original document.

What is IBS?

IBS is a chronic gastrointestinal disorder which affects approximately 10-20% of the population and is more common in women. It can be painful and debilitating, lead to feelings of anxiety and depression and has a negative impact on quality of life.

IBS is a chronic gastrointestinal disorder which can be classified as diarrhoea predominant, constipation predominate or mixed. As well as constipation and diarrhoea it can be associated with abdominal pain, bloating, nausea, reflux, the passage of mucus, lethargy, backache and urinary symptoms.

Assessment for IBS

NICE recommends an assessment for IBS if a person has had any of the following symptoms for at least six months:

  • abdominal pain or discomfort
  • bloating
  • change in bowel habit

If a person has any of the following “red flag” symptoms then there may be a serious underlying problem and referral to the hospital for assessment may be required:

  • unintentional or unexplained weight loss
  • rectal bleeding
  • family history of bowel or ovarian cancer
  • change in bowel habit in a person over 60 years-old

Assessment would usually be with the patient's GP who would take a history, examine the patient and often arrange for blood tests to exclude anaemia, signs of inflammation in the bowel, thyroid disorder and coeliac disease.

Treatment of IBS

Once a diagnosis of IBS has been made treatment and advice may include:

Diet and lifestyle advice

  • encouraging patients to make the most of their leisure time and create relaxation time (by choosing to attend hypnotherapy sessions a patient would already be fulfilling this recommendation).
  • dietary advice including: limit insoluble fibre (bran) intake, drink plenty of water, restrict caffinated/alcoholic/fizzy drinks, limit fruit intake to three portions a day and eat regular meals.
  • consider a trial of pro-biotics for at least four weeks and monitor effect.
  • if the above dietary interventions are not helpful then a patient may be advised to follow the low FODMAP (fermentable oligosaccharides, disacharrides, monosacharrides and polyols) diet. FODMAPS are carbohydrates that are poorly absorbed in the small intestine so end up reaching the large intestine where they can then ferment and worsen IBS symptoms. 


  • a patient's GP or specialist may recommend antispasmodic medications, laxatives, loperamide (Immodium) or anti-depressants (particularly the tricyclic anti-depressants, or TCAs, which are recommended as they can help relieve bowel related pain).

Psychological Interventions

  • in patients who have “refractory IBS” (defined as symptoms which persist greater than 12 months despite treatment) NICE recommends consideration of referral for psychological interventions including hypnotherapy.
  • NICE did not recommend relaxation, computerised CBT or mindfulness therapy as there was a lack of evidence to support their use.

Complementary and alternative medicine

  • no particular complementary or alternative medicine was recommended by NICE.

What does this mean for hypnotherapy?

There is a good evidence base that hypnotherapy can be helpful for patients suffering from IBS. This recent updated guideline emphasises the importance of this treatment modality for this often disabling condition. It is interesting that hypnotherapy is listed among the psychological interventions rather than the complementary and alternative medicine interventions, a placing which emphasises that it should be part of the mainstream approach. NICE also emphasises the importance of creating relaxation time, something that I help may patients to do by utilising self-hypnosis techniques so the benefits of our sessions can be reinforced and maintained.

As a practising GP I see many patients for whom dietary advice and medications alone are not the complete cure. Thankfully I am able to offer my hypnotherapy clients an approach which has no side effects, can be used alongside conventional medications and other therapy techniques and can provide lasting relief.

Dr Ruth Dyson