Scientific Management of IBS – Irritable Bowel Syndrome

Abstract

IBS (Irritable bowel syndrome) is a common disorder that affects the large intestine. The main function of the gastrointestinal tract and its other organs include digestion and the absorption of food. The waste products are thrown out from the large intestine. Excretion is the main function of the gut to keep our body clean and detoxified. In ayurveda when the doshas are disturbed the whole chain of absorption and excretion is distubured leading to hyperactivity and under activity of the gut. Today’s faulty habits, sedentary lifestyles and stress aggravates the gastrointestinal diseases. In this article we are going to discuss its causes, signs, symptoms and its management to live a healthy lifestyle.

INTRODUCTION

IBS (irritable bowel syndrome) is one of the most common gastrointestinal diseases. People with IBS have bloating, excessive gas, abdominal pain, and cramps. IBS is a functional gastrointestinal disorder which works as a gut brain interaction. These problems cause the digestive tract to be very sensitive and changes bowel muscles resulting in constipation, diarrhea, abdominal pain. IBS can be seen in childhood, adolescence, and adulthood which reoccur at any age. IBS is a mixture of discomfort or pain and has trouble with bowel habits and having different types of stools. So oftenly known as IBS colitis, Spastic colitis, Mucous colitis. IBS is not a life threatening condition but can be a long lasting problem which changes the life of every individual. Disorders such as anxiety, depression, and chronic fatigue syndrome cause IBS.

FACTS

1. Worldwide it is estimated that 5-10% of the population has IBS.
2. Most people with IBS are under 50 years of age
3. The exact cause of IBS is not known but this is the disturbance in gut, brain, nervous system interaction which changes the normal bowel movement.
4. Stress doesn’t cause IBS but the brain gut interaction triggers the symptoms.
5. Symptoms vary and are contradictory so IBS is unpredictable.

ETIOPATHOGENESIS

The pathophysiology of IBS is broad and it includes Visceral sensation, Brain gut interaction, psychological distress. Environmental contributors which affect IBS include food intolerance, antibiotics and enteric infections.  

1. In Autoimmune Disease

In autoimmune disease the immune system gets attacked and harms the body’s tissues. These disorders involve gastrointestinal manifestations which are influenced by a wide variety of diseases such as oral ulcers, constipation, diarrhea, abdominal pain, fecal incontinence, gastrointestinal bleeding. Gastrointestinal complications are a major cause of mortality and sometimes morbidity if not treated at the proper time.

2. In Psychosomatic Disease

The most common mental ailment in people with IBS is generalized anxiety disorder. Strong emotions like stress, anxiety, depression directly triggers the chemicals in the brain that turn on the signals in the gut and cause the colon to react. In psychological disorders it is associated with sporadic IBS (moment of onset).  

3. Infections

When a patient follows an exposure to acute gastroenteritis known as post-infectious IBS which denotes abdominal discomfort, diarrhea. Features of infectious illness such as bloody and mucous stools, abdominal cramps, weight loss. If diarrhea is increased and lasts for 1 week then IBS correlates with the severity of acute enteric infections. The GI tract is supplied by the enteric nervous system; it helps in blood flow regulation, food and nutrient handling.

TYPES OF IBS

• IBS -D is when the digestive system contracts quickly, transmitting the products of digestion through the digestive tract which further result in watery stools.
• IBS-C is when the digestive system contracts and slowly delays the time in digestion, resulting in hard and difficult to pass stool infrequently.
• IBS-M here is the mixture of diarrhea and constipation on the same day.

CAUSES

Physical Causes

1. Irregular meal time
2. Excess consumption of water
3. Over fasting
4. Excess intake of heavy food which is hard to digest
5. Lack of proper hygiene
6. Irregular and sedentary lifestyle
7. Regular intake of spices, oily and preserved food.

Mental Causes

Feeling of stress, fear, sorrow, grief and anxiety

1. Dysmotility– Problems with GI muscles contract and move the food.
2. Brain gut dysfunction- miscommunication between nerves in brain and gut.
3. Visceral hypersensitivity (extra sensitive nerves in the GI tract).

SYMPTOMS

1. Abdominal pain usually in the lower half of abdomen
2. Excess gas
3. Mucus in poop
4.  Feeling of incomplete evacuation (tenesmus)
5. Bloating
6. Swelling in abdomen
7. Urgency
8. Rectal bleeding (side effect of irritable bowel syndrome which causes a tear in anus which can be caused by hemorrhoids).
9. Weight loss
10. Fever
11. Vomiting
12. Anemia
13. Headache
14. Fibromyalgia
15. ⅓ of patient suffer from sexual dysunction (libido)

RISK FACTORS

1. Stress– It is indicated that psychological stress may trigger IBS in individuals. The stress response in the body involves the hypothalamic pituitary adrenal axis which operates abnormally in people with IBS.
2. Bacteria – SIBO (small intestine bacterial overgrowth) occur greatly in patients with IBS. Symptoms of SIBO include bloating, abdominal pain, and constipation.
3. Vitamin D – Is a common deficiency in individuals who suffer from IBS. Vitamin D triggers IBS including gut microbiome, inflammatory process, and immune response.
4. Females– IBS is most common in women as estrogen therapy before or after menopause cause IBS.

DIFFERENTIAL DIAGNOSIS

1. Colon cancer
2. Inflammatory bowel disease
3. Thyroid disorder
4. Giardiasis
5. Bile acid malabsorption

DIAGNOSIS

1. Medical history
2. Physical examination

Investigating Tests

1. Infections
2. Lactose intolerance/ Food allergies
3. Stool test
4. Breath test for bacterial overgrowth

TREATMENT

1. Avoid caffeine
2. Add fiber to your diet (whole grains, fruits, vegetables)
3. Dont smoke
4. Limit intake of cheese and milk
5. Triggers – (citrus food, carbonated drinks, cabbage, wheat)
6. Get enough sleep
7. Exercise regularly
8. Eat high fiber diet

Some Products Must be Eliminated from Diet

1. High gas food- Food such as carbonated drinks, alcohol which causes gas must be avoided.
2. Gluten- Food such as wheat, barley, rye must be stopped as they are rich in gluten.
3. FODMAPs- This must be excluded from diet as certain grains, fruits, dairy products must be excluded from diet as many patients are sensitive to carbohydrates such as fructose, lactose.

MEDICATIONS

1. If a patient suffers from depression then he must be prescribed antidepressant medications.
2. Probiotics- They are living organisms (bacteria and yeasts) which are introduced to the human gut.
3. Antispasmodics- It controls the muscle spasms
4. Constipation – IBS has the main problem of constipation and to prevent it certain drugs are- Linaclotide, Tegaserod,.
5. Diarrhea- For diarrhea drugs are alosetron, loperamide.

COMPLICATION

1. Impacted bowel- if a patient is constipated for a long time then stool gets blocked in the colon so it is so hard to pull out so known as fecal impaction.
2. Food intolerance- Some foods such as wheat, dairy, coffee, eggs and fats, and sugars worsen the diarrhea. So the patient must have a low fodmap diet.
3. Malnourishment
4. Haemorrhoids- Swollen blood vessels around anus from where stool comes out can be hurt and bleed.
5. Quality of life- Sometimes some symptoms flare up any time.
6. Pregnancy complication- Hormonal changes and physical pressure put the baby on bowel wall can cause digestive issues.

AYURVEDIC MANAGEMENT

IBS (Irritable bowel syndrome) is a functional disorder of the intestine which is characterized by abdominal pain, altered bowel movement. In ayurveda this is correlated with grahani. Vata, Pitta, Kapha are functional components of the system involved in carrying out the functions of the gastrointestinal tract. When these doshas are hindered up it causes hyperactivity or underactivity and damages the digestive tract. When pachaka pitta is weak there is indigestion and there is no desire for food. Kledaka kapha moistens the food and makes it easy for digestion. Samana vata which is located in the stomach with pachaka pitta digests the food properly. Useful components are absorbed in the small intestine and put into circulation by the action of pachaka pitta so excretions are propelled from the colon by samana vata. But when samana vata is affected, it hinders the digestion so the intestine fails to perform normal functions (such as receiving food from the stomach, digestion, separation of nutritious food and waste products, pushing off remnants in the intestine ) hence grahani is caused.

CAUSES

1. Due to excessive fasting
2. Heavy food intake
3. Dry and junk food
4. Improper virechana
5. Improper snehan
6. Long term chronic illness causes lowered digestion strength.
7. Anger
8. Grief
9. Fear

PRODROMAL FEATURES

1. Nausea
2. Burning sensation
3. Vomiting
4. Bloating
5. Excessive thirst
6. Giddiness
7. Gurgling sound in stomach
8. Distended abdomen
9. Delayed digestion

FEATURES ON THE BASIS OF DOSHAS

1. Vataja grahani- Abdominal pain, increased frequency in stool, Chest pain, flatus, headache.
2. Pittaja grahani- Burning of chest, belching.
3. Kaphaja grahani– Stool with mucus, heaviness in abdomen, incomplete evacuation of bowel movement.
4. Sannipatja grahani- All doshas are involved, lack of concentration, severe debility, mucus in stool, headache, flatus. This stage is known as Samgrahani.

TREATMENT

1. Deepana – Carminative property
2. Pachana-  Digestive property
3. Sangrahi- Intestine restorative
4. Laghu- Lightness

CERTAIN HERBS USED IN THE MANAGEMENT OF IBS (Irritable bowel syndrome)-

1. Yashad

Yashad bhasma is an ayurvedic medicine prepared from zinc. It is very helpful in treatment of eye disorders, diabetes, anaemia and asthma. It is astringent, pungent in nature so very effective in vataja grahani, epilepsy, tremors, and non healing wounds. This herb balances kapha and pitta dosha.Used orally and helps in boosting up immunity.

2. Abhrak

Abhrak bhasma in ayurvedic preparation prepared from mica. Abhrak bhasma is used as a rejuvenating agent so helpful in treating brain, neuropsychiatric disorders. Aphrodisiac is so useful in both males and female infertility treatment. Its anti-inflammatory property soo prevents the growth of H.pylori bacteria to grow in the gut and prevent constipation.

3. Tamra

Tamra is ayurvedic preparation from copper used in many skin diseases, piles, and obesity. Used in the treatment of pitta and kapha doshas, it has scraping quality so it can treat high cholesterol levels. Tamra is useful in grahani, liver, spleen disorders, and uterine fibroids. Patients who are suffering from abdominal distension along with acidic tamra bhasma are useful.

4. Gandhak

Gandhak rasayan is ayurvedic powder or tablet preparation used in the treatment of skin disease, chronic fever, and urinary tract disorder. Helpful in malabsorption syndrome (IBS which leads to severe weight loss and ulcerative colitis), atisara, blood vitiated disorder such as abscess. Is useful in itching, relieves gray hair and improves fertility in men and women and in certain toxic conditions.

5. Shankh

Is an ayurvedic medicine prepared from conch shells. Useful in treatment of gastritis, abdominal pain, malabsorption syndrome and provides natural calcium and vitamin C for the development of healthy bones and teeth. It decreases body heat and relieves the burning sensation. It balances vata and pitta doshas.

6. Pippali

Pippali rasayan is used for anti-aging and widely used to treat respiratory conditions. It improves metabolism and balances vata and kapha dosha. Pippali rasayan is helpful in grahani dosha (sprue syndrome), anemia, piles, and hoarseness of voice. Pippali has rejuvenating properties that promote voice, cures splenic disorders and obstinate abdomen disease, and restores youth.

7. Ativisha

Ativisha (Aconitum heterophyllum) herb is used in children. Has katu (pungent), tikta (bitter) taste, and hot veerya to relieve toxicity. It balances kapha and pitta dosha and relieves aam. Very useful drug in piles, dystenry, and acts as an aphrodisiac. Ativisha detoxifies breast milk, cures impotence, and blood vitiated disorders.

MANAGEMENT ON THE BASIS OF ETIOPATHOGENESIS

1. Antidepressant Drugs

1. Jyotishmati
2. Akarkara
3. Vacha
4. Gandira (eleva tablet)
5. Kapikachhu ghan tablet
6. Ashwagandha
7. Shilajatu
8. Yashad (Higro tablet)

2. Antibacterial Drugs

1. Chirayata ghan tablet
2. Ativisha ghan tablet
3. Chirayata, ativisha, gandhak, yashad (infexie table)
4. Ativisha, panchamrit parpati, shankh, pippali (entrid tablet)
5. Manjistha (ghan tab)
6. Sariva (ghan tab)
7. Nimba (ghan tab)
8. Guduchi (ghan tab)
9. Guggulu (ghan tab)
10. Gandhak tablet
11. Bhallataka, chitrak guggul (Revplaq tablet).

3. Use Immunomodulatory Drugs

1. Ashwagandha (ghan tab)
2. Bhallataka (ghan tab)
3. Guduchi (ghan tablet)
4. Madhuyashti (ghan tab)
5. Ashwagandha, guduchi, tulsi, pippali, yashad (Imunie tab)
6. Suvarna, ashwagandha, guduchi, tulsi, pippali, yashad (Imunie gold tab)
7. Bhumi amalaki (Phylocil tab)

4. Use Anti-inflammatory Drugs

1. Shallaki (ghan tab)
2. Guggul (ghan tab)
3. Erandmula (ghan tab)
4. Shallaki, Erandmula, Jatiphal (Loswel tab).
5. Rasna (ghan vati)
6. Parijat ( ghan tab)
7. Nirgundi (ghan tab)
8. Madhuyashti (ghan tab)
9. Bhallataka, chitrak, guggul (Revplaq tab)   

CONCLUSION

IBS (Irritable bowel syndrome) Is a common disorder that affects the large intestine. IBS can be seen in childhood, adolescence, and adulthood which recur at any age. Symptoms vary and are contradictory so IBS is unpredictable. In ayurveda this is correlated with grahani. When samana vata is affected it hinders the digestion so the intestine fails to perform normal function (as receiving food from stomach, digestion, separation of nutritive food and waste products, pushing of remnants in intestine ) hence grahani is caused. Management of this disease is discussed for a healthy well being of an individual;