Occupational therapy (OT) interventions cover a wide range of strategies and techniques. The aim is to help an individual achieve optimal functioning when participating in daily activities. But what if your mind is keen to partake in the interventions but your gut issues are saying no!!

In March 2023 Ronnie, a student doing their placement with Jo, wrote a blog post -‘Link Between Neurodiversity and Hypermobility’. In the blog Ronnie mentions how hypermobility often presents with other dysautonomia conditions. Within the examples she gives she mentions gastrointestinal problems. This got me thinking about the connection between the gut and the auto immune system. Why gut issues are a very common thing to be seen in conditions such as hyper mobility and POTs? And how it can influence OT interventions?

The Immune System and Gut Interaction

The gut, also known as the digestive system, starts at the stomach and ends at the anus. It is a hollow muscular tube that processes all the food we eat and breaks it down into nutrients for the body to use.

The gut associated lymphoid tissue (GALT) makes up a significant portion of the body’s immune system. Its main responsibility is to distinguish between harmless and harmful substances.

When people talk about autoimmune diseases, they are discussing a malfunction in the immune system causing it to attack the body’s own tissues. When this dysregulation occurs in the gut it leads to auto immune related gastrointestinal symptoms. The symptoms can manifest as:

• Abdominal bloating and pain
• Chronic diarrhea
• Vomiting
• Constipation
• Weight loss
• Appetite change

These symptoms can cause joint point, fatigue, and people who menstruate it can cause amenorrhea (missed periods). Managing some, or all, of these symptoms can be daunting and anxiety inducing. It’s easy to understand why someone would feel wary of undertaking interventions recommended by an occupational therapist.

The Brain and Gut Interaction

The gut and the brain are closely connected and, in more ways than people realise.

This close connection affects our emotions, thoughts, and overall health and is often called the “gut-brain axis”. It involves a complex network of nerves, hormones, and biochemical signals.

Firstly, the gut and brain communicate through the vagus nerve. This nerve is the longest nerve in the body and runs from the brainstem to the gut. This nerve allows signals to be sent both ways. This means that the brain can influence gut functions, and the gut can influence brain function. For example, if you are feeling stressed your brain might send signals to your gut which can cause nausea.

The gut is also called ‘the second brain’. This is because it in fact has its own nervous system. This is called the Enteric Nervous System (ENS). The ENS controls digestion and can in fact function independently of the brain. However, it does still communicate with the brain influencing our moods and emotions. For example, this is why you may feel butterflies in your stomach when you are nervous.

Another key factor in gut-brain interaction is the microbiome. Microbiome consists of trillions of bacteria and many other microorganisms living in the small and large intestines. These microbes produce substances, including neuron-transmitters like serotonin. Serotonin is often called the ‘feel good’ chemical as it plays a part in feelings of well-being and happiness. In fact, over 90% of serotonin is produced in the gut.

Strategies around Interventions

When working with clients who have gut issues, OTs need to adapt their approach to each person’s specific needs, strengths, and limitations. For instance, people with gut problems often feel tired because their bodies aren’t absorbing nutrients well. To help manage this, therapists can suggest energy-saving techniques like taking small breaks or using strategies like the traffic light system, which Jo covers in her pacing masterclass.

Chronic gut issues often come with a lot of abdominal pain, so it’s important for therapists to make adjustments that reduce discomfort during daily activities, such as being out in public. This could mean using aids that makes life just that little bit easier. Frequent bathroom trips can really get in the way of a client’s daily activities. To help, therapists should recommend a radar key for swift use of public toilets.

Stress and anxiety often go hand in hand with gut issues and can make symptoms worse. Adding stress management strategies, mindfulness techniques, and relaxation exercises into the therapy plan, can help clients manage their anxiety and reduce its impact on their gut health. Apps such as Calm can help you practice relaxation and mindfulness.

Gut issues can mess with daily routines and make it hard to stick to a schedule. So it’s important to create flexible routines and manage time wisely. For example, if a client usually has gut trouble in the morning, it might be better to schedule appointments in the afternoon.

Physical activity might be off-limits or limited due to discomfort or medical advice. In these cases, therapists should come up with exercise programs that are easy on the digestive system, like low-impact exercises, yoga, or aquatic therapy.

Since the gut and brain are connected, gut issues can also mess with cognitive functioning. To support cognitive performance, therapists can use cognitive rehab strategies. Such as memory aids like medication reminder apps, and the development of organizational techniques.

Finally, gut issues might cause people to pull back from social interactions out of embarrassment or fear of symptoms. Therapists can help clients stay socially connected by encouraging online engagement, planning social activities around safe foods and accessible locations. Plus, having a fresh set of clothes and other essentials on hand can give clients peace of mind. This helps them feel more confident in social settings.

To conclude

Gut issues have a profound impact on occupational therapy interventions. The gut-brain axis highlights the strong connection between mental health and digestive health. This will have an impact on physical health influencing how clients respond to therapy. Symptoms like abdominal pain, bloating, and chronic diarrhea can lead to fatigue, and cognitive challenges. If not managed correctly during interventions this can lead to further occupational deprivation.  

Intervention strategies such as energy conservation, ergonomic adjustments for pain management, and stress reduction techniques can help clients manage their symptoms more effectively.

By understanding the complex interplay between gut health and overall functioning, an OT can provide more holistic and personalised care. And a client can learn to advocate for their needs more. This approach addresses both the physical symptoms and supports the emotional and cognitive aspects of client’s lives. Ultimately enhancing quality of life and independence.

About the author

Rachel is a final year OT student who has completed her final placement here. She has lived experience with chronic fatigue from the age of 15 and loves working with people who have shared experiences. In her spare time she has a deep passion for photography. She’s had two exhibitions with the National Portrait Gallery and one with the V&A.