In my clinical practice, many of the clients who come to see me with IBS experience either constipation-predominant IBS (IBS-C) or mixed IBS (IBS-M), where bowel habits fluctuate between constipation and diarrhoea.

One of the things I often notice is how much attention has already been placed on food.

Many people have tried increasing fibre, drinking more water, removing certain foods, taking supplements or following restrictive diets. While nutrition is an important part of digestive health, with IBS there can be another piece of the puzzle that is sometimes overlooked: the nervous system and the communication between the gut and brain.

Having worked in nutrition for many years, my approach to IBS has evolved as our understanding of the gut–brain connection has grown.

IBS is now recognised as a disorder of gut–brain interaction. This means we need to consider not only what is happening within the digestive tract, but also how the brain, nervous system and digestive system are communicating with one another.

This communication can influence bowel motility, digestive sensitivity, pain and the way we experience symptoms.

This is one of the reasons I became so interested in Gut-Directed Hypnotherapy and ultimately created the GutBrainA 8-Week Programme.

But before we look at the gut–brain connection in more detail, let’s first look at the different ways IBS can present.

The Different Types of IBS

IBS is generally grouped according to a person’s predominant bowel pattern.

IBS-C – Constipation-Predominant IBS

Constipation is the predominant pattern, with hard or difficult-to-pass stools, infrequent bowel movements, straining or a feeling of incomplete emptying.

IBS-D – Diarrhoea-Predominant IBS

Diarrhoea is the predominant pattern, often involving loose stools, increased frequency and sometimes considerable urgency.

IBS-M – Mixed IBS

Bowel habits fluctuate between constipation and diarrhoea. Someone may experience several days of constipation followed by loose stools or urgency, making their digestive symptoms feel particularly unpredictable.

Although they all sit under the umbrella of IBS, the experience of each can be quite different.

For this reason, rather than trying to cover everything in one article, I want to explore each type individually.

We’re going to start with IBS-C, because constipation is something I see frequently in my clinical work — and understanding the relationship between constipation, bowel motility, the nervous system and the gut–brain connection can completely change the way we think about supporting it.

What Is Actually Happening When We Become Constipated?

Constipation is much more than simply “not going to the toilet”.

When stool moves slowly through the colon, it remains there for longer.

One of the colon’s jobs is to absorb water. The longer stool remains within the colon, the more water can be removed from it.

The stool can then become harder, drier and increasingly difficult to pass.

This can create a cycle.

The harder the stool becomes, the more difficult it can be to evacuate. Stool and gas may accumulate, contributing to abdominal pressure, distension and bloating.

For someone with IBS-C, these sensations can become particularly uncomfortable.

Why Can Constipation Become Painful?

As stool and gas accumulate, the intestinal wall stretches.

Within the wall of the digestive tract are sensory nerve endings continually monitoring what is happening inside the gut.

They detect changes including stretch, pressure, movement and chemical conditions within the intestine and relay this information through the nervous system.

In someone with IBS-C, these sensations may sometimes be experienced more intensely due to something known as visceral hypersensitivity.

Visceral hypersensitivity means the nervous system has become particularly sensitive to signals coming from inside the body.

A degree of stretching or pressure that another person may barely notice can therefore be experienced as significant bloating, cramping, pressure or abdominal pain.

This is an important point.

It does not mean that the pain is imagined or “all in your head”.

The pain is real.

What may be different is how information coming from the digestive system is being transmitted and processed by the nervous system and brain.

What Else Can Happen With Ongoing Constipation?

Persistent constipation can create problems beyond simply feeling uncomfortable.

Repeatedly passing hard stools and straining can contribute to haemorrhoids and small tears around the anus known as anal fissures.

More severe or prolonged constipation can sometimes lead to faecal impaction, where a hard mass of stool becomes lodged within the rectum or colon.

Some people with chronic constipation may also have pelvic-floor dysfunction, where the muscles involved in having a bowel movement do not relax and coordinate effectively.

Constipation and slow intestinal transit can also influence the environment within the colon.

The longer intestinal contents remain in the bowel, the longer they are exposed to bacterial fermentation. This can influence gas production, bloating and the environment in which our gut microorganisms live.

There is also an interesting relationship between intestinal transit time and the gut microbiome.

This relationship appears to work in both directions. Slower transit can influence which microorganisms thrive within the gut, while substances produced by our gut bacteria may themselves influence intestinal function and motility.

So rather than thinking of constipation as simply waste “sitting there”, we can think of the colon as a living environment in which transit time, bacteria, fermentation, intestinal movement and the nervous system are continually interacting.

Diverticular disease is another condition sometimes associated with constipation.

Diverticula are small pouches that form in the wall of the colon. Their development is multifactorial and can involve age, genetics, lifestyle and changes within the structure and function of the colon. Constipation alone should not be described as causing diverticulosis or diverticulitis, but maintaining comfortable bowel function is nevertheless an important part of digestive health.

This is why I prefer not to think of constipation as simply:

“I haven’t been to the toilet today.”

There is much more happening physiologically.

And that brings us to an important question.

What Actually Tells Your Bowel to Move?

Your digestive tract isn’t simply a passive tube that food travels through.

Within the walls of your gastrointestinal tract is an extraordinary network of nerve cells known as the Enteric Nervous System (ENS).

The ENS is sometimes called our “second brain” because it contains hundreds of millions of nerve cells and can coordinate many digestive processes without us consciously thinking about them.

It plays an important role in regulating intestinal movement, secretions, blood flow and the coordinated muscular contractions that move contents through the digestive tract.

These contractions are known as peristalsis.

But what are all these neurons actually communicating?

What Are the Gut Neurons Saying?

The neurons within your digestive system are constantly gathering information.

They are effectively monitoring questions such as:

Is there food or stool present?

How stretched is this section of the intestine?

What is the chemical environment within the gut?

Is the intestinal wall contracting or relaxing?

Where are the intestinal contents and where do they need to move next?

Different types of enteric neurons have different roles.

Sensory neurons detect what is happening within the intestine.

Interneurons help process and relay that information through the enteric nervous system.

Motor neurons then communicate with the smooth muscles of the digestive tract and help coordinate movement.

Imagine stool entering a section of your colon.

As the intestinal wall stretches, sensory nerves detect that stretch.

That information is communicated through local enteric neural circuits.

Motor neurons then help coordinate the smooth muscle so that the intestine can contract behind the contents while relaxing ahead of them.

This coordinated response helps move intestinal contents forwards.

This is part of peristalsis.

And remarkably, much of this is happening automatically without you ever having to think:

“Right, I need to move breakfast another few centimetres through my intestine now.”

Your Enteric Nervous System is doing it for you.

Your Gut Is Also Talking to Your Brain

While all of this local communication is taking place within the digestive system, information is also travelling between the gut and the brain.

Your brain is continually receiving information relating to:

Stretch.

Pressure.

Fullness.

Movement.

Pain.

The need to have a bowel movement.

Most of the time, we are not consciously aware of this enormous amount of information.

The brain filters much of it.

But in disorders of gut–brain interaction such as IBS, the processing of these signals can become altered.

The brain may give greater significance to information coming from the digestive tract, while the gut itself may become more sensitive to stimulation.

This means a bowel containing stool or gas may generate a much stronger sensation of pressure, bloating or pain than we might expect from the physical stimulus alone.

Again, this does not mean the symptoms are psychological.

It means the nervous system is involved in how those physical sensations are communicated and experienced.

And the Brain Talks Back to the Gut

The conversation isn’t one-way.

The gut sends information to the brain, and the brain sends information back to the digestive system.

This communication occurs through several pathways, including the autonomic nervous system, which helps regulate many of the bodily functions we don’t consciously control.

This includes digestion.

The autonomic nervous system includes both sympathetic and parasympathetic pathways.

When we feel safe and relaxed, the nervous system can support the processes associated with digestion.

When the brain perceives stress or threat, sympathetic nervous-system activity can increase — what many people know as the fight-or-flight response.

In this state, the body’s immediate priority isn’t necessarily digestion.

Changes in autonomic signalling can influence:

• Intestinal muscle contractions
• Bowel motility
• Digestive secretions
• Blood flow
• Visceral sensitivity
• How pain and discomfort are perceived

Importantly, stress doesn’t affect everyone’s digestive system in exactly the same way.

For some people, intestinal activity may increase and contribute to urgency or diarrhoea.

For others, motility may slow.

This is one reason someone’s digestive system can behave completely differently when they are relaxed on holiday compared with when they are rushing, under pressure, anxious or experiencing prolonged stress.

The brain isn’t creating imaginary digestive symptoms.

It is physically communicating with the digestive system through neural, hormonal and other signalling pathways.

The Gut–Brain Loop in IBS-C

Now we can begin to put all of this together.

Bowel motility slows.

Stool remains within the colon for longer.

More water is absorbed from the stool.

The stool becomes harder and more difficult to pass.

Stool and gas can increase stretching and pressure within the bowel.

Sensory neurons detect that stretch and communicate information through the enteric nervous system and towards the brain.

If the gut–brain system is particularly sensitive, those signals may be experienced as significant bloating, discomfort or pain.

Understandably, persistent symptoms can then lead to frustration, worry and increased attention towards the gut.

You begin wondering:

“When am I going to go?”

“Why am I so bloated?”

“Why isn’t my bowel moving?”

“What did I eat?”

“What should I stop eating?”

The brain becomes increasingly aware of signals coming from the digestive system.

Meanwhile, autonomic signals continue travelling from the brain back towards the gut, potentially influencing motility, sensitivity and digestive function further.

A gut–brain feedback loop can begin to develop.

This is why I believe it is important to look beyond the idea that constipation is simply a fibre problem.

Fibre, hydration, nutrition, movement and appropriate medical investigation absolutely have their place.

But with IBS-C, we also need to consider the conversation taking place between the bowel, Enteric Nervous System and brain.

That conversation is happening every second of every day.

And this is precisely the communication that makes the gut–brain connection so fascinating.

Working With the Gut–Brain Connection

Once we understand that the brain and gut are in constant two-way communication, we can begin to look at IBS-C from another perspective.

Rather than focusing only on what we put into the digestive system, we can also work with the nervous system involved in regulating and interpreting what is happening within it.

This is where Gut-Directed Hypnotherapy comes in.

Gut-Directed Hypnotherapy uses a deeply relaxed, focused state — similar in many ways to meditation — together with carefully designed therapeutic imagery and suggestion directed specifically towards the digestive system and the communication between the brain and gut.

The aim isn’t to consciously force the bowel to move.

Instead, we are working with the brain side of the gut–brain conversation, with the aim of influencing how digestive signals are processed and supporting healthier communication between the brain, nervous system and gut.

This is one of the reasons I created the GutBrainA 8-Week Programme.

The GutBrainA 8-Week Programme

GutBrainA is a structured 8-week Gut-Directed Hypnotherapy programme, with approximately 30 minutes of guided hypno-meditation each day.

The programme gradually builds over eight weeks rather than relying on a single session or only listening to something when symptoms become difficult.

The first part of the programme focuses on establishing the foundations of gut–brain communication, deep relaxation and nervous-system regulation.

As the programme progresses, you begin introducing sessions that are more specific to the digestive symptoms you experience.

For someone with IBS-C, this means using Gut-Directed Hypnotherapy sessions specifically created around constipation and slower bowel transit.

The language and imagery within these sessions are different from those I use for someone experiencing IBS-D and urgency.

With constipation, therapeutic suggestions can focus on rhythm, movement, flow, relaxation and comfortable digestive transit, while continuing to reinforce calmer communication between the brain and digestive system.

Other GutBrainA sessions focus specifically on symptoms such as bloating, abdominal discomfort, digestive sensitivity and pain, because IBS rarely presents as just one isolated symptom.

This symptom-specific approach was very important to me when I created GutBrainA.

If one person’s bowel is predominantly slow and another person’s bowel is predominantly fast and urgent, it doesn’t make sense to speak to those digestive systems in exactly the same way.

Training the Gut and Brain to Communicate

Gut-Directed Hypnotherapy does not mean that IBS is psychological or that digestive symptoms are “all in your head”.

Quite the opposite.

It recognises that the brain, nervous system and digestive system are physiologically connected and continually communicating with one another.

When we work with the brain, we are working with one part of the system involved in how digestive sensations are processed and how the gut–brain relationship functions.

This is the philosophy behind GutBrainA:

Train Your Gut & Brain to Communicate.

The GutBrainA programme gives you a structured eight weeks to practise this consistently, rather than waiting until your digestive system is uncomfortable before trying to calm things down.

Because when it comes to IBS-C, supporting digestive health isn’t necessarily just about asking:

“What can I eat or take to make my bowel move?”

Sometimes we also need to ask:

“What is my gut communicating to my brain — and what is my brain communicating back?”

Understanding that conversation can open the door to a very different way of understanding your digestive system.

---

Clare Seagrave
Advanced Clinical Hypnotherapist & Gut-Directed Hypnotherapy Specialist
Clinical Nutritionist & Homeobotanical Practitioner
Creator of GutBrainA