- Constipation Remedies
Aloe Vera (Aloe Vera) juice has a gentle, soothing effect on the bowel and is particularly appropriate for people with IBS who have chronic constipation. Take a tablespoon of the commercially extracted juice twice daily.
Other remedies for the constipation of IBS include psyllium seeds. Psyllium is a soluble fiber, similar to oat bran, and has a gentle, bulk-forming effect on the stool. Psyllium has been researched for more than 20 years in the treatment of IBS and many people with constipation find it effective. One reliable trial showed that both psyllium and wheat bran were effective in normalizing stool consistency and frequency in IBS, but that psyllium was better for improving frequency and reducing abdominal distension. However, results of research trials have been inconsistent, and better research is needed.
Dark psyllium seeds often work best stirred into a little warm water as a bulk laxative. Pale psyllium seeds, also known as isphagula seeds, and linseeds are other alternatives (linseed must be crushed to obtain its full effect). A tablespoon a day taken with porridge or natural yoghurt is likely to ease constipation without any side-effects. For these bulk laxatives to work effectively, drink a glass or two of water with them.
The use of anthraquinone-containing stimulant laxatives, such as rhubarb root (Rheum officinale), senna (Senna alexandrina) and cascara (Rhamnus purshiana), is generally to be avoided in the treatment of constipation associated with IBS. These remedies are likely to make it worse in the long term.
- Soothing Herbs
There are several herbs that soothe the bowel. Slippery elm (Ulmus fulva) powder contains an abundance of mucilage (a sticky substance).When mixed with powdered ginger (Zingiber officinale), cinnamon (Cinnamomum cassia) and caraway; it helps to reduce abdominal bloating. Slippery elm powder combines well with cooked porridge oats. Other herbs that soothe an irritated bowel are marshmallow root (Althea officinalis) and fenugreek (Trigonella foenum-graecum).
They work best if combined with pungent warming spices, such as ginger and/or cinnamon, when they can be used to treat both diarrhoea and constipation in people with IBS by helping to restore normal bowel function.
- Herbal Combination Products
Over the counter herbal products for IBS are popular in many countries. A recent randomized controlled trial compared two
herbal combination products, both containing a mixture of several plant extracts, including bitter candytuft (Iberis amara), chamomile and other extracts, with a bitter candytuft extract and a placebo (inactive substance). The patients taking the combination medicines had significantly fewer IBS symptoms than those taking either the bitter candytuft extract or the placebo.
- Other Remedies
A useful remedy for loose stools is arrowroot (Pueraria labata), which can be taken up to three times a day, flavored with a little ground cinnamon or nutmeg. Stir two teaspoons of arrowroot into a paste with water or chamomile tea, or combine it with live yoghurt. Commercially formulated charcoal tablets can also be effective for reducing the swing from loose bowel movements to constipation. It also helps to reduce flatulence too.
Even though insufficient research has been carried out, many people with IBS turn to herbal remedies to ease their symptoms. There are many traditional herbal remedies that can help a great deal in IBS. Since patients tend to react to remedies at a very low dose, it is always a good idea to start any remedy at low doses, gradually increasing the strength as necessary.
- Carminative Herbs
Most important in easing spasms of the gut associated with IBS are so-called carminative (flatulencerelieving) herbs. Teas of mixtures of the following carminative remedies may relieve pain, bloating and flatulence: chamomile (Matricaria recutita), caraway (Carum cari), fennel (Foeniculum vulgare), aniseed (Pimpinella anisum), cardamom (Elletaria cardamomum), peppermint (Mentha piperita), spearmint (Mentha spicata), garden mint (Mentha arvensis), dill (Anethum graveolens), lemon balm (Melissa officinalis), rosemary (Rosemarinus
officinalis) and lovage (Levisticum officinalis).
These remedies combine well with bitter aromatics such as angelica root (Angelica archangelica), tangerine peel (Citrus reticulata) and bitter orange (Citrus aurantium).
The bitter, aromatic combination is particularly calming to the disordered gut.
The carminative herb chamomile also combines well with other relaxing herbs, such as valerian, to relieve IBS aggravated by anxiety. Peppermint oil is the main ingredient in several over-the-counter products for symptoms of IBS. A metaanalysis of five randomised controlled trials of special peppermint oil capsules for IBS suggests that this preparation can be effective in relieving symptoms.
- Herbs to Aid Bile Output
A painful, bloated feeling after eating fatty foods may be due to poor bile output. In stimulating bile production and flow, these remedies enable the body to digest fats. Some herbs have an especially bitter action, which aids digestion.Wormwood (Artemisia absinthium), gentian (Gentiana lutea) and hops (Humulus lupulus) are extremely bitter and are given in small doses. Hops are sedative and relaxing to the bowel in low doses. Other bitter herbs effective for treating IBS include milk thistle (Silibum marianum), dandelion root (Taraxacum officinale) and globe artichoke (Cynara scolymus) leaves.
Artichoke Leaf Extract shows promise in treating IBS as well as dyspepsia (indigestion). It is an ingredient in many over-the-counter remedies for IBS and apparently relieves IBS symptoms in some patients. There have been no randomized controlled trials yet, but researchers at the University of Reading suggest “there is a growing body of evidence which indicates therapeutic properties for artichoke leaf extract”. In their small study, IBS patients had significant reductions in the severity of their symptoms after taking the extract. Both the patients and their doctors felt that it was effective, and 96 per cent of the patients rated the extract as better than or as good as other therapies they had tried.
Clinical guidelines for diagnosis of IBS say the person should have had a total of 12 weeks of unexplained abdominal pain in last 12 months (the 12 weeks do not have to be consecutive). The pain will have two out of three of the following characteristics: it is relieved by defecation; it is related to a change in frequency of stools; it is related to a change in the stools’ appearance.
The doctor will review your symptoms and may refer you for investigations, such as bowel X-rays or endoscopy, to exclude underlying disorders. Often, no medication is needed and the symptoms can be controlled with some lifestyle and dietary changes and relaxation techniques. However, if treatment is needed, there are various options.
- Antidiarrhoeal Drugs and Bulking Agents
Antidiarrhoeal drugs, such as loperamide, may be helpful for people with diarrhea. There is some evidence to support the use of bulking agents, such as ispagula husk, in the treatment of constipation associated with IBS. These drugs act by increasing the bulk of the stool, so stimulating normal contractions in the wall of the gut.
- Antimuscarinics and Antispasmodics
Studies have shown that some antimuscarinics, such as hyoscine butyl bromide, and antispasmodics, such as mebeverine, can help relieve the pain of IBS. These drugs are thought to reduce abnormal contractions in the gut by relaxing the muscles in the wall.
- Keep a food diary to help you identify foods that bring on attacks so you can avoid them.
- Make sure you get some exercise on a regular basis.
- If stress is a factor in your IBS, practice relaxation or meditation daily.
- Take a daily probiotic supplement.
- Try peppermint oil capsules.
- If constipation is a problem, take a gentle bulk-forming laxative regularly, but avoid bran and bran-based laxatives, which can make IBS worse.
- Do not smoke, because smoking irritates the gastrointestinal tract.
There is no disease equivalent to IBS in Traditional Chinese Medicine (TCM). Strategies for treating IBS are to be found in the discussions of treatment of three diseases well known in China: diarrhea, constipation and abdominal pain. The traditional treatment of these diseases allows modern TCM practitioners to discern a number of effective lines of treatment for IBS. TCM doctors will give appropriate dietary advice and, in common with Western doctors, will recommend that eating patterns must be regular. Meals should not be missed or eaten on the run.
There is important research that supports the use of Chinese medicine for IBS. A randomized controlled trial followed 116 patients with the condition. One-third was given capsules of a herbal formulation that was prescribed individually for them, another third were given a standard Chinese herbal mixture, and the final group were given a placebo (inactive substance). Treatment continued for 16 weeks and those who received the Chinese herbal medicines showed significant improvement. The people receiving individualized herbs did not benefit more than those taking the standard Chinese herbal preparations. However, on follow-up 14 weeks after completing treatment, only the group that received individualized treatment had maintained their improvement.
Chinese practitioners diagnose and then prescribe herbs for a variety of conditions. The first is liver Qi (energy) stagnation. The most usual cause of this is emotional disturbance. Long-term resentment, anxiety, worry or depression blocks the flow of liver Qi that in turn disrupts the smooth flow of stomach, spleen and large intestine Qi (digestive Qi), causing bloating, pain, flatulence and diarrhea and/or constipation. In women, there may be accompanying PMS marked by mood swings as well as worsening IBS.
A second common pattern of symptoms is that of deficiency of Spleen and Stomach with stagnation of Qi. In this case the patient is tired, especially after eating, and experiences bloating and dull pain after meals. A third pattern is deficiency of spleen with accumulation of “damp”. People with this syndrome have loose stools and are fatigued. A fourth common pattern is “damp heat” in the large intestine. People with this syndrome may have bloating and abdominal pain and may complain of rather explosive, bad-smelling
Bowel movements that may burn on passing. Lastly, if there is Spleen and Stomach Yin deficiency, the patient may complain of feeling hungry but not being able to eat much, abdominal bloating, dry lips, a dry mouth and irregular bowel movements with difficulty in passing stools.
Studies have shown that many people with IBS have food sensitivities. Wind and other IBS symptoms diminish when these sensitivities are discovered and the offending foods are eliminated from the diet. Clinical experience suggests that wheat is one of the most common food sensitivities in people with IBS, and this is supported by some scientific evidence.
Some people with IBS-like symptoms may not in fact be able to digest the sugars lactose (found in milk) and fructose (found in high concentrations in fruit juice and dried fruit). The artificial sweetener sorbitol (found in diabetic and sugar-free products) can make diarrhea worse. Research shows that in a large majority of IBS patients with lactose malabsorption, a lactose-restricted diet can improve symptoms markedly both in the short term and the long term. Fructose- and sorbitolreduced diets in people with fructose malabsorption reduce gastrointestinal symptoms such as bloating, cramps, diarrhea and other IBS symptoms. People with IBS should consider the possibility that milk, fruit juice, dried fruit and products containing sorbitol might make their IBS symptoms worse.
- Probiotics and Anti-Yeast Diet
An imbalance in the organisms in the gut (gut dysbiosis) is common in people with IBS. One study found reduced numbers of “friendly” bacteria such as lactobacilli and bifid bacteria and higher numbers of harmful bacteria in those with symptoms of IBS. Overgrowth of yeast organisms, such as Candida albicans, also seems very common in people with IBS. Reducing yeast in the gut is often effective in improving IBS symptoms. Probiotics appear to help people who have IBS. Some studies have shown improvements in symptoms of pain and flatulence when people with IBS took supplements.
- Fiber may help in IBS, but it depends on the type of fiber. Most studies find that people with IBS will generally not benefit by adding wheat bran to their diets. In fact, some people feel even worse after taking wheat bran supplements. However, fiber from other sources, such as psyllium (20–30g per day of psyllium seed husk fiber), may alleviate symptoms.
The evidence for the effectiveness of homeopathy in treating IBS is quite strong – two controlled studies in Germany published in the 1970s showed positive results.
However, these looked only at a single homeopathic medicine and, as with homeopathic treatment for many conditions, several medicines may be appropriate. To start with, two pills of all of the medicines discussed below should be taken twice daily in the 6C strength.
- Argentum Nitricum may be indicated when anxiety is associated with IBS. The affected person has a lot of bloating and a craving for sweet food.
- Phosphoric Acid may be indicated, particularly if a person’s symptoms have been triggered by emotional stresses, such as relationship difficulties or bereavement, and are associated with weak memory. Diarrhea is usually a prominent symptom.
- Nux Vomica may be given if there is a frequent urge to pass faces, often without result, as well as irritability and poor sleep.
Irritable bowel syndrome (IBS) describes a combination of intermittent abdominal pain, constipation and/or diarrhea. The condition usually develops in people between the ages of 20 and 30 and is twice as common in women as in men. The symptoms typically persist for many years. Although it can be very distressing, IBS does not lead to serious complications. There is no single treatment for IBS, but a combination of therapies such as drugs, dietary changes, relaxation and herbal preparations may bring relief.
Why does it occur?
The cause of irritable bowel syndrome, which accounts for more referrals to gastroenterologists than any other digestive disorder, is unknown. It is classed as a “functional disorder”, which means that the intestines appear normal but do not function normally. One theory is that it may result from abnormal contractions of the intestinal walls. Another factor may be food sensitivity. In particular, an increased sensitivity to certain foods such as fruit or the artificial sweetener sorbitol may contribute to the condition. IBS sometimes occurs after a gastrointestinal infection and the condition seems to run in families. Stress, anxiety or depression may be associated with IBS and can make it worse. In making a diagnosis of IBS, the doctor may ask whether the pain is relieved by defecation, whether you experience a change in the frequency of passing stools, and whether there is a change in the appearance of the stools. Many doctors will diagnose IBS if two out of three of these features are present.
IBS is not typically associated with pain or diarrhea that interferes with sleep, blood in the stool (either visible or on laboratory examination), weight loss, fever or any physical abnormality. If any of these symptoms is present, you should see your doctor without delay. IBS rarely begins after the age of 40. Any change in bowel habits that happens in middle age should be investigated at once by a doctor.
What are the symptoms?
IBS involves abdominal pain that is relieved by defecation. Related symptoms may include:
- A change in the frequency of stool
- A change in the appearance of the stool
There may also be:
- Fewer than three bowel movements a week or more than three a day
- Hard or lumpy stools
- Loose (watery) stools
- Straining during a bowel movement
- Urgency (having to rush to have a bowel movement)
- A feeling that the bowel has not emptied completely
- Passage of mucus during defecation
- A feeling of fullness and bloating
Why might I have this? Predisposing factors
- Food sensitivities
- Imbalance of organisms in the digestive tract
- Lactose and fructose intolerance
- Sorbitol (an artificial sweetener)
- Trigger-point activity from muscles of the abdomen or back
- Antidiarrhoeal drugs and bulking agents
- Food elimination diet
- Antimuscarinics and antispasmodics
- Probiotics and anti-yeast diet
- Western and Chinese herbal medicine
- Mind–body therapies
- Individualized homeopathy
- Breathing retraining
- Bodywork and movement therapies
Depression is prevalent in IBS patients, as is diminished quality of life. IBS can affect sleep, sexual functioning, business and personal obligations and social life. The condition may be complicated by other conditions, such as Fibromyalgia, chronic fatigue syndrome and thyroid problems. Since there are no definitive diagnostic tests, IBS is a diagnosis of exclusion. Drug treatment is geared toward symptom management, not cure. If you have IBS, you might want to consider mind–body therapies, such as relaxation or hypnosis, since research supporting their use is very positive indeed.
- Psychotherapy and Antidepressants are very effective in patients with severe IBS. A study randomly allocated 257 patients with severe IBS to receive either eight sessions of individual psychotherapy, 20mg daily of the antidepressant paroxetine, or routine care. Patients having either psychotherapy or paroxetine did not feel better psychologically, but reported feeling better physically than those getting routine medical care. During the follow-up year, the patients who had psychotherapy maintained the improvement in that they were less likely to need other medication or to see doctors. The improvement was not maintained in the paroxetine group.
- Relaxation, Biofeedback and Hypnosis
Relaxation and biofeedback have shown success in improving symptoms of IBS and preventing the condition from recurring. One approach using relaxation therapy and medication was effective in two-thirds of patients who had not found relief using medication alone. Another approach using progressive muscle relaxation, thermal biofeedback, cognitive therapy and education had a 50 per cent success rate, and four years later those patients still showed improvement. Hypnosis has been shown to improve IBS symptoms, even in severe cases and in cases where psychotherapy had failed.
- Other Therapies
Mind–body therapies are effective in alleviating depression and improving quality of life. A self-help program that includes meditation and visualization can improve abdominal pain and reduce or eliminate symptoms, so less medication may be needed.
The spinal nerves that govern digestive function can either speed up or slow down the organs of digestion. The sympathetic nerves that emerge from the spine roughly between the shoulder blades, down to the low back, slow down digestive functions, while the parasympathetic nerves, which emerge from the very top and very bottom of the spine, restore digestive function to normal, or speed it up. Another branch of the nervous system exists in the abdomen itself, and this contains almost as many nerve cells as are found in the spine itself.
Mechanical stress resulting from spinal restrictions, or from trigger points in the muscles of the back or abdomen, can influence these “slowing down” or “speeding up” processes. Since IBS may involve a speeding up of the activities of the bowel (diarrhea) and sometimes a slowing down (constipation), either branch of the nervous system might be involved.
- Chiropractic and Osteopathy
There have been no reliable clinical trials of chiropractic and osteopathic treatments for IBS. Clinical experience however suggests they can be useful. A case report illustrates the possible benefit of spinal treatment. The patient was a 25-year-old woman with a history of five years of diarrhea, abdominal pain and cramping. On examination her spine was found to have a number of areas of marked restriction, in the neck, middle and lower back. She reported sustained improvement after chiropractic treatment that mobilized the restrictions in the spine. If you have IBS, a chiropractor or osteopath should be able to tell you whether spinal restrictions are contributing to your condition, and should also be able to treat them if they are.
- Deactivation of Trigger Points
Trigger points are sensitive areas in muscles that usually cause pain or discomfort, not only where they are situated but also in areas some distance away. Those in the spinal or the abdominal muscles can cause symptoms in the intestinal tract itself. Research conducted nearly 50 years ago and confirmed by recent evidence shows that trigger points in the lower abdomen can cause or encourage diarrhea, one of the common symptoms of IBS. Trigger points can be deactivated by acupuncture as well as by manual pressure and stretching techniques as used by osteopaths, massage therapists (particularly those with neuromuscular therapy training) and some physiotherapists and chiropractors.
- Breathing Retraining
IBS and Fibromyalgia co-exist in many patients. Studies have shown that patients with IBS may also have significantly more tender points in muscles than normal. Some experts suspect that the link between IBS and Fibromyalgia might be a breathing-rate disorder, such as hyperventilation. A common side-effect of rapid upper-chest breathing is elimination of too much carbon dioxide from the body. This can cause your bloodstream to become too alkaline (a condition known as respiratory alkalosis), making the smooth muscle layer around the digestive tract contract. Sluggish or interrupted digestion may result, which can lead to constipation. Breathing-pattern disorders, such as a tendency to breathe using only the upper chest, can usually be improved or corrected with breathing rehabilitation, which involves learning slow, diaphragmatic (yoga-type) breathing methods. Osteopathic correction of restrictions that may have developed in overused and stressed muscles and joints can also help.