Slow, deep breathing intervention improved symptoms and altered rectal sensitivity in patients with constipation-predominant irritable bowel syndrome

Abstract

Background and aimLimited treatment options have been shown to alter the natural course of irritable bowel syndrome (IBS). Slow, deep breathing (SDB) is a common pain self-management intervention. This pilot study aimed to explore the impact of SDB on measures of autonomic and anorectal functions as well as patient-reported symptoms in constipation-predominant IBS (IBS-C).MethodsEighty-five IBS-C patients were enrolled in this study and randomly assigned to the experimental group (Group A, n = 42) and the control group (Group B, n = 43). SDB was conducted at six breathing cycles per minute with an inhalation for 4 s and exhalation for 6 s at a ratio of 2:3 and repeated for 30 min during the intervention. All subjects underwent high-resolution anorectal manometry (HRAM) and completed the standardized IBS symptom severity system (IBS-SSS) questionnaire. Meanwhile, changes in stool consistency, weekly frequency of complete spontaneous bowel movements (CSBMs), and weekly frequency of spontaneous bowel movements (SBMs) were recorded. All IBS-C patients received electrocardiogram (ECG) recordings for heart rate variability (HRV) analysis at baseline, weeks 3, 6.ResultsAt baseline, no differences were found between Groups A and B. The IBS-SSS score and its five sub-scores of Group B patients were significantly higher at week 6 than those of Group A patients (all p < 0.001). Furthermore, compared with Group B patients, Group A patients had a significantly higher threshold volume for the first sensation (p < 0.001), desire to defecate (p = 0.017), and maximum tolerable volume (p = 0.018) at week 6 of the SDB treatment. We also noted significant improvements in stool consistency (p = 0.002), weekly SBM frequencies (p < 0.001), and weekly CSBM frequencies (p = 0.018) of Group A patients at week 6 when compared with Group B patients. Finally, the corrected high frequency (HF) of Group A patients was significantly higher than the HF of Group B patients at week 3 (p < 0.001) and at week 6 (p < 0.001). Likewise, patients in Group A had a significantly higher root mean square of the successive differences (RMSSD) than that of patients in Group B at week 3 (p < 0.001) and at week 6 (p < 0.001).ConclusionWe found that a 6-week SDB intervention improved symptoms and altered rectal sensation in IBS-C patients. Moreover, SDB enhanced vagal activity. These findings suggest that the effect of SDB on IBS-C may be due to mechanisms involving autonomic responses.

The Effects of Heart Rate Variability Biofeedback on Functional Gastrointestinal Disorders: A Scoping Review

“…Out of the four studies that were conducted, only two found a statistically significant improvement in symptoms for the group of participants who partook in the HRV biofeedback intervention (Stern, Guiles, and Gevirtz 2014;Liu et al 2022). Out of the four studies, only two of them employed the use of a control group as a comparison for the biofeedback groups results (Liu et al 2022;Jurek et al 2022), while the other two did not employ a control or similar method (Stern, Guiles, and Gevirtz 2014;Ebert 2012). The studies that did use a control group found no statistically significant difference in any measurement.…”

“…Of the two studies that included a control group (Liu et al and Jurek et al) within their protocol, both found no significant changes in the IBS-SSS sores over the study, compared to baseline. One of the studies (Liu et al 2022) found a trend that could be indicative of such a period of time to find efficacy. Within their study, they completed follow ups at weeks three and six after the commencement of the slow, deep breathing exercise (SDB).…”

“…From the four relevant studies identified in the literature search, three were conducted in the USA (Stern, Guiles, and Gevirtz 2014;Ebert 2012;Katherine Jurek et al 2022) and one in China (Liu et al 2022). The majority of these addressed IBS, while some studies addressing functional abdominal pain, functional constipation, as well as other subtypes, were found to be lacking (Table 2).…”

“…Two of the studies were randomised control trials (Liu et al 2022;Katherine Jurek et al 2022) while the other two were interventional studies where HRV biofeedback was not compared to a sham control scenario (Stern, Guiles, and Gevirtz 2014;Ebert 2012). These four articles also varied in terms of the target population, with two focused on paediatric populations (Stern, Guiles, and Gevirtz 2014;Ebert 2012) and the other two on adult populations (Liu et al 2022;Katherine Jurek et al 2022). (Table 2) All of the included studies used the same primary metrics when quantifying the HRV present, relying on time and frequency domain metrics, to make inferences of vagal and sympathetic tone (Katherine Jurek et al 2022).…”

“…All four studies identified had similarities in having a strong focus on the symptoms associated with the specific FGID subtype they were investigating. Only one of the studies conducted a clinical test, specifically anorectal manometry, in order to identify the changes in the threshold of anorectal sensation (Liu et al 2022). This focus on symptoms is likely due to the historic focus on the symptoms of FGID, such as in the Rome criteria of diagnosis, as relatively little is conclusively known about the physiology underlying these disorders ("Rome IV Criteria" 2020).…”