IBS (Irritable Bowel Syndrome) and Ayurveda:

IBS and Ayurveda:

Etymology:
IRRITABLE – abnormally sensitive to stimuli BOWEL – intestine SYNDROME – symptom complex
IBS is conceptualized as a ‘cluster of bowel syndrome’ in which bowel is irritable or hypersensitive to emotional, mechanical or chemical stimuli, most of from all emotions.

Synonyms:
Spastic colitis, Irritable colon syndrome, Nervous diarrhoea, Mucus colitis, Colon neurosis;
Grahani, Pravahika (in Ayurveda)
Etiological factors:

• Unwholesome food (Heavy, Coarse food)
• Irregular eating habits
• Suppression of natural urges
• Sexual abuse
• Mental Stress (in 70 to 90% of Patients)
• Both anxiety & depression can impact on the perception of symptoms
• Post infection

Clinical Features:
“The abdomen is the sounding board of the emotion” and more than any other system reflects disturbances in the emotional sphere. Hence it is that from mouth to anus occur a variety of symptoms included within the digestion, “functional disorders of the gastrointestinal tract”.
a) Abdominal pain:
Abdominal pain in IBS is highly variable in intensity and location. Pain may be mild enough to be ignored or it may interfere with daily activities. Pain is variously described as vague, bloating, crampy, burning, dull, aching, knife like sharp or steady pain. It may be mild, moderate or severe and localized or diffuse. Pain is often exacerbated by eating or emotional stress and relieved by passage of flatus or stool.
b) Altered Bowel Habits:
Alteration in bowel habits is the most consistent clinical feature in IBS. Symptoms usually begin in adult life. Only a small number have lifelong bowel irregularity.
In the constipation predominant group: At first, constipation may be episodic but eventually it becomes continuous and increasingly intractable to treatment with laxatives. Stools are usually hard with narrow calibre (described as pencil thin or ribbon like), possibly reflecting excessive dehydration caused by prolonged colonic retention and spasm. Most patients also experience a sense of incomplete evacuation, thus leading to repeated attempts at defecation in a short time span. Patients whose predominant symptom is constipation may have weeks or months of constipation interrupted with brief periods of diarrhoea.
In the diarrhoea predominant group: Diarrhoea resulting from IBS usually consists of small volumes of loose stools, and most patients have stool volumes of <200 ml. Evacuation is often preceded by extreme urgency or tenesmus, occurring typically in the morning or after meals. Diarrhoea may be aggravated by emotional stress or eating.
c) Gas and Flatulence:
Patients with IBS frequently complain of abdominal distension and increased belching or flatulence, all of which they attribute to increased gas.
d) Mucus with stool:
Stool may be accompanied by passage of large amounts of mucus, but this mucus is just an exaggeration of normal; hence the term mucous colitis has been used to describe IBS. This is a misnomer, since inflammation is not present.
e) Upper Gastrointestinal Symptoms:
Between 25-50% patients with IBS complain of dyspepsia, heartburn, nausea, and vomiting. This suggests that areas of the gut other than the colon may be involved. Some patients of IBS have been wrongly diagnosed to be having an acute attack of appendicitis and even surgery has been performed on them. It is because of this varied presentation that the word “Syndrome” has been affixed to this disease entity.
f) Extra-intestinal symptoms:
Dysmenorrhoea is noted in as many as 90% of patients with IBS, urinary frequency in 65% and dyspareunia in 33%. Migraine is also very commonly associated. This shows that IBS is possibly associated with autonomic disturbance as well. (CMJ Vol. X No.1 April 2004)
g) Psychological features and stress:
Symptoms of IBS appear after or during period of stress and emotional tension. Patients with IBS report increased frequency of stressful life experiences. The particular vulnerability of intestine (rather than skin, bronchi or vascular systems) to stressful conflicts may originate during early life as a result of visceral responses that are learnt through social reinforcement (secondary gain). Alternatively, patients with IBS may have an inherited or otherwise abnormal myoelectric and motor abnormality.

Recommended Laboratory Tests for IBS:
Because IBS is in part a diagnosis of exclusion, certain diagnostic test should be performed routinely; others may be required depending on the specific presenting symptoms.

A) Recommended for all patients:

• Haematology (TLC, DLC, ESR): Anaemia, inflammation.
• Stool for occult blood : Any cause of GI bleeding
• Flexible sigmoidoscopy : Obstruction
• Lactose : Lactose intolerance test

B) Recommended when indicated by history:

• Stool (microbiology) : Amoebiasis, Clostridium difficile
• Anal canal pressure or EMG : Pelvic floor muscle dyssynergia
• Endoscopy : Peptic ulcer disease
• Glucose breath test : Bacterial overgrowth syndrome
• Small bowel X-Rays : Inflammation bowel disease
• Colonoscopy : Right colonic disease

Ayurvedic treatment for IBS (Irritable bowel syndrome):
Counselling and assurance: Psychic treatment is not simply diverting the mind from incompatible objects and thoughts along with this include assurance and replacement of emotions. Physician should try and explain the disease pathogenesis and allay the patient’s fear. It should be explained to the patient that this disease is a long lasting one and sometimes has relapses and recurrences. Recurrences will occur depending upon the stressful situations. It also must be explained that this disease will not in any way reduce the life span of the patient. By and large, a caring and reassuring psychological support which aims at identifying stressful precipitating factors will suffice. The psychiatric support generally, is not required.
Diet:
One should follow the ‘Ayurvedic life-style’ including Ayurvedic dietetics described on the home page of this website. Ayurvedic dietetics is also described in the miscellaneous/uncategorized  category.
The IBS patient should avoid the milk and all other dairy products except buttermilk and goat milk. He should also avoid irregular diet habits and the food articles which are cold, heavy for digest. One should consume the boiled water all the time with Ayurvedic herbs ‘Sunthi/Dry ginger (Zinziber officinale)’ and ‘Musta (Cyprus rotundus)’ which has anti-spasmodic effect and it also improves digestion and give relief in constipation as well as in mucus mixed with stool.
Excellent Ayurvedic formulations for treatment of IBS:

• Aam-paachak kwath (Decoction prepared with Ayurvedic herbs of Haritaki, Sunthi and Mustak)
• Vaishwanar Churna( Powder made with Ayurvedic herbs Haritaki, Sunthi, Ajamoda and Sandhav)
• Syrup Mustarishta (which has natural alcohol of around 4-7%)
• Tab. Shatyadi vati
• Tab. Diarex (Himalaya drug company)
• Tab. Indrayavadi vati