Irritable bowel syndrome

Homoeopathy for the layman

IRRITABLE BOWEL SYNDROME (IBS)

Introduction

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, distention and change in bowel habits. It’s prevalence in western countries is about 15-20% in adults with female predominance. In India its prevalence is increasing due to increased psychological stress and the westernization of the diet with a male predominance.

Causes
In most of the patients psychological conditions like anxiety, depression and fear are responsible. These conditions play a causative as well as maintaining role in IBS.
Other causes include weak vitality and poor adaptability.
This syndrome can also be triggered by acute gastrointestinal infection, irregular food habits, abuse of laxatives and other medications etc.

Symptoms
Gastrointestinal symptoms of IBS are:
1. Abdominal Pain - It is felt in lower abdomen, dull or colicky in nature and usually relieved by defecation or passing flatus. It is usually worse after meals.
2. Abdominal distension and bloating - Sense of abdominal distention or bloating is usually complained by majority. It is usually worse throughout the day but is not due to excessive intestinal gas.
3. Variable bowel habits – Most of the patients have alternate episodes of diarrhea and constipation but it is useful to classify patients as having predominantly constipation or predominantly diarrhea. The constipated type tends to pass infrequent pellet like stools, usually in association with abdominal pain. Those with diarrhea have frequent defecation but produce low volume stools and are rarely worse at night. Mucous is commonly seen with stools and no rectal bleeding is there.
4. Other symptoms associated are nausea, headaches; Pains in back, thigh or chest; frequent urination and fatigue. Despite severe symptoms, patients do not loose weight

The diagnosis of IBS is made if the symptoms are present for more than 3 months. The various type of IBS are - Diarrhea predominant (IBS-D), Constipation predominant (IBS-C), Alternating stool pattern (IBS-A).

Investigations
As it a functional problem, no structural changes are present and tests reveal nothing. Usually lab investigations are done to rule out other disease. In older patients barium enema and colonoscopy is done to exclude colorectal cancer. While younger patients with persistent diarrhea may require endoscopy to rule out ulcerative colitis.

Management
Most of the patients have a relapsing and remitting course. Aggravation of the complaints often follow stressful life events, occupational dissatisfaction and difficulties with inter personal relationships.
Along with medicines following measures are of utmost importance in the management of IBS.
1. Diet: - Increase of fibrous diet with supplementation with bulking agents as coarse wheat bran or isaphgul husk. Intake of smaller meals at frequent intervals. Avoidance of alcohol, spices, fatty meals & dietary items that aggravate the condition.
2. Other measures include relaxation techniques for stress management, regular exercise, yoga etc.

Role of Homoeopathy
As per Homoeopathic system of medicine, Disease is a total response of a patient to adverse environmental factors, external or internal; it is conditioned by constitutional factors, inherited and acquired; and it manifests itself through symptoms in the three spheres – emotional, intellectual and physical. This response is divisible into
a) Individual response – characteristic symptoms which denote the constitutional type; which vary from person to person and
b) Group response – diagnostic symptoms.

In Homoeopathic system of medicine, the individual response of the patient is much important than the group response. So, in a set of patients having the same diagnostic symptoms (group response), the medicine given to each of them is different as the individual response of each varies. As in most of patients, the condition of the mind is responsible for IBS; homoeopathy has a much greater role to play. So, while the allopathic physician may refer such patient to the psychiatrist for treatment of mind symptoms, in homoeopathy the patient is treated as a single unit and the medicine which is suited to him for his mental as well as physical state is prescribed. Thus the patient is treated in a holistic way with homoeopathy.

With an eye on the constitution, temperament, totality of symptoms, life style and diet of the patients suffering from IBS, successful results can be obtained with homoeopathic medicines.

Homoeopathic medicines for IBS: - Medicines commonly used for IBS are Abies-nigra,
Aloes, Argentum nitricum, Arsenic Album, Asafoetida, Baptisia, Belladonna, Calcarea carb, Carbo-veg, Causticum, Chamomilla, China, Colchicum, Colocynthis, Gratiola, Ignatia, Iris v, Kali Bich, Lilium tig, Lycopodium, Merc sol, Merc cor, Natrum carb, Natrum mur, Natrum phos, Nux vomica, Phosphorus, Pulsatilla, Raphanus sat, Sulphur, Veratrum alb.




The indications for few of the above remedies are as follows:-

Argentum nitricum: - Digestive upsets accompanied with Anxiety and nervousness.
Diarrhea can be sudden, greenish and may come on immediately after drinking water. Patient has great craving for sugar or salt which aggravate the complaints; meat and fat are disliked. The patient who needs this remedy is impulsive, has fear of heights, claustrophobia & anxiety about health. There is distention of abdomen with rumbling and nausea. Pain is worse when lying on right side.

Asafoetida: - This remedy is suited to hysterical persons with tendency to easy fainting. Flatulence with explosive eructation that smell like garlic. It has a hysterical rising in throat, as if a ball or large body ascended from stomach to esophagus. A feeling that food moves in a wrong way i.e. instead of going down is coming upwards. Excessive abdominal distension and sensation as if everything in the abdomen would burst through the mouth. Complaints are mostly left sided.

Colocynthis: - This remedy is suited to extremely irritable & impatient individuals. Problems start or are aggravated after anger and resentment from being slighted or humiliated especially if not expressed. Agonizing, cutting pains in abdomen causing patient to bend over double and press on the abdomen for relief. Violent, cutting, gripping, grasping, clutching or radiating, colicky. Pains, come in waves, better doubling up, hard pressure, worse least food or drink, except coffee and tobacco smoking.

Gratiola: - It is an important remedy where there is a feeling of incomplete evacuation of stool. Stool is green, yellow gushing, as if water running from a hydrant. It is aggravated in summer and by drinking water. The patient feels empty after meals. Diarrhea alternates with constipation. There is a strong craving for bread and the patient wants nothing but bread.

Lycopodium: - This remedy is suited to intellectual persons with anticipatory anxiety with extreme lack of confidence. Excessive accumulation of flatulence; constant sensation of satiety; good appetite, but a few mouthfuls fill up to the throat, and he feels bloated; fermentation in abdomen, with loud grumbling, croaking, especially lower abdomen. Rumbling with sensation as if everything turns into gas. Warm food and drinks ameliorate. Pains: aching-pressure, drawing; chiefly right-sided, worse four to eight p.m.

Natrum carbonicum: This remedy is suited to persons who are gentle and ready to serve selflessly. They have a cheerful expression even when sad. They are oversensitive to external atmospheric impressions & dietetic errors. Diarrhea from milk. Empty, gnawing, hungry sensation in stomach at 5 a.m.; must leave bed and have some biscuits. Emptiness and hungry feeling also at 10-11 a.m. and 10-11 p.m..Greedy, always nibbling.






Natrum muriaticum: This remedy is suited to persons who are vulnerable to emotional injury especially disappointment in love and do not express their emotions easily. Abdomen is hard to the touch, cramps up, and is accompanied by severe pain as if the colon were being grasped and squeezed by a tight fist. Those afflicted are compelled to double up with this acute attack, which is followed by the passage of flatus and eventually stool. The pains are often precipitated by the abdomen becoming full of gas or by constipation. Patient craves for salty things.

Raphanus sativa – This remedy is suited to hysterical persons where sadness alternates with hopefulness and a delusion that she has an unrecognized disease. Sensation of accumulation and incarceration of gas in abdomen. Colic, griping about navel. During colic, there is a pad-like swelling and movement of the intestines. Intolerance of clothing around abdomen. Post-operative gas pains and constipation. Vomiting of faecal matter.

Homoeopathic medicines should be taken under the advice of a qualified homoeopath after a thorough case taking which includes the mental & physical causes, present at the start of the IBS. The dose, potency and the repetition of the medicines should be under the supervision of a homoeopathic physician.


Dr Dushyant Kamal Dhari
M.D. (Hom)