IRRITABLE BOWEL SYNDROME Dr. R.Y. Nadaf M.D(Hom) Pricipal, P.G. Guide, Dr. B.D.Jatti Homoeopathic Medical College, Hospital & Post-Graduate research Centre, Dharwad

What Is IBS, Really 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.

Epidemiology About 15% of the general population have symptoms that justify a diagnosis of IBS; however, only about 20% of these will seek medical opinion, prompting a suggestion of hypersensitivity in them. IBS is the most common single reason for referral to gastroenterologists. In Western series, female patients predominate; in India, most reporting patients are young men, probably only because of social inhibitions in women. Half of the people who have IBS develop symptoms before age 35, and 40% develop symptoms between the ages of 35 and 50. In women, IBS is 2 to 3 times more common than in men.

Who else gets IBS? People who have panic disorder or other psychological conditions. People who have a family history of IBS. People who have a history of physical or sexual abuse or other psychological trauma. People with other conditions including Chronic Fatigue Syndrome, a condition that causes severe fatigue, Fibromyalgia, a condition that causes widespread muscle and soft-tissue pain and tenderness, and Temporomandibular (TM) disorder which causes pain and discomfort in the jaw muscles and joint.

What causes IBS? IBS encompasses a wide range of symptoms and a single cause is unlikely. It is generally believed that most patients develop symptoms in response to psychosocial factors, altered gastrointestinal motility, altered visceral sensation or luminal factors.

Pathophysiology Intestinal hypersensitivity to pain and discomfort and associated reflex alterations in motility might explain the symptoms of functional bowel diseases.

What are the symptoms of IBS? Main symptoms: Abdominal pain or discomfort that occurs along with constipation or diarrhea. Other common symptoms: Bloating. Mucus in the stools. Or a sense that one has not completely emptied your bowels.

Is IBS a Dangerous Condition? A given episode of IBS may be milder or more severe than the one before it, but the disorder itself does not become worse over time. Irritable bowel syndrome does not lead to more serious diseases, such as inflammatory bowel disease or cancer, but a person who has IBS may also have one of these illnesses. IBS does not shorten life expectancy. However, long term suffering from IBS may lead to depression and unwanted lifestyle adjustments.

Is IBS permanent? Symptoms of IBS may persist for a long time and it is rare for a person to suffer from it constantly. The pattern of IBS varies from one person to the next and from one bout to the next. Some people have symptoms off and on for many years, yet you may go months or years without having any symptoms. Most people, however, have recurrent episodes of symptoms that may affect their daily lives. With the appropriate treatment, symptoms may improve over time in most people.

Is Watchful Waiting an option? Watchful waiting is not appropriate if one has any "alarm symptoms," which could indicate a serious problem. Alarm symptoms include: Fever, unexplained weight loss, blood in stools. Anemia, which is a decrease in the amount of oxygen-carrying substance (hemoglobin) found in red blood cells. Family history of colon cancer or inflammatory bowel disease, which causes chronic inflammation of the intestines. Abdominal pain that is now in one area (localized) more than any other area.

Subtypes IBS IBS can be subdivided into Diarrhea-predominant (IBS-D) Constipation-predominant (IBS-C) Alternating diarrhea and constipation

Approach to the Patient of IBS IBS is a disorder for which no pathognomonic abnormalities have been identified, its diagnosis relies on recognition of positive clinical features and elimination of other organic diseases. A careful history and physical examination are frequently helpful in establishing the diagnosis. C/F suggestive of IBS include the following: Recurrence of lower abdominal pain with altered bowel habits over a period of time without progressive deterioration. Onset of symptoms during periods of stress or emotional upset, absence of other systemic symptoms such as fever and weight loss, and small-volume stool without any evidence of blood.

Diagnostic Criteria Rome II Diagnostic criteria. Manning’s Criteria.

Rome II Diagnostic Criteria. Supportive symptoms. Constipation predominant: one or more of: Bowel movements less than 3 times a week. Hard or lumpy stools. Straining during a bowel movement. Diarrhoea predominant: one or more of: More than 3 bowel movements per day. Loose [mushy] or watery stools. Urgency.

Manning’s Criteria. Three or more features should have been present for at least 6 months: Pain relieved by defecation. Pain onset associated with more frequent stools. Looser stools with pain onset. Abdominal distension. Mucus in the stool. A feeling of incomplete evacuation after defecation.

What exams or tests are needed? Few tests are required for patients who have typical IBS symptoms and no alarm features. The American Gastroenterological Association has delineated factors to be considered when determining the aggressiveness of the diagnostic evaluation. These includes Duration of symptoms Change in symptoms over time, Age and sex of the patient, Referral status of the patient Prior diagnostic studies Family history of colorectal malignancy, and Degree of psychosocial dysfunction. A positive diagnosis, based on Manning’s criteria may provoke less anxiety than extensive tests.

Differential Diagnosis Inflammatory bowel disease. Cancer. Diverticulosis. Endometriosis.

Treatment options Irritable bowel syndrome is a long-term (chronic) but manageable condition. Treatment will depend on the types of symptoms and their severity, as well as how they affect the daily life.

Treatment options… No single type of treatment for irritable bowel syndrome works best for everyone. One has to determine what may be the triggering symptoms. Standard medical treatments have not enjoyed a great rate of success and may, themselves, cause unwanted side effects. Homoeopathic treatment for IBS has proven to be more successful than conventional allopathic therapies.

Are there other treatment choices? The following treatment options may help relieve symptoms of irritable bowel syndrome (IBS). These treatment methods are usually more effective if they are used along with other treatment methods, such as diet changes, stress reduction, and sometimes medication. Therapy. Psychotherapy and behavioral therapy may be effective for pain caused by IBS. Some people who use these treatment methods may have long-term relief.

Are there other treatment choices? ….. Hypnosis. Hypnosis can help some people relax, which may relieve abdominal pain. Relaxation or meditation. Relaxation training and meditation may be helpful in reducing generalized muscle tension and abdominal pain. Biofeedback. Biofeedback training may help relieve pain from intestinal spasms. It also may help improve bowel movement control in people who have severe diarrhea.

What about diet? The following suggestions may help prevent or relieve some IBS symptoms: Avoid caffeine. Limit your intake of fatty foods. Fats increase gut sensations, which can make abdominal pain seem worse. If diarrhea is your main symptom, limit dairy products, fruit, or the artificial sweetener sorbitol. Increasing fiber in your diet may help relieve constipation. Avoiding foods such as beans, cabbage, or uncooked cauliflower or broccoli can help relieve bloating or gas.

Homoeopathic Remedies Argentum nitricum: Digestive upsets accompanied by nervousness and anxiety suggest the use of this remedy. Bloating, rumbling flatulence, nausea, and greenish diarrhea can be sudden and intense. Diarrhea may come on immediately after drinking water. Eating too much sweet or salty food (which the person often craves) may also lead to problems. A person who needs this remedy tends to be expressive, impulsive, and claustrophobic, and may have blood sugar problems.

Asafoetida: A feeling of constriction all along the digestive tract (especially if muscular contractions in the intestines and esophagus seem to be moving in the wrong direction) strongly indicates this remedy. The person may have a feeling that a bubble is stuck in the throat, or that a lump is moving up from the stomach. The abdomen feels inflated, but the person finds it hard to pass gas in either direction to get relief. Constipation brings on griping pains. Diarrhea can be explosive, and the person may even regurgitate food in small amounts.The person may exhibit a strong emotional or “hysterical” element when this remedy is needed.

Colocynthis: This remedy is indicated when cutting pains and cramping occur, making the person bend double or need to lie down and press on the abdomen. Cramps may be felt in the area of the pubic bone. Pain is likely to be worse just before the diarrhea passes, and after eating fruit or drinking water. Problems tend to be aggravated by emotions, especially if indignation or anger has been felt but not expressed. Back pain, leg pain, and gall bladder problems are sometimes seen when this remedy is needed.

Lilium tigrinum: When this remedy is indicated, the person may make frequent unsuccessful efforts to move the bowels all day and have sudden diarrhea the following morning. A feeling of a lump in the rectum, worse when standing up, is common. Hemorrhoids may develop. Constricting feelings are often felt in the chest. The person is likely to be worse from excitement and strong emotions, and may tend toward irritability or even rage.

Lycopodium: This remedy is often indicated for people with chronic digestive discomforts and bowel problems. Bloating and a feeling of fullness come on early in a meal or shortly after, and a large amount of gas is usually produced. Heartburn and stomach pain are common, and the person may feel better from rubbing the abdomen. Things are typically worse between four and eight p.m. Despite so many digestive troubles, the person can have a ravenous appetite, and may even get up in the middle of the night to eat. Problems with self-confidence, a worried facial expression, a craving for sweets, and a preference for warm drinks are other indications for Lycopodium.

Natrum carbonicum: This remedy is often indicated for mild people who have trouble digesting and assimilating many foods and have to stay on restricted diets. Indigestion, heartburn, and even ulcers may occur if offending foods are eaten. The person often is intolerant of milk, and drinking it or eating dairy products can lead to gas and sputtery diarrhea with an empty feeling in the stomach. The person may have cravings for potatoes and for sweets (and sometimes also milk, but has learned to avoid it). A person who needs this remedy usually makes an effort to be cheerful and considerate, but, when feeling weak and sensitive wants to be alone to rest.

Nux vomica: Abdominal pains and bowel problems accompanied by tension, constricting sensations, chilliness, and irritability can indicate a need for this remedy. Soreness in the muscles of the abdominal wall, as well as painful gas and cramps are common. Firm pressure on the abdomen brings some relief. When constipated, the person has an urge to move the bowels, but only small amounts come out. The person may experience a constant feeling of uneasiness in the rectum. After diarrhea has passed, the pain may be eased for a little while. A person who needs this remedy often craves strong spicy foods, alcohol, tobacco, coffee, and other stimulants—and usually feels worse from having them.

Podophyllum: This remedy is indicated when abdominal pain and cramping with a gurgling, sinking, empty feeling are followed by watery, offensive-smelling diarrhea—alternating with constipation, or pasty yellow bowel movements containing mucus. Things tend to be worse in the very early morning, and the person may feel weak and faint or have a headache afterward. Rubbing the abdomen (especially on the right) may help relieve discomfort. A person who needs this remedy may also experience stiffness in the joints and muscles.

Sulphur: This remedy is often indicated when a sudden urge toward diarrhea wakes the person early in the morning (typically five a.m.) and makes them hurry to the bathroom. Diarrhea can come on several times a day. The person may, at other times, be constipated and have gas with an offensive and pervasive smell. Oozing around the rectum, as well as itching, burning, and red irritation may also be experienced. A person who needs this remedy may tend to have poor posture and back pain, and feel worse from standing up too long.