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Irritable Bowel Syndrome

What is Irritable Bowel Syndrome (IBS) and why is it so named?

It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements. Diarrhoea or constipation may predominate, or they may alternate. IBS may begin after an infection, a stressful life event, or onset of maturity without any other medical indicators.

The term, irritable bowel, is not particularly accurate since it implies that the bowel is responding irritably to normal stimuli. However, this may or may not be the case. Several terms have been used for IBS, including spastic colon, spastic colitis, nervous colon, irritable colon and mucous colitis. These attest to the difficulty of getting a proper description of the ailment. Moreover, all these terminologies are as problematic as the term IBS.

IBS is one of the most common disorder of digestive system producing a spectrum of symptoms such as persistent and recurring abdominal pain associated with passing of motion, change of bowel habit (diarrhoea, constipation, or alternate diarrhoea and constipation), etc. without any ‘decipherable’ cause. It is not a single symptom, rather a conglomeration of symptoms. It leads to several other symptoms, even in addition to those above mentioned, like cramping, bloating, acidity, frequent urge to pass stools, sensation of incomplete evacuation etc.

IBS is best described as a functional disease. The concept of functional disease is particularly useful when discussing diseases of the gastrointestinal tract. The concept applies to the muscular organs of the gastrointestinal tract; the oesophagus, stomach, small intestine, gallbladder, and colon. What is meant by the term, functional, is that either the muscles of the organs or the nerves that control the organs are not working normally, and, as a result, the organs do not function normally. The nerves that control the organs include not only the nerves that lie within the muscles of the organs but also the nerves of the spinal cord and brain to which they are connected.

The distinction between functional disease and non-functional disease may not be distinctive. Even functional diseases may have associated biochemical or molecular abnormalities that ultimately will be able to be measured. For example, functional diseases of the gastric system may in future be known to be caused by reduced levels of some chemicals. If we can measure an associated or causative abnormality, the disease may no longer be considered functional.

Causes, incidence, and risk factors

About 1 in 6 people have symptoms of IBS. It is the most common intestinal problem that causes patients to be referred to a bowel specialist (gastroenterologist). However, it is still not clear why patients develop IBS. Sometimes it occurs after an infection of the intestines. This is called post-infectious IBS. There may also be other triggering factors.

Young age, prolonged fever, anxiety, and depression are the major risk factors for the development of IBS. IBS can occur at any age, but it often begins in the teen years or early adulthood. It is twice as common in women as in men.

The intestine is connected to the brain. Signals go back and forth between the bowel and brain. These signals affect bowel function and symptoms. The nerves can become more active during stress, causing the intestines to be more sensitive and squeeze (contract) more.

A mind-body connection

Recent research is linking psychological factors to physiological functioning in many of these digestive disorders. Indeed, the mind-body component of chronic disease has been receiving attention with the help of people like the Dalai Lama and Jon Kabat-Zinn. Their work on mindfulness-based stress reduction has been incorporated into pain management programs since the early 1980s, and meditation and stress reduction are now becoming standard advice for those with irritable and inflammatory bowel disorders too.

While it is true that conscious awareness plays a role in the reduction of stress and thus the symptoms it provokes, chronic diseases often cannot be alleviated by stress reduction alone. Try as they might, many people simply cannot stop the thoughts, worries, and anxieties that cause their suffering.

What kind of symptoms one with IBS has?

Patients of irritable bowel syndrome form nearly 50% of the cases seen in gastrointestinal clinics all over the world. In a large number of patients the main complaint is incomplete evacuation. Often they learn to go to the toilet for the second time after breakfast or in the evening. Many patients of irritable bowel syndrome are silent sufferers. They do not visit the doctors because they consider these symptoms as part of normal life or related to stress.

Patients complaining of "abdominal pain" as a predominant symptom with or without altered bowel habit may later present with a hepatic flexure syndrome, splenic flexure syndrome, severe spasm of the caecum. They can be easily mistaken to be suffering from cholecystitis, perforated ulcer or appendicitis. So, the patient can land up with the surgeon and a laparotomy may be performed. In that case, morbidity and mortality of laparotomy will be applicable to them. Surprisingly such presentation is much less common in Indians. Some patients may have bloating and abdominal distension especially after fatty meals as the main symptom. In the absence of any bowel complaints, (in our country and in many other parts of the world) these patients are investigated for gall bladder disease and a wrong diagnosis of non-calculus chronic cholecystitis is made and the gall bladder is removed. Thus they are subjected to morbidity and mortality of this major surgery.

Some patients suffer so much that normal life activities are interfered with. For example, one has 5-6 bowel movements early morning before and after breakfast. Such patients are often handicapped by this early morning diarrhoea and cannot reach their office in time. Also the fear of post-lunch-gastrocolic reflex leads to inability to concentrate on their work.

Other patients have the main problem of "time" spent in evacuation. Such people spend as much as half to one hour in the toilet. Not only are they a nuisance to other family members, but often they cannot keep their schedule.. After sitting in the toilet for so long, they get exhausted physically and mentally (specially if they use an Indian toilet).

Some patients develop symptoms of irritability of the other organs. Thus, they can develop irritable oesophagus, irritable rectum and irritable heart syndrome. Irritable oesophagus leads to chest pain, burning and other symptoms of upper abdominal dyspepsia. The irritable rectum can lead to severe urgency of stool or unproductive call to the toilet which becomes a nuisance. Irritable heart patients develop symptoms of palpitations, dyspnoea and cardiac neurosis and often land up with a cardiologist.

Some patients develop a 'stool fixation'. They keep on looking at the contents of the stools passed and worry about the appearance of undigested food-particles, skin of the tomatoes and shape and consistency of the stools and brood over them.

People may even lose weight because they avoid food for fear of the urge to stool after food. However, majority of the patients of irritable bowel syndrome who have learnt to live with the disease have a very good appetite and often are overweight.

How is IBS diagnosed?

A proper medical history is usually sufficient to diagnose irritable bowel syndrome (IBS) in patients and there are no specific tests to diagnose it. However, the physician may ask for certain tests to rule out other conditions that may mimic irritable bowel syndrome (IBS). Some of the investigations that may be performed for this purpose include:

  • Blood tests
  • Stool test
  • Sigmoidoscopy or colonoscopy
  • Computerized tomography scan (CT scan) of abdomen and pelvis
  • Lactose intolerance tests - Tests may be done to find out if you have intolerance to lactose (which is found in milk and milk products)

If the results of these tests do not substantiate diagnosis of any other disease condition, the physician may confirm the diagnosis of irritable bowel syndrome (IBS).

According to Rome criteria for IBS, a patient must have the following symptoms for at least 12 weeks in the previous 12 months; these weeks need not be consecutive:

Abdominal pain which is:

  • Relieved by passage of stools
  • Accompanied by change in frequency of stools at the onset
  • Accompanied by change in consistency of stools at the onset

In addition, the patient must also have two of the following features at least 25% of the times:

  • Altered stool frequency
  • Altered stool form
  • Altered passage of stools (straining, urgency, etc.)
  • Mucus with stools
  • Bloating of abdomen

These criteria are often used by physicians to diagnose IBS.

General measures

Lifestyle changes can help in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms.

Dietary changes can be helpful. However, no specific diet can be recommended for IBS, because the condition differs from one person to another. Those with lactose intolerance should stop milk and milk products which may almost give a new life to them.

The following changes may help:

  • Avoid foods and drinks that stimulate the intestines (such as caffeine, tea, or colas)
  • Avoid large meals
  • Increase fibre in the diet (this may improve constipation but make bloating worse)
  • Probiotic supplements, which contain “friendly” bacteria (as in yogurt and cultured dairy products), known to stabilize the intestinal flora, as well as fish oils rich in omega-3 and omega-6 fatty acids, which are known to decrease inflammation will help many patients.

Can Homoeopathy help and how?

The goal of treatment is to relieve symptoms and prevent recurrence or relapse of the condition. Homeopathy comes to the rescue of patients of IBS since homeopathic treatment is safe, gentle and devoid of side effects. The medication targets the root of the ailment and thus the healing occurs at the level of the altered immunity. It considers both physical and mental makeup, leading to control and relief of the symptoms. There is effective decline in irregular bowel movements, constipation, diarrhoea, abdominal discomfort, and other manifestations. Regular treatment helps in reducing the frequency of attacks gradually so that the person's health is restored back to normalcy.

Unlike conventional medicines for irritable bowel syndrome (IBS) such as purgatives, anti-diarrhoeals, antidepressants, etc., Homeopathy treatment is without side effects. This is because the medicine is targeted at the patient as a whole and not just to his bowels. Thus the treatment is not superficial or simply symptomatic in nature. The treatment also helps in preventing recurrence of the condition with the continued treatment.