IRRITABLE BOWEL SYNDROME:
INTRODUCTION:
Irritable bowel syndrome(IBS) is a gastrointestinal disorder characterized by altered bowel habits and abdominal pain in the absence of detectable structural abnormalities
Irritable bowel syndrome, is a problem that affects mainly the bowel, which is also called the large intestine. The bowel is the part of the digestive system that makes and stores stool. The word syndrome means a group of symptoms. IBS is a syndrome because it can cause several symptoms. For example, IBS causes cramping, bloating, gas, diarrhea, and constipation.
IBS is not a disease. It’s a functional disorder, which means that the bowel doesn’t work as it should. With IBS, the nerves and muscles in the bowel are extra-sensitive.
EPIDEMIOLOGY:
IBS can be painful. But it does not damage the bowel or cause any other diseases.
The IBS accounts for an estimated $8 billion in direct medical costs.
Approximately 15 % of U.S. adults report symptoms that are consistent with the diagnosis of IBS
Women: Men= 3:1
IBS is the most common diagnosis made by gastroenterologists in the U.S.
Only 25 percent of persons with this condition seek medical care for it
Those who seek care are more likely to have behavioral and psychiatric problems than are those who do not.
Pts with IBD at inc. risk for other, nongastrointestinal functional disorders such as fibromyalgia and interstitial cystitis.
CAUSES OF IBS:
Researchers have yet to discover any specific cause for IBS. One theory is that people who suffer from IBS have a colon (large bowel) that is particularly sensitive and reactive to certain foods and stress. The immune system, which fights infection, may also be involved.
Normal motility, or movement, may not be present in a colon of a person who has IBS. It can be spasmodic or can even stop working temporarily.
The lining of the colon, which is affected by the immune and nervous systems, regulates the flow of fluids in and out of the colon. In IBS, the epithelium appears to work properly. However, when the contents inside the colon move too quickly, the colon looses its ability to absorb fluids. The result is too much fluid in the stool. In other people, the movement inside the colon is too slow, which causes extra fluid to be absorbed. As a result, a person develops constipation.
A person’s colon may respond strongly to stimuli such as certain foods or stress that would not bother most people.
Pathophysiological Features:
1. Altered Bowel Motility
2. Visceral Hypersensitivity
3. Psychosocial Factors
4. Neurotransmitter Imbalance
5. Infection and Inflammation
Visceral Hypersensitivity:
Balloon-distention studies of the rectosigmoid and the ileum have shown that patients with IBS experience pain and bloating at balloon volumes and pressures that are significantly lower than those that induce pain in control subjects.
An explanation is that the sensitivity of receptors in the viscus is altered through the recruitment of silent nociceptors in response to ischemia, distention, intraluminal contents, infection, or psychiatric factors.
Psychosocial Factors:
The presence or absence of a history of abuse in childhood (sexual, physical, or both) is correlated with the severity of symptoms in patients with IBS.
It has even been proposed that experiences early in life may affect the CNS and confer a predisposition to a state of hypervigilance.
Neurotransmitter Imbalance:
5% percent of serotonin is located in the CNS, and the remaining 95% is in the GI tract.
Evidence suggests that patients with the irritable bowel syndrome have increased serotonin levels in plasma and in the rectosigmoid colon.
Infection and Inflammation:
Mucosal inflammatory cytokines may activate peripheral sensitization or hypermotility.
It has been reported that in patients with infectious enteritis, the presence of hypochondriasis and stressful life events at the time of the acute infection predicted the subsequent development of IBS.
SO WHICH ONE?????
To date, no single conceptual model can explain all cases of the syndrome.
What are the symptoms of IBS?
Disorder of young people before age 45
Abdominal pain:
- variable in intensity & location
- episodic and crampy
- location – 25% hypogastrum
- 20% right side
- 20% left side
-10% epigastrium
- < eating, emotional stress
- > passage of flatus or stool.
Altered bowel habits:
- most consistent feature of IBS
- constipation or diarrhea or
alternate diarrhea & constipation
The most common pattern is constipation alternating with diarrhea.
Usually with one of these symptoms predominating
Constipation:
- 1st episodic gradually becomes continuous &
intractable to treatment of laxative.
- Stool hard with narrow caliber.
- Sense of incomplete evacuation.
Diarrhea:
- Loose stool, volume < 200ml.
- No nocturnal diarrhea
- < emotional stress, eating
- May accompanied by passage of mucous.
Gas or flatulence:
-Although some patients with these symptoms actually may have a larger amount of gas, quantitative measurements reveal that most patients who complain of increased gas generate no more than a normal amount of intestinal gas.
Upper Gastrointestinal symptom:
Prevalent in 25%- 50% of cases
-Dyspepsia
-Heartburn
-Nausea & Vomiting
In people with IBS in hospital OPD.
25% have depression.
25% have anxiety.
Patients with IBS symptoms who do not consult doctors [population surveys] have identical psychological health to general population.
In one study 70% of women IBS sufferers have dyspareunia.
Stressful life events are associated.
Compared with controls people with IBS are less well educated and have poorer general health.
DIGNOSIS:
ROME II SYMPTOM CRITERIA FOR IBS At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two out of three features: 1) Relieved with defecation; and/or 2) Onset associated with a change in frequency of stool; and/or 3) Onset associated with a change in form (appearance) of stool. Other symptoms that are not essential but support the diagnosis of IBS:
Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week);
Abnormal stool form (lumpy/hard or loose/watery stool);
Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation);
Passage of mucus;
Bloating or feeling of abdominal distension.
Manning’s criteria for diagnosis of IBS:
Pain eased after bowel movement
Looser stools at onset of pain
More frequent bowel movements at onset of pain
Abdominal distension
Mucus per rectum
Feeling of incomplete emptying
Categories of IBS:
According to the predominant symptom:
1. Abdominal pain
2. Diarrhea
3. Constipation
4. Constipation alternating with diarrhea
TREATMENT:
Patients’ concerns.
Explanation.
Treatment approaches.
Patients’ Concerns:
Usually very concerned about a serious cause for their symptoms.
Take time to explore the patients agenda.
Remember that investigations may heighten anxiety.
Must offer a plausible reason for symptoms.
Even if cause is unknown, patients require some explanation.
Drawing a parallel with baby colic may help.
Stress is currently a socially acceptable explanation for many symptoms in life.
DIET:
High-fiber/low-fat diet
If you have constipation, a high-fiber diet can help. Try to eat 20 to 35 grams of fiber each day. Use food labels to tell how many grams of fiber are in foods you eat.
Low-fiber/low-residue diet
During a flare-up of IBS, a low-fiber/low-residue diet can help control diarrhea. Certain foods produce loose stools. You should avoid these if diarrhea is a problem. Sometimes changing the number of meals you eat, choosing different foods, and adjusting food temperature can help relieve diarrhea. All of these suggestions may not work for everyone. If there is something you haven’t tried, test it to see if it helps you.
Important points to keep in mind:
• The foods that have the most fiber are grains (especially bran), whole-grain breads and cereals, fruits, and vegetables.
• Foods high in soluble fibers (like oats, peas, and beans) have been shown to ease both constipation and diarrhea.
Read food labels. Look for breads and cereals that list whole-grain or whole-wheat first.
• Put more fiber in meat dishes by adding pinto beans, kidney beans, black-eyed peas, bran, or oatmeal. Look for cooked and ready-to-eat cereals with at least 5 grams of fiber per serving.
• Drink plenty of fluids — at least 8 cups per day. Water is best, but fruit juice and decaf drinks also are fine.
• Add more fiber to your diet a little at a time. Too much fiber added quickly may cause gas, cramping, bloating, or diarrhea. Be sure to increase your fluid intake at the same time.
• Pay attention to when your symptoms occur. If you can relate these times with certain foods, avoid those foods. Keeping a food diary is sometimes helpful.
• Eat smaller, more frequent meals — for instance 4 or 5 small meals instead of 3 large meals.
• A multi-vitamin and mineral supplement with 100 percent of the U.S. recommended daily intake (RDI) may be helpful. Check with your doctor or dietitian.
• Ask your doctor if a fiber supplement can help you. • Eat more slowly — take the time to enjoy your food.
• Avoid foods and drinks that have caffeine and alcohol. They may cause diarrhea.
PHYSCOTHERAPHY:
Relaxation training teaches ways to relax the body and mind.
Cognitive Behavioral Therapy (CBT) incorporates a number of steps aimed at changing behavior to improve health and coping. It often includes information to ensure a better understanding of the illness, as well as teaching techniques to change thought patterns by challenging automatic, distressing and self-defeating thoughts that can trigger gut reactions. CBT also typically includes relaxation training.
Hypnotherapy uses mental imagery to specifically reduce gut sensations and foster a state of calmness.
Brief Dynamic Therapy focuses on significant personal relationships. In therapy, the individual is helped to identify and deal with challenging interpersonal situations and interpersonal stressors.
TREATMENT APPROACH:
Placebo effect of up to 70% in all IBS treatments.
Treatment should depend on symptom sub-type.
Often considerable overlap between sub-groups.
HOMEOPATHIC TREATMENT:
Irritable Bowel Syndrome (IBS) medically do not pose much problem to the health of an individual, nevertheless, it can have significant impact on individual's social, personal, and professional life.
As the precise cause of this malady is not known, conventional medicine fails to offer definite cure to this condition.
The homoeopathy medicine works at the deeper level, bringing the deviations of harmony among various systems of body back to normalcy. The homeopathic medicine establishes a good communication between the brain and the gut thus ensuring proper relay of signals.
The positive outcome of this is that the motility of intestines becomes regular and rhythmic thus relieving complaints of either diarrhea or constipation or both.
Moreover, homoeopathy improves the pain threshold of an individual thus alleviating symptoms of pain and cramps associated with IBS.
The two factors that are triggering causes of IBS are emotional stress and exaggerated sensitivity to food items.
Homoeopathy has very well perceived the influences of psyche on the physique of an individual. Homeopathy medicines positively influences the emotions and thinking of an individual so that the person can cope with stress optimistically. Homoeopathy medicines have proven efficacy to manage mental stress and its offshoots like IBS.
Moreover homoeopathy medicines aid in minimizing food sensitivities and allergies.
While making the case analysis of IBS, patient’s most minute details about the presenting complaints are noted carefully, as regard to the severity of diarrhea, constipation, complaints regarding abdominal pain, cramps, presence of mucus in the stools, associated complaints like nausea, heartburns, distention, triggering factors, findings of laboratory studies, etc.
Besides, a grater deal of emphasis is given to patient’s individual features such as eating habits, food preference, thermal attributes, and sleep pattern. The study of the patient's mind and emotional spheres is conducted meaningfully. Furthermore, patient’s history of past diseases and that of the family diseases is understood to know the miasmatic background of the patient.
BASED ON ;
SUB-TYPES/ PREDOMINANT FEATURES
PAST HISTORY
FAMILY HISTORY
OCCUPATION
ARGENTUM NITRICUM:
In this drug the neurotic effects are very marked,
Symptoms of inco-ordination,
Loss of control and want of balance everywhere, mentally and physically.
Desire for sweet and salt
Upper abdominal affections brought on by undue mental exertion.
Diarrhoea, chronic, resulting from emotional disturbances.
Diarrhoea from anticipation.
CARCINOCIN:
Family history of cancer, diabetes, tuberculosis.
Excessive parental control, prolonged fear or
unhappiness.
Is worse or better at the seaside
History of suppression and abuse in childhood.
Too much responsibility at a young age.
NUXVOMICA:
Abdominal pains and bowel problems accompanied by tension, constricting sensations, chilliness, and irritability.
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.
Craves strong spicy foods, alcohol, tobacco, coffee, and other stimulants—and usually feels worse from having them.
LYCOPODIUM:
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.
Things are typically worse between 4p.m. to 8 p.m.
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
NATRUM CARBONICUM:
Mild people who have trouble digesting and assimilating many foods and have to stay on restricted diets.
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.
Cravings for potatoes and for sweets.
Oversensitive to heat; must be shaded while walking in sun.
Cold body in winter, hot head in summer.
ASAFOETIDA:
A feeling of constriction all along the digestive tract strongly indicates this remedy.
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.
Person may exhibit a strong emotional or “hysterical” element when this remedy is needed.
LILIUM TIGRINUM:
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.
Likely to be worse from excitement and strong emotions, and may tend toward irritability or even rage.
COLOCYNTHIS:
When cutting pains and cramping occur, making the person bend double or need to lie down and press on the abdomen.
Pain < eating or drinking least amount.
Problems tend to be aggravated by emotions, especially if indignation or anger has been felt but not expressed.
PODOPHYLLUM:
PODOPHYLLUM
Pain in abdominal 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.
< In the very early morning, and the person may feel weak and faint or have a headache afterward.
TROMBODIUM:
TROMBODIUM
Diarrhoea after eating and drinking; from fruit; from sugar. Stools only after eating; stools return after dinner and supper, but not after breakfast.
Symptoms < eating or drinking; 9the grand keynote
GELSEMIUM
Diarrhoea from emotional excitement, fright, bad news [Ph-ac.]; disposition to go to stool whenever anything startles her.
Acts specifically on nerves and muscles of rectum.
General prostration. Dizziness, drowsiness, dullness, with trembling
DYSENTRICO
Anticipatory nervous tension
Hypersensitive to criticism
Selective action on the pylorus causing spasm & retention of digestive content.
GAMBOGIA
Soon after eating irresistible desire to evacuate bowels, which continued as long as there was anything to pass.
Diarrhoea alternate with constipation.
Great relief after stool
MOMORDICA BALSAMINA
Griping, colic, pain in back and hypogastrium
Accumulation of flatus in splenic flexure of colon
GRATIOLA
Acts especially on gastrointestinal tract. Chronic catarrhal conditions.
Useful in mental troubles from overweening pride.
Especially useful in females. Nux vomica symptoms in females
Combination of sexual excesses and gastrointestinal problems.
EASY PRESCRIPTION:
H/o.Induced abortion or MTP --- Kali.carb
H/o.Septic fever after delivery --- Pyrogen
In drainage cleaners/ workers --- Pyrogen
Lactogen intolerance in childhood --- Aethusa
H/o. Artificial feeding --- Alumina
Staying in newly painted house --- Plumb.met
Use of Uterine devices(IUCD, etc) ---- Silicea
Turpentine oil ( wood polishers) ---- Terebinth
H/o.Dog bite --- Ledum.pal
H/o. Anti-Rabies Vaccine --- Lyssin
Sand filling --- Silicea
H/o. Forceps Delivery --- Allium.cepa
Tailoring --- Actea Racemosa
Diggers, Cutters & Coblers --- Bovista
Brick & Pot Makers --- Alumina
Police, Army, Excise,Forest Dept. --- Lachesis
Use of Hair dyes --- Alumina
H/o. Dental Cleaning --- Staphysagria
OCCUPATION:
Anasthesia – Acetic acid.,Phos.,
Cosmetics- Bovista.
Fire works ,Match industry -- Phosphorus
Rubber tyres etc --Sulphur
Thermometer, barometer --Mercury
Stone cutter – Silicea.
Coal mines – Nat. c.
Welder – Glonoine.
Tobacco –Tabacum.
Painter/printing – Plumbum.Alumina
FAMILY HISTORY:
Cancer - Carcinosin
Tuberculosis - Tuberculinum
Eczema - Psorinum
Gonorrhoea - Medorrhinum
Patients suffering from IBS presents themselves with several psychosomatic symptoms and other constitutional disturbances apart from local symptoms of GIT.
We have to treat the patients with two groups of remedies
the drugs which can relive the acute suffering
&
the group of remedies to eradicate the tendency of constitutional / psychosomatic symptoms.
Most of the patients of IBS are highly intellectual , either always brooding over the past or unusually suffer from anticipatory anxiety with fixed ideas.
Most of them are highly emotionally imbalanced , irritable, impulsive and conflicting in nature and suffer from bowel symptoms with very little variation in errors of diet.
Irritable bowel syndrome(IBS) is a gastrointestinal disorder characterized by altered bowel habits and abdominal pain in the absence of detectable structural abnormalities
Irritable bowel syndrome, is a problem that affects mainly the bowel, which is also called the large intestine. The bowel is the part of the digestive system that makes and stores stool. The word syndrome means a group of symptoms. IBS is a syndrome because it can cause several symptoms. For example, IBS causes cramping, bloating, gas, diarrhea, and constipation.
IBS is not a disease. It’s a functional disorder, which means that the bowel doesn’t work as it should. With IBS, the nerves and muscles in the bowel are extra-sensitive.
EPIDEMIOLOGY:
IBS can be painful. But it does not damage the bowel or cause any other diseases.
The IBS accounts for an estimated $8 billion in direct medical costs.
Approximately 15 % of U.S. adults report symptoms that are consistent with the diagnosis of IBS
Women: Men= 3:1
IBS is the most common diagnosis made by gastroenterologists in the U.S.
Only 25 percent of persons with this condition seek medical care for it
Those who seek care are more likely to have behavioral and psychiatric problems than are those who do not.
Pts with IBD at inc. risk for other, nongastrointestinal functional disorders such as fibromyalgia and interstitial cystitis.
CAUSES OF IBS:
Researchers have yet to discover any specific cause for IBS. One theory is that people who suffer from IBS have a colon (large bowel) that is particularly sensitive and reactive to certain foods and stress. The immune system, which fights infection, may also be involved.
Normal motility, or movement, may not be present in a colon of a person who has IBS. It can be spasmodic or can even stop working temporarily.
The lining of the colon, which is affected by the immune and nervous systems, regulates the flow of fluids in and out of the colon. In IBS, the epithelium appears to work properly. However, when the contents inside the colon move too quickly, the colon looses its ability to absorb fluids. The result is too much fluid in the stool. In other people, the movement inside the colon is too slow, which causes extra fluid to be absorbed. As a result, a person develops constipation.
A person’s colon may respond strongly to stimuli such as certain foods or stress that would not bother most people.
Pathophysiological Features:
1. Altered Bowel Motility
2. Visceral Hypersensitivity
3. Psychosocial Factors
4. Neurotransmitter Imbalance
5. Infection and Inflammation
Visceral Hypersensitivity:
Balloon-distention studies of the rectosigmoid and the ileum have shown that patients with IBS experience pain and bloating at balloon volumes and pressures that are significantly lower than those that induce pain in control subjects.
An explanation is that the sensitivity of receptors in the viscus is altered through the recruitment of silent nociceptors in response to ischemia, distention, intraluminal contents, infection, or psychiatric factors.
Psychosocial Factors:
The presence or absence of a history of abuse in childhood (sexual, physical, or both) is correlated with the severity of symptoms in patients with IBS.
It has even been proposed that experiences early in life may affect the CNS and confer a predisposition to a state of hypervigilance.
Neurotransmitter Imbalance:
5% percent of serotonin is located in the CNS, and the remaining 95% is in the GI tract.
Evidence suggests that patients with the irritable bowel syndrome have increased serotonin levels in plasma and in the rectosigmoid colon.
Infection and Inflammation:
Mucosal inflammatory cytokines may activate peripheral sensitization or hypermotility.
It has been reported that in patients with infectious enteritis, the presence of hypochondriasis and stressful life events at the time of the acute infection predicted the subsequent development of IBS.
SO WHICH ONE?????
To date, no single conceptual model can explain all cases of the syndrome.
What are the symptoms of IBS?
Disorder of young people before age 45
Abdominal pain:
- variable in intensity & location
- episodic and crampy
- location – 25% hypogastrum
- 20% right side
- 20% left side
-10% epigastrium
- < eating, emotional stress
- > passage of flatus or stool.
Altered bowel habits:
- most consistent feature of IBS
- constipation or diarrhea or
alternate diarrhea & constipation
The most common pattern is constipation alternating with diarrhea.
Usually with one of these symptoms predominating
Constipation:
- 1st episodic gradually becomes continuous &
intractable to treatment of laxative.
- Stool hard with narrow caliber.
- Sense of incomplete evacuation.
Diarrhea:
- Loose stool, volume < 200ml.
- No nocturnal diarrhea
- < emotional stress, eating
- May accompanied by passage of mucous.
Gas or flatulence:
-Although some patients with these symptoms actually may have a larger amount of gas, quantitative measurements reveal that most patients who complain of increased gas generate no more than a normal amount of intestinal gas.
Upper Gastrointestinal symptom:
Prevalent in 25%- 50% of cases
-Dyspepsia
-Heartburn
-Nausea & Vomiting
In people with IBS in hospital OPD.
25% have depression.
25% have anxiety.
Patients with IBS symptoms who do not consult doctors [population surveys] have identical psychological health to general population.
In one study 70% of women IBS sufferers have dyspareunia.
Stressful life events are associated.
Compared with controls people with IBS are less well educated and have poorer general health.
DIGNOSIS:
ROME II SYMPTOM CRITERIA FOR IBS At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two out of three features: 1) Relieved with defecation; and/or 2) Onset associated with a change in frequency of stool; and/or 3) Onset associated with a change in form (appearance) of stool. Other symptoms that are not essential but support the diagnosis of IBS:
Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week);
Abnormal stool form (lumpy/hard or loose/watery stool);
Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation);
Passage of mucus;
Bloating or feeling of abdominal distension.
Manning’s criteria for diagnosis of IBS:
Pain eased after bowel movement
Looser stools at onset of pain
More frequent bowel movements at onset of pain
Abdominal distension
Mucus per rectum
Feeling of incomplete emptying
Categories of IBS:
According to the predominant symptom:
1. Abdominal pain
2. Diarrhea
3. Constipation
4. Constipation alternating with diarrhea
TREATMENT:
Patients’ concerns.
Explanation.
Treatment approaches.
Patients’ Concerns:
Usually very concerned about a serious cause for their symptoms.
Take time to explore the patients agenda.
Remember that investigations may heighten anxiety.
Must offer a plausible reason for symptoms.
Even if cause is unknown, patients require some explanation.
Drawing a parallel with baby colic may help.
Stress is currently a socially acceptable explanation for many symptoms in life.
DIET:
High-fiber/low-fat diet
If you have constipation, a high-fiber diet can help. Try to eat 20 to 35 grams of fiber each day. Use food labels to tell how many grams of fiber are in foods you eat.
Low-fiber/low-residue diet
During a flare-up of IBS, a low-fiber/low-residue diet can help control diarrhea. Certain foods produce loose stools. You should avoid these if diarrhea is a problem. Sometimes changing the number of meals you eat, choosing different foods, and adjusting food temperature can help relieve diarrhea. All of these suggestions may not work for everyone. If there is something you haven’t tried, test it to see if it helps you.
Important points to keep in mind:
• The foods that have the most fiber are grains (especially bran), whole-grain breads and cereals, fruits, and vegetables.
• Foods high in soluble fibers (like oats, peas, and beans) have been shown to ease both constipation and diarrhea.
Read food labels. Look for breads and cereals that list whole-grain or whole-wheat first.
• Put more fiber in meat dishes by adding pinto beans, kidney beans, black-eyed peas, bran, or oatmeal. Look for cooked and ready-to-eat cereals with at least 5 grams of fiber per serving.
• Drink plenty of fluids — at least 8 cups per day. Water is best, but fruit juice and decaf drinks also are fine.
• Add more fiber to your diet a little at a time. Too much fiber added quickly may cause gas, cramping, bloating, or diarrhea. Be sure to increase your fluid intake at the same time.
• Pay attention to when your symptoms occur. If you can relate these times with certain foods, avoid those foods. Keeping a food diary is sometimes helpful.
• Eat smaller, more frequent meals — for instance 4 or 5 small meals instead of 3 large meals.
• A multi-vitamin and mineral supplement with 100 percent of the U.S. recommended daily intake (RDI) may be helpful. Check with your doctor or dietitian.
• Ask your doctor if a fiber supplement can help you. • Eat more slowly — take the time to enjoy your food.
• Avoid foods and drinks that have caffeine and alcohol. They may cause diarrhea.
PHYSCOTHERAPHY:
Relaxation training teaches ways to relax the body and mind.
Cognitive Behavioral Therapy (CBT) incorporates a number of steps aimed at changing behavior to improve health and coping. It often includes information to ensure a better understanding of the illness, as well as teaching techniques to change thought patterns by challenging automatic, distressing and self-defeating thoughts that can trigger gut reactions. CBT also typically includes relaxation training.
Hypnotherapy uses mental imagery to specifically reduce gut sensations and foster a state of calmness.
Brief Dynamic Therapy focuses on significant personal relationships. In therapy, the individual is helped to identify and deal with challenging interpersonal situations and interpersonal stressors.
TREATMENT APPROACH:
Placebo effect of up to 70% in all IBS treatments.
Treatment should depend on symptom sub-type.
Often considerable overlap between sub-groups.
HOMEOPATHIC TREATMENT:
Irritable Bowel Syndrome (IBS) medically do not pose much problem to the health of an individual, nevertheless, it can have significant impact on individual's social, personal, and professional life.
As the precise cause of this malady is not known, conventional medicine fails to offer definite cure to this condition.
The homoeopathy medicine works at the deeper level, bringing the deviations of harmony among various systems of body back to normalcy. The homeopathic medicine establishes a good communication between the brain and the gut thus ensuring proper relay of signals.
The positive outcome of this is that the motility of intestines becomes regular and rhythmic thus relieving complaints of either diarrhea or constipation or both.
Moreover, homoeopathy improves the pain threshold of an individual thus alleviating symptoms of pain and cramps associated with IBS.
The two factors that are triggering causes of IBS are emotional stress and exaggerated sensitivity to food items.
Homoeopathy has very well perceived the influences of psyche on the physique of an individual. Homeopathy medicines positively influences the emotions and thinking of an individual so that the person can cope with stress optimistically. Homoeopathy medicines have proven efficacy to manage mental stress and its offshoots like IBS.
Moreover homoeopathy medicines aid in minimizing food sensitivities and allergies.
While making the case analysis of IBS, patient’s most minute details about the presenting complaints are noted carefully, as regard to the severity of diarrhea, constipation, complaints regarding abdominal pain, cramps, presence of mucus in the stools, associated complaints like nausea, heartburns, distention, triggering factors, findings of laboratory studies, etc.
Besides, a grater deal of emphasis is given to patient’s individual features such as eating habits, food preference, thermal attributes, and sleep pattern. The study of the patient's mind and emotional spheres is conducted meaningfully. Furthermore, patient’s history of past diseases and that of the family diseases is understood to know the miasmatic background of the patient.
BASED ON ;
SUB-TYPES/ PREDOMINANT FEATURES
PAST HISTORY
FAMILY HISTORY
OCCUPATION
ARGENTUM NITRICUM:
In this drug the neurotic effects are very marked,
Symptoms of inco-ordination,
Loss of control and want of balance everywhere, mentally and physically.
Desire for sweet and salt
Upper abdominal affections brought on by undue mental exertion.
Diarrhoea, chronic, resulting from emotional disturbances.
Diarrhoea from anticipation.
CARCINOCIN:
Family history of cancer, diabetes, tuberculosis.
Excessive parental control, prolonged fear or
unhappiness.
Is worse or better at the seaside
History of suppression and abuse in childhood.
Too much responsibility at a young age.
NUXVOMICA:
Abdominal pains and bowel problems accompanied by tension, constricting sensations, chilliness, and irritability.
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.
Craves strong spicy foods, alcohol, tobacco, coffee, and other stimulants—and usually feels worse from having them.
LYCOPODIUM:
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.
Things are typically worse between 4p.m. to 8 p.m.
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
NATRUM CARBONICUM:
Mild people who have trouble digesting and assimilating many foods and have to stay on restricted diets.
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.
Cravings for potatoes and for sweets.
Oversensitive to heat; must be shaded while walking in sun.
Cold body in winter, hot head in summer.
ASAFOETIDA:
A feeling of constriction all along the digestive tract strongly indicates this remedy.
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.
Person may exhibit a strong emotional or “hysterical” element when this remedy is needed.
LILIUM TIGRINUM:
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.
Likely to be worse from excitement and strong emotions, and may tend toward irritability or even rage.
COLOCYNTHIS:
When cutting pains and cramping occur, making the person bend double or need to lie down and press on the abdomen.
Pain < eating or drinking least amount.
Problems tend to be aggravated by emotions, especially if indignation or anger has been felt but not expressed.
PODOPHYLLUM:
PODOPHYLLUM
Pain in abdominal 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.
< In the very early morning, and the person may feel weak and faint or have a headache afterward.
TROMBODIUM:
TROMBODIUM
Diarrhoea after eating and drinking; from fruit; from sugar. Stools only after eating; stools return after dinner and supper, but not after breakfast.
Symptoms < eating or drinking; 9the grand keynote
GELSEMIUM
Diarrhoea from emotional excitement, fright, bad news [Ph-ac.]; disposition to go to stool whenever anything startles her.
Acts specifically on nerves and muscles of rectum.
General prostration. Dizziness, drowsiness, dullness, with trembling
DYSENTRICO
Anticipatory nervous tension
Hypersensitive to criticism
Selective action on the pylorus causing spasm & retention of digestive content.
GAMBOGIA
Soon after eating irresistible desire to evacuate bowels, which continued as long as there was anything to pass.
Diarrhoea alternate with constipation.
Great relief after stool
MOMORDICA BALSAMINA
Griping, colic, pain in back and hypogastrium
Accumulation of flatus in splenic flexure of colon
GRATIOLA
Acts especially on gastrointestinal tract. Chronic catarrhal conditions.
Useful in mental troubles from overweening pride.
Especially useful in females. Nux vomica symptoms in females
Combination of sexual excesses and gastrointestinal problems.
EASY PRESCRIPTION:
H/o.Induced abortion or MTP --- Kali.carb
H/o.Septic fever after delivery --- Pyrogen
In drainage cleaners/ workers --- Pyrogen
Lactogen intolerance in childhood --- Aethusa
H/o. Artificial feeding --- Alumina
Staying in newly painted house --- Plumb.met
Use of Uterine devices(IUCD, etc) ---- Silicea
Turpentine oil ( wood polishers) ---- Terebinth
H/o.Dog bite --- Ledum.pal
H/o. Anti-Rabies Vaccine --- Lyssin
Sand filling --- Silicea
H/o. Forceps Delivery --- Allium.cepa
Tailoring --- Actea Racemosa
Diggers, Cutters & Coblers --- Bovista
Brick & Pot Makers --- Alumina
Police, Army, Excise,Forest Dept. --- Lachesis
Use of Hair dyes --- Alumina
H/o. Dental Cleaning --- Staphysagria
OCCUPATION:
Anasthesia – Acetic acid.,Phos.,
Cosmetics- Bovista.
Fire works ,Match industry -- Phosphorus
Rubber tyres etc --Sulphur
Thermometer, barometer --Mercury
Stone cutter – Silicea.
Coal mines – Nat. c.
Welder – Glonoine.
Tobacco –Tabacum.
Painter/printing – Plumbum.Alumina
FAMILY HISTORY:
Cancer - Carcinosin
Tuberculosis - Tuberculinum
Eczema - Psorinum
Gonorrhoea - Medorrhinum
Patients suffering from IBS presents themselves with several psychosomatic symptoms and other constitutional disturbances apart from local symptoms of GIT.
We have to treat the patients with two groups of remedies
the drugs which can relive the acute suffering
&
the group of remedies to eradicate the tendency of constitutional / psychosomatic symptoms.
Most of the patients of IBS are highly intellectual , either always brooding over the past or unusually suffer from anticipatory anxiety with fixed ideas.
Most of them are highly emotionally imbalanced , irritable, impulsive and conflicting in nature and suffer from bowel symptoms with very little variation in errors of diet.
Comments
Post a Comment
PLEASE WRITE YOUR SYMPTOMS HERE TO GET SUGGESTION.