Gut feelings got you down? Try Homeopathy in IBS

Dr Purvang Gajjar

CASE DEFINITION
Irritable bowel syndrome (IBS) is a chronic functional bowel disorder in which abdominal pain or discomfort is associated with defecation and or change in bowel habits often in the absence of detectable structural abnormalities. Bloating, distension and,disordered defecation are the commonly associated features.

INCIDENCE / PREVALENCE
Depending on the diagnostic criteria employed, IBS affects around 11% of the population globally. Around 30% of people who experience the symptoms of IBS will consult physicians for their IBS symptoms.

IBS affect 10-20% population of western countries with female predominance whereas inIndia, 4.2 -7.9% population is affected by IBS with male predominance . IBS is more common in the younger age group.

AETIOLOGY

The aetiology of IBS is uncertain and likely multifactorial. There are several mechanisms which are responsible for IBS:

1. Visceral hypersensitivity – Visceral hypersensitivity is responsible for pain in the abdomen in IBS which occurs due to hypersensitivity of peripheral and CNS due to inlammatory or non-inlammatory agents.
2. Abnormal gut motility – Gut motility is regulated by sympathetic & parasympathetic nerves through serotonin mediator. Mental stress, anxiety, or other psychiatric illnesses (panic disorder, depression etc.) affect the sympathetic system & serotonin levels which leads to abnormality in gut motility.
3. Small intestinal bacterial overgrowth (SIBO) – About 84% of patients with IBS are found to have small intestinal bacterial overgrowth. In India, SIBO is acommon cause of IBS.
4. Psychosocial factor – Patients with a history of physical or sexual abuse, loss, or separation during childhood & conlicts in interpersonal relationships are at increased risk of IBS.
5. Genetic factor – Studies suggest that 33% of patients with IBS have a positive family history.
6. Food allergy or intolerance – Certain foods (like chocolate, spice, fat, milk, alcohol, cabbage,beans etc.) lead to a hypersensitivity reaction in the body & mast cell degranulation and thus trigger IBS.

CLASSIFICATION

Rome III criteria divide irritable bowel syndrome (IBS) based on predominant stool pattern as

1. Diarrhea predominant IBS (IBS- D) : Loose stool >25% of the time and hard stool<25% of the time. One-thirdof cases have this type of IBS. This condition is more common in males.
2. Constipation predominant IBS (IBS-C) : Hard stools >25% of the time and loose stool <25% of the time. One-thirdof cases have this type of IBS. This condition is more common in females.
3. Mixed IBS (IBS-M): Hard or lumpy stool with at least 25%, and loose or watery stool with at least 25% of bowel movements.
4. Un-subtyped IBS: Insuf icient abnormality of stool consistency to meet criteria for IBS-C, D, or -M.

DIAGNOSIS

Diagnosis of IBS is mostly done based on clinical history.

Clinical presentation

Common symptoms of IBS which help to diagnosis are:

• Abdominal pain, alternate diarrhea and constipation.
• Abdominal distension, relief of abdominal symptoms with bowel motions, increased frequency of stool, sense of incomplete evacuation.
• Pencil thin stool, heart burn, bloating, back pain, weakness, faintness, palpitation.

DIAGNOSIS CASCADE

INVESTIGATION

• Full blood count, ESR, C – reactive protein
• Stool test for occult blood, ova & parasite
• Serum biochemistry, Thyroid function tests
• Colonoscopy, biopsy
• Liver Function Tests
• Abdominal ultrasound
• Endoscopy
• Faecal inlammation marker

EVALUATION AND ASSESSMENT

• Functional bowel disorder severity index
• IBS-QOL questionnaire.

RED FLAGS

• Unintended weight loss
• Persistent or progressive pain
• Rectal bleeding
• High-grade fever
• Abdominal /rectal masses
• Raised inlammatory markers
• Nocturnal or large volume (>300ml/day) diarrhoea.

MANAGEMENT

General management

• Dietary management
• Consumption of a balanced diet
• Avoid foods which trigger the disease condition like fat diet, fad diet, cabbage, beans, and legumes.
• Maintain regular meal timings
• Include a ibre-rich diet & bulking agents like psyllium iber as it relieves constipation. Fibre content must be increased slowly to reduce bloating & latulence
• Exclusion of milk products from the diet if lactose & fructose intolerance is elicited
• Intake of suficient fluid daily.
• Lifestyle and Psychological management.
• Inquiry into stressful factors & their resolution
• Advice for exercise, yoga, and meditation practices on daily basis. Advice to the patient about cognitive behaviour therapy, psychodynamic interpersonal therapy, and relaxation training to reduce stress if required.
• Regularity in sleep pattern and meal timings.

Homoeopathic management

Homoeopathic research studies on IBS have shown positive treatment implications. There are many medicines available in the homoeopathic literature which can be selected based on the presenting totality of each case for treatment of this syndrome. Synthesis repertory enlists around 584 medicines under the rubric – “diarrhoea”, 434 medicines under the rubric“constipation”, 121 remedies for “alternate constipation & diarrhoea” and around 7 medicines for “stool ameliorate the pain”. A few important remedies which can be used in the treatment of IBS include. Antimonium crudum: indigestion after a huge meal along with alternate constipation and diarrhoea. Staphysagria: IBS caused by suppressed anger. Arsenicum album: intolerable abdominal pain with diarrhoea, restlessness & excessive thirst in sips. Aloe socotrina: IBS with abdominal pain, gas formation, diarrhoea and want of confidence in sphincter ani. Carbo vegetabilis: flatulent colic, distended abdomen when simplest food disagrees & eructations give temporary relief.

Argentum Nitricum:

• Urgent diarrhea triggered by anxiety or anticipation.
• Bloating, flatulence, and cramping relieved by passing stool or gas.
• Emotional stress or anticipatory fear worsening symptoms.
• Cravings for sweets, which may aggravate the condition.

Cinchona officinalis:

• Bloating and excessive gas with a feeling of fullness, even after small meals.
• Weakness and exhaustion, often linked to diarrhea or fluid loss.
• Sensitivity to touch, smells, and noises.

Lycopodium clavatum:

• Bloating, especially in the lower abdomen, worsened by eating.
• Excessive gas, with rumbling in the abdomen.
• Constipation alternating with diarrhea.
• Symptoms worse in the late afternoon or evening.
• Cravings for sweets and warm drinks, with an aversion to cold food.
• Emotional triggers like anxiety, irritability, or low confidence.

Nux vomica:

• Frequent urge to pass stool but incomplete evacuation.
• Bloating, cramping, and alternating constipation and diarrhea.
• Triggers: overeating, alcohol, spicy food, or stress.
• Emotional signs: irritability and impatience.

Pulsatilla nigricans:

• Indigestion, bloating, or diarrhea after fatty or rich foods.
• Symptoms change frequently and worsen in the evening.
• Relief from open air and gentle motion.
• Emotional sensitivity, mood swings, or a need for reassurance.

Sulphur:

• Persistent diarrhea with urgency and a feeling of incomplete evacuation.
• Bloating, indigestion, and discomfort after eating, especially spicy or rich foods.
• Strong body odor and a tendency to feel warm or flushed.
• Itching or burning sensations, especially around the anus.

Reference

1. World Gastroenterology Organization Global guideline. Irritable bowel syndrome: a global perspective [Internet]. 2009 [cited 2015 Mar. 12]. Available from http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/20_irritable_bowel_syndrome.pdf
2. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014; 6: 71–80.
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7. Talley NJ. Functional Gastrointestinal disorders: Irritable Bowel Syndrome, Dyspepsia and non-cardiac chest pain. In Goldman L, Ausiello D.  Cecil Medicine, 23rd edition, vol. I, New Delhi; Elsevier: pg. 990-942006;130(5):1480–91.
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10. Allen HC. Allen’s Keynotes- Rearranged and classi ied with leading remedies of the Materia Medica and bowel nosodes. 10th Reprint edition. Jan 2006.
11. 11.Boericke W. Boericke’s New Manual of Homoeopathic Materia Medica with Repertory: Third Revised & Augmented Edition based on Ninth Edition. New Delhi: B. Jain Publishers; 2010.

Dr Purvang Gajjar
PG Scholar, Department of Organon of Medicine
Rajkot Homoeopathic Medical College