Congratulations, you’ve reached the skills content for this week! 

As we’ve discussed, coping with stress and taking time out to relax are important parts of managing irritable bowel syndrome symptoms. People with irritable bowel syndrome are often in a state of chronic stress, which keeps their symptoms going. Luckily, there are things you can do to calm your body and mind to help reduce the impact of daily stress on your irritable bowel syndrome. Below, we introduce several techniques to help you do this. These skills are unlikely to solve your problems overnight. However, with adequate practice, they are likely to lead to noticeable improvements. 

Relaxation techniques 

Earlier, we talked about the importance of rest and relaxation. One of the issues with modern life is that it doesn’t allow much time for either. People with irritable bowel syndrome often struggle to relax and unwind, which just makes their symptoms worse. The symptoms of irritable bowel syndrome themselves also act as a barrier to relaxation. After all, it’s hard to sit and enjoy some quiet time when you’re in pain or having to run to the toilet every few minutes. As such, many people with irritable bowel syndrome are caught in a cycle of chronic stress.

As we discussed above, relaxation is beneficial for health on many levels. It can reverse the body’s fight or flight response, reduce the symptoms of irritable bowel syndrome, and improve your quality of life. As such, it is important to introduce relaxation into your daily routine. If you feel hesitant about this, ask yourself what your barriers to action are. Would you be willing to try a new medication if it gave you a chance of relief from your symptoms? If yes, why not relaxation? 

Some people make negative assumptions when it comes to relaxation. They might think it isn’t ‘medical’ enough for their symptoms or that it sounds like a waste of time. If you hold these views, that’s ok. However, we suggest that you test out your theory by giving it a go anyway. Try to approach relaxation in the same way as you would a new medication. Take your daily dose, tolerate any temporary minor side-effects (e.g., frustration, inconvenience), and give it a chance before expecting major improvements. 

The evidence for relaxation is strong and you may be surprised at how powerful these simple techniques can be. Below we discuss strategies to help you introduce relaxation into your schedule. 

Deep breathing

Taking slower and deeper breaths is a great way to calm your body and let go of tension. When you’re stressed, your breathing gets faster and shallower. You can test this out by placing one hand on your belly and another one on your chest. Take a few fast breaths, followed by some slow, deep ones. As you do this, notice which hand moves more. Shallow breaths often come from the chest, whereas deeper breaths come from the belly. With that said, it’s best to aim for slow, deep breaths as much as you can. 

Without even realising it, you may be breathing inefficiently most of the time. This can reduce the amount of oxygen in your body and result in symptoms like cramping, aches and pains. As such, it can help to slow your breathing down. You can use the following tips to help you:

• Find a relaxed position to sit or lie down in.
• Breathe in through your nose and out through your mouth.
• If you like, count the length of your inhale and exhale and try to make your exhale longer.
• As you inhale, take the air right down into your lungs, so that you can see and feel your lower belly rise up.
• After you inhale, pause for a moment before exhaling.
• On your exhale, allow your body to relax and let go of any tension and stress.
• After you exhale, pause for a moment before inhaling.
• As you breathe deeply, try to focus on the sensation of your breath entering and leaving your body.
• Repeat this breath cycle for 5 to 10 minutes.

Slowing down your breathing can signal to your brain to switch off the fight or flight response, reduce physical tension and slow the release of stress hormones in the body. There are different ideas about how long your in- and out-breaths should be. For example, some suggest a count of 4-2-6 or 4-7-8 seconds for the ‘in-pause-out’ cycle. Play around and see what works best for you. If you get distracted often during the exercise, there are many guided breathing exercises freely available online that can help. 

Progressive muscle relaxation (PMR)

Stress builds up and is often stored in the body as physical tension. A technique called progressive muscle relaxation (PMR) can help with this. Studies have shown that PMR can effectively decrease stress and anxiety. PMR involves deliberately tensing and relaxing different muscles in your body. Like deep breathing, this is another way to reverse the fight or flight response. 

Here’s how you can practice:

Step 1: Find a quiet place with no distractions. 

Step 2: Find a comfortable position. Ideally, lying on your back with your body parts uncrossed. 

Step 3: For each muscle group, gently tense your muscles for 5-10 seconds and then release for 5-10 seconds. Notice the sense of relaxation that follows. One at a time, work your way through all the major muscle groups in your body. Never tense your muscles to the point of pain or extreme physical discomfort. 

For example, the major muscle groups could include your: 

• Face (frown, close your eyes tightly, scrunch your nose, clench your teeth)
• Neck and shoulders (shrug your shoulders up towards your ears)
• Arms (make fists, tense your muscles as though you’re trying to lift something)
• Back (arch your back and pull your shoulder blades together)
• Stomach (clench stomach muscles by pulling them towards your spine)
• Legs (point your toes, clench your thighs, squeeze your buttocks together).
• Feet (clench your toes, point your feet and turn them inwards to face each other). 

The main aim of tensing and releasing is that you learn to recognise the difference between tension and relaxation. When people are chronically stressed, their muscles are often so tense that they have forgotten what a relaxed state feels like. As you get more skilled, you will be able to relax your muscles automatically to reduce tension. All up, this exercise should take no longer than 10-15 minutes. 

Schedule some ‘time out’

Take time out to do things that give you a sense of relaxation and pleasure. Make a list of activities that interest you. Think about things that you don’t usually do, perhaps because you can’t find the time. What do you say “no” to? Are there things you used to enjoy, but no longer do? Are there new things you’ve been meaning to try, but haven’t made time for? Write them all down. 

For example, Veronica’s list looked like this:

• Go for a massage
• Paint my nails 
• Take a bubble bath
• Have a hot tea and do a crossword puzzle
• Read a fiction book
• Do some yoga
• Watch a movie

Once you have your list of activities, don’t stop there. Pick one to get started with and schedule it into your week. Without scheduling a specific date and time, it’s unlikely you’ll follow through. Make sure you allow yourself enough time to really relax and enjoy the activity. This way, you’ll get the most benefit from it. Don’t delay getting started, try scheduling something in the near future and treat it like an important meeting or appointment that can’t be cancelled. 

Some other ideas for relaxation include doing something creative (e.g., art, dance), hanging out with pets, listening to music, spending time in nature, doing a puzzle, listening to a guided meditation, and massage therapy. Making time for relaxing activities during the week can be enough to slow things down and introduce some calm into your life. This can have a profound effect on your stress levels and reduce an overactive fight or flight response. It is also a good way to achieve balance in your life and prevent irritable bowel syndrome from taking over. 

For example, Veronica had been suffering from irritable bowel syndrome for years. Her life revolved around her symptom flare ups. When she was unwell, she spent most of her time in bed. However, this wasn’t restorative rest, because she spent the time worrying about what she should have been doing instead. When Veronica was not crippled by her symptoms, she worked hard to catch up on what she’d fallen behind on. 

Desperate for change, Veronica started to schedule some time out during her symptom free periods. She scheduled a regular ‘movie night’ with her husband and allocated Saturday mornings for relaxing activities. Although she technically had less time to catch up on work, she found that she was more productive. She also felt less stressed and lighter in her mood. Over time, Veronica also noticed that her symptoms started to bother her less.