Massage therapists today see many clients presenting with chronic and often difficult-to-understand digestive issues. The ubiquitous irritable bowel syndrome, stomachs that are extremely sensitive to stressful situations, ulcerative colitis, diverticulitis, and many other problems leave people struggling to live with and manage their digestive system.

A digestive system that is not functioning well can be very debilitating, painful, and uncomfortable to live with at best, and can have serious health and well-being implications at worst. Lives can be restricted and limited in many chronic gut situations where people are either too exhausted or too wary of needing a toilet very quickly to leave the house. People try all kinds of restrictive diets and supplements to help themselves, and some end up on heavy medication and may even require major surgery that can leave them with a stoma bag for life.

While nutrition is important, there is one piece of the puzzle that is often not considered, and when it is considered, there is often no simple solution: Our emotional history going all the way back through our life, as well as our current emotional status and stress levels, and the physical impact it has on different gut tissues, cells, and interactions.

Emotional Health: The Missing Piece in Chronic Digestive Issues

It was for these reasons that, as an Upledger CranioSacral therapist, I became interested in the gut and the enteric nervous system, which is embedded in nearly the whole length of the gastrointestinal tract. I also became fascinated with the microbiota when I noticed there was so much new research and insight into the incredible world of gut bacteria.

My interest was also personal, as I had struggled with chronic gut issues for years as part of Post-Traumatic Stress Disorder (PTSD), as well as seeing many clients struggling with them in my practice. Many people with PTSD have chronic digestive issues, though they’re seldom mentioned as part of the symptom profile.

I have started using my own description for this issue: Post Traumatic Gut. As I worked on myself and with clients that came to me with similar issues, I became increasingly aware of this missing piece of the chronic gut puzzle and how chronic gut issues are most commonly described. The search for this missing piece was my motivation to create a body of work to help myself and others.

Rethinking the Importance of Gut Health

Many people think our digestive system is simply a long tube (9 meters or about 29 feet) where food goes in one end (the mouth) and feces come out of the other end (anus). I realized that a new approach to this system would be helpful, and that further research and education was needed.

If we look instead at Eastern philosophies and perspectives, such as Buddhism, Yoga, and Tai Chi, we discover the belly is considered a place of emotional and spiritual growth—a place to focus awareness during meditation.

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Buddhist monks teach their students that the belly should be greatly valued, heard, and respected, and is where they need to put their focus during meditation.

It was time for me to research and delve into the space between these two views in order to help people with chronic digestive issues. It was time to talk openly about the gut and its connection to mental health.

What I found is that our gut function impacts our mental and emotional health as directly as our mental and emotional health impacts our gut function. Many massage therapists are familiar with the gut-brain axis (GBA) and the emerging model of the microbiota/gut/brain axis.

The connections with the brain via the parasympathetic superhighway being numerous, including the Vagus nerve (Cranial nerve X), the metabolites produced by gut bacteria and sent up to the brain, as well as inflammatory substances breaching a permeable intestinal epithelial barrier and escaping into the blood stream to travel up to the brain.

On top of this, there are also vast numbers of messages from sensory and motor nerves in the enteric nervous system and all the tissues in the tube traveling to the brain giving it information about the state of our enteric nervous system and gut. This is part of our interoceptive sensory system that sends information from all the viscera to the brain, helping us learn to connect with and listen to our bodies.

Interoception is fundamental to the work of a CranioSacral therapist because we work to help facilitate our clients’ listening to their bodies.

Helping Gut Health with CranioSacral therapy

As a massage therapist, you already know that our whole history is written in our body. Patterns of stress and tension are found in our muscles, ligaments, joints, and the delicate matrix of fascia that permeates our whole body. The hands-on approach I have developed is to learn to palpate and recognize the individual layers of the small and large intestine, and really listen to any patterns of tension and any significance detectors (a significance detector is the abrupt halt of the craniosacral rhythm).

Diaphragm techniques, direction of energy techniques, and significance detectors are all very useful when working with this system. Often, I use a diaphragm technique to allow the tissue an opportunity to unwind, sometimes a simple direction of energy, or the dynamic poise technique developed by my colleague Tad Wanveer. The significance detector is an opportunity to explore any emotional component held in that part of the tissue.

When the significance detector shows up in a particular cell population or layer in the intestines, we can use the imagery and dialoguing techniques learned in Somato-Emotional Release classes to explore the history there to better facilitate release or find out what that part of the body needs to rebalance.

Working on the delicate, complex layers here requires a very grounded, neutral presence.

Dialoguing with the Inner Physician, or the body’s biological wisdom, is helpful to connect with the clients’ inner treatment plan. As Upledger CranioSacral therapists, we always intend to connect with this through a combination of knowledge of the anatomy and physiology, sensitive palpation skills, and the use of imagery and dialoguing. This would also be part of our armory of techniques to explore and resolve issues arising when working on the gut.

Imagine someone who is often in sympathetic dominance, fight and flight, and how that could impact their enteric system. Perhaps they experience a quick and uncomfortable transit of food through their intestines resulting in loose stools. Or someone where the parasympathetic aspect of their autonomic nervous system is spiking.

They may tend toward constipation and long-term issues. In clinical practice, the digestive system is often a place from which people disassociate, which makes time and safety two paramount issues in terms of the therapeutic relationship. I have learned the importance of being grounded and neutral with my energy and giving the person the space to meet me when they are ready. These are fundamental elements in teaching this work on the gut. The enteric nervous system is noticing moment by moment how safe we feel and responding accordingly. Therefore, creating a safe space and allowing time is very important if the patterns of tension or any other issues are going to reveal themselves to our touch.

When our hands are on someone’s belly, we can listen to many conversations. Every activity there—from making serotonin (95% is manufactured and stored in the gut) to peristalsis to absorbing nutrients—is the result of a massive team effort. There are constant conversations between enteric neurons, enteric glial cells, gut bacteria, enteroendocrine cells, neuroendocrine cells, immune cells (70% of our immune system lies in the gut), and many others.

In my book on this subject, “It’s All In The Gut, Let Your Second Brain Guide You to Optimal Health”, as well as in the new course I have developed for the Upledger Institute “CranioSacral Therapy and Listening to the Second Brain,” I try to inspire people to view the long tube as a place where we respond to the outside world. I would like people to be fascinated and amazed at the complex layers of the small and large intestine, layers of muscle, nerve complexes, and immune layers taking us to a final delicate single cell layer that meets the lumen, the space in the middle of the tube.

This final layer being our intestinal epithelial layer, an important boundary that is buffeted every day by the digestive process and is damaged by stress (physical and emotional) but can regenerate given the right support.

The right support requires healthy cell populations, healthy diversity in the gut microbiota, relaxed, well-functioning layers in the intestines, and a life that has strategies to deal with stresses. We can achieve this by becoming aware of where our intense stresses originate (both past and present), doing our emotional work, receiving some skilled bodywork on the gut, addressing our current lifestyle and making positive change as far as possible, including taking regular exercise, doing things that make us happy, and eating a healthy clean diet.

My hope is that by having an increased understanding and insight into the components and functioning of the digestive system, especially the small and large intestines, and by realizing the enormous part emotional and physical safety plays in the ability of this system to function comfortably and effectively, CranioSacral therapists will be able to apply many of the tools they already have in their toolkit to support and help the people that come to them.

Nikki Kenward is a United Kingdom Upledger CranioSacral therapist with over 20 years of experience specializing in gut health, pediatrics, PTSD and trauma. She has 15 years of experience teaching internationally as a Certified International HealthCare Educator. Additionally, Nikki is an author and a poet.