Acupressure for IBS

MedlinePlus describes irritable bowel syndrome (IBS) as a problem of the large intestine that causes belly pain and cramps, gas, bloating and a change in bowel habits: some people have mostly diarrhea (IBS-D), some mostly constipation (IBS-C), and some go back and forth (IBS-M). The pain often eases after a bowel movement. Symptoms can flare for a few weeks, then settle for a while. IBS is common, it can last for life, and it does not harm the intestines or lead to cancer.

IBS is not the same as inflammatory bowel disease (IBD), such as Crohn disease or ulcerative colitis, which is a different illness. There is no single test for IBS, so a provider usually diagnoses it from the symptoms and may run tests to rule out other problems.

The IBS page is the reference; this post explains the routine and the evidence behind it. Related pages: Bloating, Constipation and Stomach Cramps.

MedlinePlus is clear that blood in the stool and weight loss you can't explain are not part of IBS, and that IBS pain should not wake you from sleep. Get medical help right away, or call your local emergency number, if you are vomiting blood or have blood in your stool, have sudden sharp belly pain, a belly that is tender or hard to the touch, or can't pass stool, especially while vomiting. Belly pain while pregnant also needs help right away.

Contact your provider if you have IBS-type symptoms or a change in bowel habits that doesn't go away. MedlinePlus adds that symptoms starting at age 50 or over, weight loss, bloody stools or abnormal blood tests may call for a colonoscopy. See also when not to self-treat.

We found no Cochrane review of acupressure for IBS. The nearest is a Cochrane review of needle acupuncture for IBS (Manheimer 2012; 17 trials, 1,806 adults; searches up to November 2011):

• In the five trials that compared real acupuncture with sham (placebo) acupuncture, which were well designed, acupuncture did no better for symptom severity or quality of life. The quality of this evidence was moderate.
• In unblinded trials, mostly from China, more people improved with acupuncture than with antispasmodic drugs (84% against 63%), but that evidence was low quality. The authors could not say whether the difference came from acupuncture itself or from people's preference for it and greater expectations of it.

The review's summary notes that placebo effects are often seen in IBS. So little high-quality research supports pressing points for IBS. The points below are tradition, labelled as such, and the everyday habits further down come first.

Traditional use: in TCM, points such as CV-12, ST-25 and SP-6 are traditionally used for belly discomfort and irregular bowels. Each point's page shows where to find it and when to skip it.

• Main points: CV-12 Middle Duct (Zhōng wǎn) on the upper belly, ST-25 Heaven's Pivot (Tiān shū) beside the navel, and SP-6 Three Yin Intersection (Sān yīn jiāo) on the inner lower leg.
• For stress-related flares: LR-3 Great Rushing (Tài chōng) on the top of the foot.
• With nausea: PC-6 Inner Pass (Nèi guān) on the inner forearm.
• Optional: ST-36 Leg Three Miles (Zú sān lǐ) below the knee. BL-20 Spleen Shu (Pí shū) on the back is used too, if a helper can reach it.

The IBS routine takes 10 to 15 minutes. The idea behind it: MedlinePlus explains that the gut and the brain signal each other, and that during stress the nerves become more active, so the intestines can grow more sensitive and contract more. That is why the routine opens with slow breathing in a calm place, and why the belly points stay light: during a flare the belly may be sensitive. The leg and foot points, away from the belly, take firmer pressure.

1. Breathe slowly into your belly for 3 minutes, with your hands resting on it and gentle clockwise strokes.
2. With your knees bent to relax the belly, press CV-12 lightly and slowly as you breathe out, for 1 to 2 minutes. Never push deep.
3. Massage ST-25 on both sides of the navel with light pressure. If the belly is sore in a flare, keep it lighter still or skip it.
4. Press SP-6 for 1 minute on each leg, into the soft tissue beside the bone rather than on it.
5. For a flare that came with stress, add LR-3 for 1 minute on each foot, beside the pulse rather than hard on it.
6. With nausea, add PC-6 for 1 minute on each arm.
7. Optional: ST-36 for 30 seconds on each leg.

If you are new to it, hold each point for 15 to 30 seconds and work up to 1 to 2 minutes. Pressure should be firm but never painful.

Pregnancy: CV-12, ST-25 and SP-6 are not pressed during pregnancy. Ask a trained professional instead.

Skip: the belly points with sudden or severe belly pain or swelling, which needs medical care, not pressure. ST-25 with severe inflammatory bowel disease. SP-6 and ST-36 after leg surgery, and ST-36 with an injury or infection of the lower leg. LR-3 after foot surgery or with very low blood pressure. PC-6 after a wrist injury or surgery, and ease off if your fingers tingle. Don't press on broken, irritated or blistered skin, bruises or new scars. If you have a bleeding or clotting disorder or low platelets, press more lightly and for less time, or ask your doctor first.

MedlinePlus says most people with IBS control their symptoms with diet, stress management, probiotics and medicine. No one diet suits everyone, because IBS differs from person to person. Changes that may help:

• eating smaller meals;
• cutting down on drinks that stimulate the intestines, such as coffee, tea and colas;
• adding fiber, which may help constipation or diarrhea but can make bloating worse;
• exercising regularly and sleeping better, which may ease anxiety and bowel symptoms.

Psychological therapy may also help. Talk with your provider before taking any over-the-counter medicine or probiotic: no one medicine works for everyone.