Irritable bowel syndrome (IBS) is a recurrent condition characterized by abdominal pain accompanied by diarrhea, gas and bloating. It is estimated that IBS affects 8% to 14% of the population and is the most common of all gastrointestinal ailments (1
). Among pediatric samples, data indicate that IBS is experienced by approximately 17% of high school children and 8% of middle school children (2
). Children with this recurring syndrome frequently experience interference with day-to-day activities, such as missed school, withdrawal from physical activities, mood disturbances (eg, anxiety and depression) and disruptions in peer relationships (2
Despite high rates of prevalence and the disabling nature of the condition, IBS is not well understood. Only recently have criteria for diagnosis of IBS in adults been adopted through a consensus forum (5
). Although IBS has been the focus of many investigational studies, little definitive information is available concerning etiology and treatment. However, it is generally well accepted that stress and anxiety can exacerbate IBS symptoms (6
). Recent research indicates that IBS may be a result of alteration in the perception of visceral events and altered regulation of gastrointestinal motility and epithelial function (7
). The data from functional magnetic resonance imaging studies (9
) suggest that IBS patients differ from healthy controls in that those with IBS show an activation of pain amplification regions with no activation of inhibitory pain areas, leading to visceral hypersensitivity. Mayer (9
) suggests a disruption model for intervention with this brain-gut axis in which pain persistence is disrupted by either pharmacology or mind-body therapies, such as hypnosis. While the exact mechanism leading to the clinical entity of IBS is not fully known, it is clear that both physiological and emotional factors are integrated in a complex way to modulate the symptoms in any given individual.
Many different interventions have been recommended to manage IBS, including nutrition, exercise, medication, behaviour modification and emotional support (1
). Little research, however, has systematically examined these interventions among pediatric patients. As a result, no reliable evidence-based treatment intervention exists to help children and adolescents with IBS alter their maladaptive patterns, reduce pain and distress, and increase participation in daily living activities.
Recently, mind-body approaches such as hypnosis have been recommended as holding considerable promise as meaningful and cost-effective interventions for adult patients with IBS (10
). Mind-body approaches also include tai-chi, meditation and yoga, among others. Yoga is one of the most commonly practiced mind-body practices, with an estimated 15 million American adults having used yoga in the past year (11
). Nearly 50% of adults who have used yoga report that they have used it to manage a health condition (11
). Of the various forms or systems of yoga that have evolved over the centuries, the more active form of yoga, Hatha yoga, involves physical poses and controlled breathing. One of the most common forms of Hatha yoga practiced in North America is Iyengar. The main component of the practice of Iyengar is the poses, or, in Sanskrit, ‘asanas’. In essence, a person will assume a number of stationary poses that use contraction and relaxation of different muscles to create specific body alignments (12
). The physical postures with breathing and meditative techniques involved in yoga are intended to reduce anxiety, improve body tone and increase feelings of well-being (13
An increasing number of studies have examined the effectiveness of yoga among adults for managing painful conditions such as migraine (14
), carpal tunnel syndrome (16
), osteoarthritis (17
) and multiple sclerosis (12
), as well as other health conditions, such as asthma (18
), hypertension (19
) and chronic low back pain (20
). After 16 weeks of Iyengar yoga, Williams et al (20
) found a significant decrease in pain and functional disability associated with chronic back pain. Among adult patients with IBS, yoga was recently found to decrease bowel symptoms and anxiety, and enhance parasympathetic reactivity (21
Of the limited research involving pediatric samples, yoga has been used to improve posture among children with physical malformations (22
) and to treat anxiety in child and adolescent psychiatric patients (23
). Yoga has been found to improve children’s hyperactive and inattentive behaviour, self-esteem and relationship quality with parents (24
). Additionally, Telles and Srinivas (25
) found yoga to decrease physiological anxiety among children with vision impairments. Similarly, Jain et al (26
) found that yoga exercises in adolescents who had childhood asthma resulted in an increase in pulmonary function and exercise capacity. A published abstract by Raghavan et al (27
) reported the results of a four-month yoga protocol among a small group of young adults (aged 15 to 22 years) with IBS. They found decreased illness perception and increased general well-being, but no direct improvements in IBS symptoms. However, the results of this preliminary study were based on the randomization of a total of only seven IBS patients to either a yoga intervention or wait list control group, and no statistical analyses were reported. Anecdotal reports of the use of yoga with children with IBS in our clinical practice suggest the potential for efficacious outcomes; however, controlled research is needed to systematically examine yoga as a potential treatment for IBS.
The purpose of the present study was to determine whether an instructional session in yoga followed by four weeks of daily yoga practice using a video of selected yoga poses (asanas) for abdominal comfort would result in a reduction in pain, gastrointestinal symptoms and functional disability (primary outcomes) among adolescents with IBS when compared with a wait list control group. In addition, the effects of yoga on pain coping, anxiety and depression were also explored (secondary outcomes). It was expected that adolescents who received the yoga treatment would report lower scores in each of these domains following the yoga interventions when compared with those in the control group.