Great things happen when we are well-rested: our breath is full, slow, and deep, the digestive system works well, and the body can focus on repair – including reduction of inflammation, tissue repair, and hormone production. In fact, getting regular, restful sleep is the best medicine for improving a health condition or for simply maintaining a healthy lifestyle. But modern living comes with a price. Overbooked, highly stressed, and often running on reserves, as many as one-third of adults in the United States are not getting the quality of sleep the body requires.
Impact of Stress on Body
Let’s face it, stress is a fact of life. Stress is a biological and psychological response that occurs when we encounter a threat that we do not feel we have the resources to deal with. Any number of stressors, such as exams, divorce, illness, the death of a loved one, moving, or job loss, will create a physical response in the body. You may experience an increase in heart rate, an increase in breathing, a rush of energy to the limbs, a decrease in digestive activity (impacting elimination), and the liver is stimulated to release glucose for energy.
This physiological process also referred to as fight, flight, or freeze, is an instinctual survival mechanism controlled by the autonomic nervous system (ANS). When we operate under stress on a daily basis, the heightened activity of the ANS can end up causing more damage than benefits. The key becomes how a person can effectively manage – or downregulate – the stress response, and this is something that can be practiced and developed over time.
Self-Assessment
By answering a few simple questions you can get a good sense of whether the amount and quality of sleep you are getting on average per night is enough. If your answer is “no” to any one of the questions below, it’s a good indicator that your sleep pattern needs adjustment*.
Do you have a regular bedtime?
Do you get up at the same time every day?
Do you sleep the entire night through?
Do you have a way to downshift or release stress from your day?
Do you wake up in the morning feeling rested and restored?
*If you are concerned that your sleep pattern indicates a serious problem, please give us a call at 703-532-4892 and ask to speak to a nurse or schedule an appointment.
Preparing for Restful Sleep
Once you’ve identified that your sleep pattern needs improvement, there are several ways to teach yourself how to downregulate the nervous system in order to prepare for a better night’s sleep. This means setting some guidelines for yourself during the day and establishing a nighttime/sleep routine.
During the daytime:
Avoid drinking caffeinated beverages after noon and exercise should also be completed a solid two hours before sleeping.
If there are worries on your mind, jot them down in a journal to temporarily release them from your mind. Keeping a running list of “things to do” handy also helps to clear your mind before the evening.
Another extremely important element to getting restful sleep is managing others’ expectations and honoring your own boundaries. Taking on more tasks than one can handle is quite common, but it can really push us to our limits and cause unintentional stress. By setting some boundaries and staying within those lines as much as possible we can make more time available to decompress from the day’s activities.
In the evenings, aim for the following:
Avoid food or excessive drink after 7 p.m.
Avoid caffeine after Noon
Avoid alcoholic beverages
Honor your bedtime
Dim lights & disconnect from technology 2 hours before bed. Yes, 2 hours!
Arrange for comfort (soft sheets, warm blankets, and comfortable clothing)
Set the room temperature to one that is comfortable for you (some people sleep better in a cooler room)
Soothe the nervous system with meditation and stress reduction exercises – for tips, read on!
Stress Reduction
Aside from meditation, there are a number of exercises and other techniques to relax the nervous system before bed that can be done either with a partner or alone.
Just Breathe…
Belly breathing, also called diaphragmatic breathing, can soothe the nervous system. Watch and feel your belly expand with each inhalation. Breathing into the belly, instead of the upper lungs, can slow the heart rate and calm the nervous system. In addition, when your exhale breath is longer than your inhale breath, the heart rate slows down.
Practice inhaling for 2 counts and exhaling for 4 counts and repeat. As your heart rate slows, you may try to do a 4 count inhale and a 6 count exhale. Repeat this 4-5 times at least 30 minutes before bed. Note that your body may respond differently to the breathing, listen to your body and notice what calms your system and practice that.
Adrenal Hold
This is a soothing partner activity which involves cradling the adrenals to initiate feelings of calmness and relaxation. We have two adrenal glands, located on the top of each kidney. The adrenals are responsible for releasing the hormones cortisol, aldosterone, adrenaline, and noradrenaline that, among other processes, are involved in the fight, flight or freeze response.
Have the receiver sit comfortably in a chair so their partner, the holder, can easily reach their back to gently cradle the adrenals with warm hands (please, no energy work or bodywork). The holder creates a “safe basket” of warmth for the glands and allows the receiver to relax. This can also be done without a partner by using a warm pack for 5 minutes on the area. After a few minutes, the receiver will notice that they start to slow their breathing and may start to feel more relaxed. This is a wonderful way to calm down after a busy day of work and settle into a restful evening.
Triple Warmer Meridian
Within Traditional Chinese Medicine’s perspective on healing, you’ll find the concept of body meridians. Twelve major meridians channel life energy – or Qi – throughout the body, interacting with every major organ system. Good health is an indicator of balance within these energy pathways; likewise, diminished health and illness are indicative of an imbalance that must be corrected.
Triple Warmer is the meridian that controls our fight, flight or freeze response. According to Donna Eden, author of Energy Medicine, the triple warmer impacts the immune system and our ability to manage stress. When it is activated, the body is on high alert. When you practice tracing your triple warmer meridian backward, it can sedate or calm the fight or flight response.
Create a bedtime routine to prepare your body for sleep. This may include setting the stage so you are most comfortable and relaxed and ready for sleep:
Calming fragrances (lavender, chamomile)
Calming beverages (Organic Chamomile tea, Sleepy Time tea)
Dimming bedroom lights at least an hour before bed
Eye bags
SleepPhones and soothing sounds
White noise or a fan
Weighted Blanket – The deep pressure generated from a weighted blanket signals the brain to release serotonin, which in turn naturally calms and relaxes the body, promoting sleep and stress relief. Weighted blankets help calm children and adults with sensory integration disorder, autism, Rett Syndrome, Asperger’s Syndrome, ADHD, PTSD and Restless Leg Syndrome!
Sleep is our birthright and we have more control over it than we may think! Find the methods that work best for you to enjoy better quality sleep and the health benefits that go along with it.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
Long-COVID or post-COVID syndrome is a wide range of new or persisting symptoms that COVID-19 sufferers continue to experience even after recovering from a COVID-19 infection. According to the Centers for Disease Control (CDC), long-COVID symptoms can last for weeks or even months.
It is estimated that somewhere between 10-30% of patients develop long-COVID syndrome. Unfortunately, no formal treatment for long-COVID exists. This has made managing long-COVID a difficult and sometimes lonely experience for many sufferers. With few guidelines on the treatment of long-COVID, it is important to consider some of the effects that our lifestyle choices may have on long-COVID symptoms. One such area is the dietary choices that we make.
Long-COVID with nutrition
There is some evidence to suggest that adoption of a plant-based diet leads to reduced intake of inflammatory mediators and higher consumption of phytonutrients that reduce the inflammation in the body and help facilitate health and healing. Addressing some aspects of our diet can help to tackle long-COVID associated inflammation.
Nutrients that support the immune system
Some recent studies have highlighted the benefits of a healthy plant-based diet in fighting underlying conditions linked to poor COVID-19 outcomes. A plant-based diet consists of the following components
Minimally processed foods
Variety of colorful vegetables and fruits
Whole grains, and legumes
Exclusion of all animal products (such as red meat, poultry, fish, and dairy)
Nuts, seeds
High fiber foods
Plant-based diets are abundant in fiber, antioxidants, and phytochemicals. They are also free of cholesterol and low in saturated fat and pro-inflammatory animal-derived molecules.
How nutrients can help
The specific benefits of some food items in a plant-based diet were pointed out in the study above. They include:
Fiber – fiber may be associated with deeper, more restorative sleep and lowers bad cholesterol.
Antioxidants and polyphenols – Naturally-occurring dietary polyphenols exhibit antidepressant activity. This is important for some COVID patients.
Polyunsaturated fats – Eating more polyunsaturated fats and less saturated fats could potentially improve long-COVID-related sleep disorders
Evidence on nutrition and long-COVID
A recent population study that was carried out in 2021 highlights some potential benefits of following a plant-based diet. The study was conducted in six countries and found that adopting a plant-based dietary pattern was associated with 73% lower odds of moderate-to-severe COVID-19-like illness. In contrast, those individuals following “low carbohydrate, high protein diets” had substantially greater odds of moderate-to-severe COVID-19.
Although formal evidence of an association between diet and COVID-19 is still new, the evidence to date points to a potentially significant link between COVID-19 and our dietary patterns.
Management of long-COVID
At Kaplan Center, our goal is to treat long-COVID by taking a holistic, whole-body approach. That includes the use of new and emerging research and treatment that might produce better outcomes for patients. Dietary habits may be part of that approach and we may suggest this alongside other treatment options when dealing with long-COVID.
This article was published in March, 2022 and updated in March 2024.
Long-COVID Recovery Services
If you are experiencing symptoms beyond six weeks of being diagnosed with COVID-19, learn more about our Long-COVID Recovery Services to regain your strength, energy, and vitality. Click here for more information.
Irritable Bowel Syndrome (IBS) is a chronic, functional disorder of the digestive system. People with IBS can experience several unpleasant symptoms, including cramping, constipation, bloating, diarrhea, and abdominal pain. It is not uncommon for people with IBS to also experience bouts of anxiety and depression.
Research has not confirmed an exact cause of IBS, but has identified several factors that may contribute, including childhood trauma, stress, genetics, bacterial or viral infections, or changes in a person’s microbiome.
Treatments
There is no cure for IBS. Treatment focuses on identifying triggers to reduce the frequency of flare-ups and managing symptoms when they do arise.
Dietary modifications are a must. Working with a nutritionist can help you determine which foods are triggers and need to be eliminated and which foods can help restore balance to your microbiome.
Daily activity, relaxation techniques, and improving sleep habits are also highly encouraged. Depending on your symptoms and their severity, your provider may also recommend prescription medications, over-the-counter medications, or supplements.
Outside of allopathic (traditional western) medicine, visceral manipulation, a type of osteopathic manual therapy (OMT), is another effective therapy used by both physicians and physical therapists to treat IBS and other gut disorders.
To understand how a manual therapy can treat a disorder of the digestive system, one should first understand one of the basic principles of OMT: structure and function are reciprocally interrelated. This means that when there are structural imbalances within one of the body systems, the proper functioning of other body systems is limited.
Providers trained in osteopathic manual therapy use their hands and gentle touch to locate these structural imbalances and once identified, manual therapies can assist the patient in recovering.
Visceral manipulation is an organ-specific massage technique that helps your internal organs (visceral organs) move smoothly and naturally.
How OMT & Visceral Manipulation Improves Symptoms of IBS and Other Digestive Disorders
The digestive system is composed of the GI tract (mouth, pharynx, large and small intestines, esophagus, and anal canal) and the biliary system (liver, gallbladder, pancreas, and bile ducts), and relies on the smooth muscles of the muscular system to push food and liquid through the GI tract. During this process important nutrients are broken down and absorbed while waste is eliminated. A healthy muscular system is crucial to maintain the motility (natural movement) and function of digestive system’s visceral organs.
Motility becomes restricted when the connective tissue around the organs become inflamed. This can be a result of infections, trauma, poor diet, surgical scar tissue, toxins, or stress. As a result, functional and structural imbalances occur and manifest as symptoms. In the case of IBS, they can manifest as pain, gas, bloating, constipation, or any of the other symptoms mentioned above.
First, a manual assessment is done to determine if restrictions are the cause of your symptoms. If so, visceral manipulation techniques are then used to improve the function of the organ by relaxing smooth muscle tissue (improving gut motility), increasing blood flow (promoting healing), and improving lymphatic drainage (reducing swelling).
Our bodies are in constant motion, but we don’t often think about internal motion and what happens when our internal organs lose their motility. With visceral disorders, there is always a structural component. OMT can be a serious help in treating IBS as well as other digestive disorders such as colitis, GERD, irritable bowel disease, etc.
Fundamental health relies on all body systems working harmoniously. Visceral manipulation is one of many tools we use at the Kaplan Center to maintain the internal harmony of the body. Please give us a call at 703-532-4892 if you have IBS or other chronic pain symptoms that have not responded well to traditional treatments.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
Downshift Your Day and Get Set for Restful Sleep
/in Wellness/by Kaplan CenterGreat things happen when we are well-rested: our breath is full, slow, and deep, the digestive system works well, and the body can focus on repair – including reduction of inflammation, tissue repair, and hormone production. In fact, getting regular, restful sleep is the best medicine for improving a health condition or for simply maintaining a healthy lifestyle. But modern living comes with a price. Overbooked, highly stressed, and often running on reserves, as many as one-third of adults in the United States are not getting the quality of sleep the body requires.
Impact of Stress on Body
Let’s face it, stress is a fact of life. Stress is a biological and psychological response that occurs when we encounter a threat that we do not feel we have the resources to deal with. Any number of stressors, such as exams, divorce, illness, the death of a loved one, moving, or job loss, will create a physical response in the body. You may experience an increase in heart rate, an increase in breathing, a rush of energy to the limbs, a decrease in digestive activity (impacting elimination), and the liver is stimulated to release glucose for energy.
This physiological process also referred to as fight, flight, or freeze, is an instinctual survival mechanism controlled by the autonomic nervous system (ANS). When we operate under stress on a daily basis, the heightened activity of the ANS can end up causing more damage than benefits. The key becomes how a person can effectively manage – or downregulate – the stress response, and this is something that can be practiced and developed over time.
Self-Assessment
By answering a few simple questions you can get a good sense of whether the amount and quality of sleep you are getting on average per night is enough. If your answer is “no” to any one of the questions below, it’s a good indicator that your sleep pattern needs adjustment*.
*If you are concerned that your sleep pattern indicates a serious problem, please give us a call at 703-532-4892 and ask to speak to a nurse or schedule an appointment.
Preparing for Restful Sleep
Once you’ve identified that your sleep pattern needs improvement, there are several ways to teach yourself how to downregulate the nervous system in order to prepare for a better night’s sleep. This means setting some guidelines for yourself during the day and establishing a nighttime/sleep routine.
During the daytime:
In the evenings, aim for the following:
Stress Reduction
Aside from meditation, there are a number of exercises and other techniques to relax the nervous system before bed that can be done either with a partner or alone.
Just Breathe…
Belly breathing, also called diaphragmatic breathing, can soothe the nervous system. Watch and feel your belly expand with each inhalation. Breathing into the belly, instead of the upper lungs, can slow the heart rate and calm the nervous system. In addition, when your exhale breath is longer than your inhale breath, the heart rate slows down.
Practice inhaling for 2 counts and exhaling for 4 counts and repeat. As your heart rate slows, you may try to do a 4 count inhale and a 6 count exhale. Repeat this 4-5 times at least 30 minutes before bed. Note that your body may respond differently to the breathing, listen to your body and notice what calms your system and practice that.
This is a soothing partner activity which involves cradling the adrenals to initiate feelings of calmness and relaxation. We have two adrenal glands, located on the top of each kidney. The adrenals are responsible for releasing the hormones cortisol, aldosterone, adrenaline, and noradrenaline that, among other processes, are involved in the fight, flight or freeze response.
Have the receiver sit comfortably in a chair so their partner, the holder, can easily reach their back to gently cradle the adrenals with warm hands (please, no energy work or bodywork). The holder creates a “safe basket” of warmth for the glands and allows the receiver to relax. This can also be done without a partner by using a warm pack for 5 minutes on the area. After a few minutes, the receiver will notice that they start to slow their breathing and may start to feel more relaxed. This is a wonderful way to calm down after a busy day of work and settle into a restful evening.
Triple Warmer Meridian
Within Traditional Chinese Medicine’s perspective on healing, you’ll find the concept of body meridians. Twelve major meridians channel life energy – or Qi – throughout the body, interacting with every major organ system. Good health is an indicator of balance within these energy pathways; likewise, diminished health and illness are indicative of an imbalance that must be corrected.
Triple Warmer is the meridian that controls our fight, flight or freeze response. According to Donna Eden, author of Energy Medicine, the triple warmer impacts the immune system and our ability to manage stress. When it is activated, the body is on high alert. When you practice tracing your triple warmer meridian backward, it can sedate or calm the fight or flight response.
For Triple Warmer techniques based on Donna Eden’s program, click here.
Other Tools to Achieve a More Restful Sleep
Create a bedtime routine to prepare your body for sleep. This may include setting the stage so you are most comfortable and relaxed and ready for sleep:
Sleep is our birthright and we have more control over it than we may think! Find the methods that work best for you to enjoy better quality sleep and the health benefits that go along with it.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
References
Centers for Disease Control and Prevention: Sleep and Sleep Disorders
AlShareef SM. The impact of bedtime technology use on sleep quality and excessive daytime sleepiness in adults. Sleep Sci. 2022 Apr-Jun;15(Spec 2):318-327. doi: 10.5935/1984-0063.20200128. PMID: 35371396; PMCID: PMC8906383.
Green, M. Cohen-Zion, A. Haim & Y. Dagan (2017) Evening light exposure to computer screens disrupts human sleep, biological rhythms, and attention abilities, Chronobiology International, 34:7, 855-865, DOI: 10.1080/07420528.2017.1324878
Cleveland Clinic: Diaphragmatic Breathing
Ma X, Yue ZQ, Gong ZQ, Zhang H, Duan NY, Shi YT, Wei GX, Li YF. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Front Psychol. 2017 Jun 6;8:874. doi: 10.3389/fpsyg.2017.00874. PMID: 28626434; PMCID: PMC5455070.
Nutrition and Long COVID
/in COVID-19, Long Covid, Nutrition/by Kaplan CenterLong-COVID or post-COVID syndrome is a wide range of new or persisting symptoms that COVID-19 sufferers continue to experience even after recovering from a COVID-19 infection. According to the Centers for Disease Control (CDC), long-COVID symptoms can last for weeks or even months.
It is estimated that somewhere between 10-30% of patients develop long-COVID syndrome. Unfortunately, no formal treatment for long-COVID exists. This has made managing long-COVID a difficult and sometimes lonely experience for many sufferers. With few guidelines on the treatment of long-COVID, it is important to consider some of the effects that our lifestyle choices may have on long-COVID symptoms. One such area is the dietary choices that we make.
Long-COVID with nutrition
There is some evidence to suggest that adoption of a plant-based diet leads to reduced intake of inflammatory mediators and higher consumption of phytonutrients that reduce the inflammation in the body and help facilitate health and healing. Addressing some aspects of our diet can help to tackle long-COVID associated inflammation.
Nutrients that support the immune system
Some recent studies have highlighted the benefits of a healthy plant-based diet in fighting underlying conditions linked to poor COVID-19 outcomes. A plant-based diet consists of the following components
Plant-based diets are abundant in fiber, antioxidants, and phytochemicals. They are also free of cholesterol and low in saturated fat and pro-inflammatory animal-derived molecules.
How nutrients can help
The specific benefits of some food items in a plant-based diet were pointed out in the study above. They include:
Evidence on nutrition and long-COVID
A recent population study that was carried out in 2021 highlights some potential benefits of following a plant-based diet. The study was conducted in six countries and found that adopting a plant-based dietary pattern was associated with 73% lower odds of moderate-to-severe COVID-19-like illness. In contrast, those individuals following “low carbohydrate, high protein diets” had substantially greater odds of moderate-to-severe COVID-19.
Although formal evidence of an association between diet and COVID-19 is still new, the evidence to date points to a potentially significant link between COVID-19 and our dietary patterns.
Management of long-COVID
At Kaplan Center, our goal is to treat long-COVID by taking a holistic, whole-body approach. That includes the use of new and emerging research and treatment that might produce better outcomes for patients. Dietary habits may be part of that approach and we may suggest this alongside other treatment options when dealing with long-COVID.
This article was published in March, 2022 and updated in March 2024.
Long-COVID Recovery Services
If you are experiencing symptoms beyond six weeks of being diagnosed with COVID-19, learn more about our Long-COVID Recovery Services to regain your strength, energy, and vitality. Click here for more information.
Special Report: Understanding Long-COVID Syndrome
In this Special Report, we cover:
References
Long Covid Household Pulse Survey
Kim H, Rebholz CM, Hegde S, et al. Plant-based diets, pescatarian diets and COVID-19 severity: a population-based case–control study in six countries. BMJ Nutrition, Prevention & Health 2021;bmjnph-2021-000272. doi: 10.1136/bmjnph-2021-000272
Transforming Gut Health with Osteopathic Manual Therapy: Overcoming IBS Naturally
/in Digestive Issues/by Kaplan CenterIrritable Bowel Syndrome (IBS) is a chronic, functional disorder of the digestive system. People with IBS can experience several unpleasant symptoms, including cramping, constipation, bloating, diarrhea, and abdominal pain. It is not uncommon for people with IBS to also experience bouts of anxiety and depression.
Research has not confirmed an exact cause of IBS, but has identified several factors that may contribute, including childhood trauma, stress, genetics, bacterial or viral infections, or changes in a person’s microbiome.
Treatments
There is no cure for IBS. Treatment focuses on identifying triggers to reduce the frequency of flare-ups and managing symptoms when they do arise.
Dietary modifications are a must. Working with a nutritionist can help you determine which foods are triggers and need to be eliminated and which foods can help restore balance to your microbiome.
Daily activity, relaxation techniques, and improving sleep habits are also highly encouraged. Depending on your symptoms and their severity, your provider may also recommend prescription medications, over-the-counter medications, or supplements.
Outside of allopathic (traditional western) medicine, visceral manipulation, a type of osteopathic manual therapy (OMT), is another effective therapy used by both physicians and physical therapists to treat IBS and other gut disorders.
To understand how a manual therapy can treat a disorder of the digestive system, one should first understand one of the basic principles of OMT: structure and function are reciprocally interrelated. This means that when there are structural imbalances within one of the body systems, the proper functioning of other body systems is limited.
Providers trained in osteopathic manual therapy use their hands and gentle touch to locate these structural imbalances and once identified, manual therapies can assist the patient in recovering.
Visceral manipulation is an organ-specific massage technique that helps your internal organs (visceral organs) move smoothly and naturally.
How OMT & Visceral Manipulation Improves Symptoms of IBS and Other Digestive Disorders
The digestive system is composed of the GI tract (mouth, pharynx, large and small intestines, esophagus, and anal canal) and the biliary system (liver, gallbladder, pancreas, and bile ducts), and relies on the smooth muscles of the muscular system to push food and liquid through the GI tract. During this process important nutrients are broken down and absorbed while waste is eliminated. A healthy muscular system is crucial to maintain the motility (natural movement) and function of digestive system’s visceral organs.
Motility becomes restricted when the connective tissue around the organs become inflamed. This can be a result of infections, trauma, poor diet, surgical scar tissue, toxins, or stress. As a result, functional and structural imbalances occur and manifest as symptoms. In the case of IBS, they can manifest as pain, gas, bloating, constipation, or any of the other symptoms mentioned above.
First, a manual assessment is done to determine if restrictions are the cause of your symptoms. If so, visceral manipulation techniques are then used to improve the function of the organ by relaxing smooth muscle tissue (improving gut motility), increasing blood flow (promoting healing), and improving lymphatic drainage (reducing swelling).
Our bodies are in constant motion, but we don’t often think about internal motion and what happens when our internal organs lose their motility. With visceral disorders, there is always a structural component. OMT can be a serious help in treating IBS as well as other digestive disorders such as colitis, GERD, irritable bowel disease, etc.
Fundamental health relies on all body systems working harmoniously. Visceral manipulation is one of many tools we use at the Kaplan Center to maintain the internal harmony of the body. Please give us a call at 703-532-4892 if you have IBS or other chronic pain symptoms that have not responded well to traditional treatments.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
References
Bath M, Owens J. Physiology, Viscerosomatic Reflexes. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Lotfi C, Blair J, Jumrukovska A, Grubb M, Glidden E, Toldi J. Effectiveness of Osteopathic Manipulative Treatment in Treating Symptoms of Irritable Bowel Syndrome: A Literature Review. Cureus. 2023 Jul 24;15(7):e42393. doi: 10.7759/cureus.42393. PMID: 37621836; PMCID: PMC10446503.
https://www.aacom.org/become-a-doctor/about-osteopathic-medicine#
https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016