Thinking About the Box: Muscular Relaxation for Abdominal Pain

Brought to you by Creative Healing for Youth in Pain's Parenting Blog

Rebecca Cherry, MD MPH
March 25, 2024 / 3 mins read

Clinical hypnosis is a highly effective method to treat abdominal pain in children, with a response rate of roughly 80%. Most people have experienced a clear connection between emotions and abdominal sensations, and it seems intuitively obvious that a treatment that modulates the brain-gut connection can help resolve these symptoms. But at the same time, there is another, more straightforward way that hypnosis can help in this situation: plain old muscle relaxation.

There are so many factors that affect GI-related pain: diet, antibiotic use, bowel habits, acid suppression, anxiety, sleep cycle, and many more. However, one major factor which we often overlook is the musculoskeletal system.

The abdominal organs are enclosed in a "canister" or "box" of bones and muscles. The "lid" or top of the canister is the diaphragm, a dome-shaped muscle that separates the chest from the abdomen and which moves down and up with each breath. The diaphragm also shifts position after a meal based on reflexes triggered by the arrival of food in the small intestine. The bottom of the canister is the pelvis, a framework of bone with a "floor" of muscles. The pelvic floor muscles move down and up with the passage of urine and stool.

If the up/down movements of the diaphragm or the pelvic floor become uncoordinated, limited, or otherwise disrupted, a person might experience bloating, distention, constipation, reflux symptoms, and pain. But often, we gastroenterologists are so focused on what might be happening inside the stomach or intestine to cause these symptoms that we forget to consider what is happening with the muscles around them.

So, when a person learns to relax their body using hypnosis – and finds muscle tension in the body decreasing – that same easing of tight abdominal or pelvic muscles may lead to pain reduction even if they don't feel a change in their anxiety. It's not an outside-the-box process – it's a process that includes the box!

This impact of the abdominal muscles on sensation inside the abdomen is another reason why so many modalities, like physical therapy, can also address abdominal pain. It also shows why a team approach can be so helpful in kids with chronic symptoms like these.