Irritable bowel syndrome (IBS)

Overview of Irritable bowel syndrome (IBS)

No clear diagnostic markers exist for IBS, thus, the diagnosis of the disorder is based on clinical presentation. In 2006, the Rome II criteria for the diagnosis of IBS were revised.

Moreover, Throughout the world, about 10–20% of adults and adolescents have symptoms consistent with IBS, and most studies show a female predominance.

Severity of symptoms varies and can significantly impair quality of life, resulting in high health care costs. Advances in basic, mechanistic, and clinical investigations have improved our understanding of this disorder and its physiologic and psychosocial determinants. [1]

Causes of Irritable bowel syndrome (IBS)

The precise cause of IBS isn’t known. Factors that appear to play a role include:

• Muscle contractions in the intestine i.e.:

  The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Contractions that are stronger and last longer than normal can cause gas, bloating and diarrhea. Weak intestinal contractions can slow food passage and lead to hard, dry stools.

• Nervous system i.e.:

  Abnormalities in the nerves in your digestive system may cause you to experience greater than normal discomfort when your abdomen stretches from gas or stool. constipation.

• Severe infection i.e.:

  IBS can develop after a severe bout of diarrhoea (gastroenteritis) caused by bacteria or a virus

• Early life stress i.e.:

  People exposed to stressful events, especially in childhood, tend to have more symptoms of IBS.

• Changes in gut microbes i.e.:

  Examples include changes in bacteria, fungi and viruses, which normally reside in the intestines also play a key role in health.

Triggered factors are:

• Food i.e.:

  The role of food allergy or intolerance in IBS isn’t fully understood. Additionally, A true food allergy rarely causes IBS.

• Stress i.e.:

  Most people with IBS experience worse or more-frequent signs and symptoms during periods of increased stress. But while stress may aggravate symptoms, it doesn’t cause them. [2]

Risk factor of Irritable bowel syndrome (IBS)

Many people have occasional signs and symptoms of IBS. But you’re more likely to have the syndrome if you:

• Are young- IBS occurs more frequently in people under age 50.
• Are female- In the United States, IBS is more common among women. Additionally, Estrogen therapy before or after menopause also is a risk factor for IBS.
• Have a family history of IBS- Genes may play a role, as may shared factors in a family’s environment or a combination of genes also environment.
• Have anxiety, depression or other mental health issues- A history of sexual, either physical or emotional abuse also might be a risk factor. [2]

Pathophysiology of Irritable bowel syndrome (IBS)

The pathogenesis of IBS is poorly understood, although roles of abnormal gut motor and sensory activity, central neural dysfunction, psychological disturbances, mucosal inflammation, stress, also luminal factors have been proposed. [1]

Sign & Symptoms of Irritable bowel syndrome (IBS)

The signs and symptoms of IBS vary but are usually present for a long time. The most common include:

• Abdominal pain, either cramping or bloating that is related to passing a bowel movement
• Changes in appearance of bowel movement
• Changes in how often you are having a bowel movement
• Other symptoms that are often related include bloating, increased either gas or mucus in the stool.

More-serious signs and symptoms include:

• Weight loss
• Diarrhea at night
• Rectal bleeding
• Iron deficiency anemia
• Unexplained vomiting
• Difficulty swallowing
• Persistent pain that isn’t relieved by-passing gas or a bowel movement. [2]

Diagnosis of Irritable bowel syndrome (IBS)

There’s no test to definitively diagnose IBS. Your doctor is likely to start with a complete medical history, physical exam and tests to rule out other conditions, such as celiac disease.

After other conditions have been ruled out, your doctor is likely to use one of these sets of diagnostic criteria for IBS:

• Rome criteria:

These criteria include abdominal pain and discomfort lasting on average at least one day a week in the last three months, associated with at least two of these factors: Pain and discomfort are related to defecation, the frequency of defecation is altered, or stool consistency is altered.

• Type of IBS:

For the purpose of treatment, IBS can be divided into three types, based on your symptoms: constipation-predominant, diarrhoea-predominant or mixed.

Your doctor will also likely assess whether you have other signs or symptoms that might suggest another, more serious, condition.

These signs and symptoms include:

• Onset of signs and symptoms after age 50
• Weight loss
• Rectal bleeding
• Fever
• Nausea or recurrent vomiting
• Abdominal pain, especially if it’s not related to a bowel movement, or occurs at night
• Diarrhoea that is persistent or awakens you from sleep
• Anemia related to low iron

If you have these signs or symptoms, or if an initial treatment for IBS doesn’t work, you’ll likely need additional tests. [2]

Differential Diagnosis of Irritable bowel syndrome (IBS)

• Inflammatory bowel disease as in Crohn’s disease (ulcerative colitis)
• Intestinal pseudo-obstruction
• Abuse of medications such as laxatives or bowel binders
• Lactose intolerance
• Psychiatric disorders (such as depression, anxiety or somatization disorder)
• Infections of the digestive tract
• Malabsorption syndromes (such as celiac disease or pancreatic insufficiency)
• Endocrine disorders (such as hypothyroidism, hyperthyroidism, diabetes or Addison’s disease)
• Certain rare endocrine tumors (such as gastrinoma or carcinoid tumors)
• Carcinomas of the intestine [5]

Treatment of Irritable bowel syndrome (IBS)

Stool-Bulking Agents

• High-fiber diets and bulking agents, such as bran or hydrophilic colloid, are frequently used in treating IBS.
• The water-holding action of fibers may contribute to increased stool bulk because of the ability of fiber to increase fecal output of bacteria. Fiber also speeds up colonic transit in most persons.

Antispasmodics

• Clinicians have observed that anticholinergic drugs may provide temporary relief for symptoms such as painful cramps related to intestinal spasm.

Antidiarrheal Agents

• Peripherally acting opiate-based agents are the initial therapy of choice for IBS-D.

Antidepressant Drugs

• In addition to their mood-elevating effects, antidepressant medications have several physiologic effects that suggest they may be beneficial in IBS.

 Antiflatulence Therapy

• The management of excessive gas is seldom satisfactory, except when there is obvious aerophagia or disaccharides deficiency.

Modulation of Gut Flora

• Antibiotic treatment benefits a subset of IBS patients.

Homeopathic Treatment of Irritable bowel syndrome (IBS)

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Irritable bowel syndrome (IBS):

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Nux Vomica:

• In general, Flatulent distension with spasmodic colic.
• Bruised soreness of abdominal walls.
• Furthermore, Colic with upward pressure, causing short breath also desire to stool.
• Constipated with frequent ineffectual urging.
• Besides this, Irregular peristaltic action.
• Dysentery, stools relieve pain for a time.
• Worse – morning, after eating, spices, stimulants, cold. On the other hand, Better – rest, damp, wet weather.

Aloe:

• Abdomen feels full, heavy, hot, bloated.
• Pulsating pain around navel. Additionally, Great accumulation of flatus pressing downwards, causing distress in lower bowels.
• Sensation of plug between symphysis pubis and coccyges, with urging to stool. Basically, Colic before and during stool. Burning copious flatus.
• Sense of insecurity in rectum, when passing flatus. In detail, Lumpy watery stool.
• Especially, Jelly-like stools, with soreness in rectum after stool.
• Burning in anus also rectum.
• Constipation with heavy pressure in lower part of abdomen. Diarrhoea from beer. Worse – heat. whereas Better – cold.

Asterias Rubens:

• Ineffectual desire.
• Stool like olives – diarrhoea, watery brown, gushing out in jet.

Podophyllum:

• Generally, in Long standing diarrhoea.
• Constipation, clay coloured, hard, dry, difficult.
• Constipation alternating with diarrhoea.
• Green watery fetid, profuse, also gushing.
• Prolapse of rectum before or with stool.
• Worse – specifically hot weather.

Antimonium Crudum:

• Excessive irritability also fretfulness. Loss of appetite. In detail, Constant belching.
• Bloated after eating. Diarrhoea alternating with constipation, especially in old people.
• Diarrhoea after acids, sour wine, overeating. Additionally, Slimy flatulent stools. Mucus. Piles. Continued oozing of mucus, hard lumps mixed with watery discharge.
• Catarrhal proctitis. Besides this, Stools composed entirely of mucus.
• Worse – heat, acids, wine, water. On the other hand, Better – rest, moist warmth.

Lycopodium:

• Basically, Abdomen is bloated, full.
• Pain shooting across lower abdomen from right to left.
• Furthermore, Diarrhoea, inactive intestinal canal. Ineffectual urging, stool hard, difficult, small, incomplete.
• Worse – especially right side from right to left, from above downward, 4-8.00 p.m., heat. On the other hand, Better – motion, warm food and drinks.
• On getting cold, from being uncovered.

Chelidonium Major:

• Fermentation and sluggish bowels. Distension.
• Constipation stools hard round balls like sheep’s dung.
• Bright yellow pasty clay coloured.
• Alteration of diarrhoea and constipation.
• Burning and itching of anus.
• Worse – motion, touch, change of weather, but Better by- after dinner, from pressure.

Gambodia–

• Garcinia Morella: Pain and distension of abdomen, from flatulence, after stool.
• Rumbling and rolling. Dysentery with retained scybala, with pain in sacral region.
• Diarrhoea with sudden and forcible ejection of bilious stools.
• Tenesmus after, with burning of anus.
• Ileo-sacral region sensitive to pressure.
• Profuse watery diarrhoea in hot weather, particularly in old people.
• Worse – towards evening, especially night.

Iodum:

• Anxiety and depression. Acute catarrh of all mucus membranes.
• Acute exacerbation of chronic inflammation.
• Cutting pain in abdomen. Constipation alternating with diarrhoea.
• Constipation with ineffectual urging.
• Diarrhoea whitish, frothy, fatty.
• Hemorrhage at every stool.
• Worse – quiet, warm room. whereas Better – open air, walking about.

Diet & Regimen of Irritable bowel syndrome (IBS)

To ease chronic IBS-associated constipation

IBS-C: Compliant Foods i.e.

• Whole-grain bread and cereals, Oat bran
• Fruits (especially apples, pears, kiwifruit, figs, and kiwifruit)
• Vegetables (especially green leafy vegetables, sweet potato, and Brussels sprouts)
• Beans, peas, and lentils, Clear soups
• Dried fruit, Prune juice
• Non-fat milk
• Yogurt and Kefir
• Skinless chicken, Fish
• Seeds (especially chia seed and ground flaxseed)

IBS-C: Non-Compliant Foods i.e.

• White bread, pasta, also crackers
• Unripe bananas
• Fast or fried foods, Baked goods (e.g. cookies, muffins, cakes)
• White rice
• Full-fat cream and dairy (including ice cream)
• Alcohol (especially beer), Red meat[4]
• Potato chips, Chocolate, Creamy soups

If IBS symptoms involve diarrhea,

 IBS-D: Compliant Foods i.e.

• White bread, pasta, and crackers, Whole grains
• White rice, Oatmeal
• Skinless chicken, Lean meat
• Lean fish ,Eggs
• Boiled or baked potato
• Beans, peas, and legumes
• Rice milk, almond milk, or coconut milk
• Low-fat lactose-free milk
• Low-fat probiotic yogurt
• Unsweetened clear fruit juice

IBS-D: Non-Compliant Foods i.e.

• Fast or fried foods, Foods high in sugar (e.g., baked goods)
• Fatty meats ,Processed meats
• Sardines and oil-packed canned fish
• Cruciferous vegetables ,Salad greens also raw vegetables
• Bean, peas, and legumes
• Citrus fruits, Dried fruits
• Caffeine, Alcohol
• Milk and dairy products
• Sweetened juices and fruit nectars [4]

Frequently Asked Questions

What is Irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of detectable structural abnormalities.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Irritable bowel syndrome?

• Nux Vomica
• Aloe
• Asterias Rubens
• Podophyllum
• Antimonium Crudum
• Lycopodium
• Chelidonium Major
• Gambodia
• Iodum

What are 3 causes of Irritable bowel syndrome?

• Muscle contractions in the intestine
• Abnormalities in the nerves in your digestive system
• Severe infection
• Early life stress
• Changes in gut microbes

What are the symptoms of Irritable bowel syndrome?

• Abdominal pain, cramping or bloating
• Changes in appearance of bowel movement
• Changes in how often you are having a bowel movement
• Increased gas or mucus in the stool.
• Weight loss
• Diarrhea at night
• Rectal bleeding
• Unexplained vomiting
• Difficulty swallowing