Irritable bowel syndrome(IBS) is functional bowel disorder in which abdominal pain is associated with defeacation or change in bowel habit.
Aetiology- IBS shows wide range of symptoms and a single cause is unlikely. It is generally believed that most of patients develope symptoms in response to psychological factors , altered gastrointestinal motility, altered visceral sensation or luminal factors.
a) Psychological factors- About 50% of patients of IBS shows psychological symptoms such as anxiety, depression, neurosis and panic attacks. These causes are known to alter visceral perception and gastrointestinal motility in IBS.
b) Altered gastrointestinal motility- These include diarrhoea or constipation patients. Diarrhoea as predominant symptom exhibits clusters of rapid jejunal contraction waves and increased number of fast and propagated colonic contractions. Those who are predominantly constipated have decreased orocaecal transit and reduced number of colonic contraction waves.
c) Abnormal visceral sensation or visceral hypersensitivity- IBS is assoaciated with increase in sensitivity to intestinal distention due to altered CNS processing of visceral sensation.
d) Luminal factors- It includes gastroenteritis, intolerance to specific diatary components (e.g. lactose, wheat, caffiene etc.) and abnormalities of gut microflora leading to increased fermentation and gases production .
Clinical features of IBS
1.Recurrent abdominal pain(usually colicky or cramping) which is felt in lower abdomen and relieved by defeacation.
2. Abdominal distention.
3. Altered bowel habit i.e. alternate diarrhoea and constipation.
4. Passage of mucus through stool.
5. Feeling of incomplete defecation.
Management: The most important step is to make a positive diagnosis and reassuarance the patient. Reassurance is first and main treatment of IBS. Next step in management is to treat the predominant symptoms . Next step in management is use of tricyclic antidepressants e.g. Amitryptilene (Tryptomer). Exclusion of substances such as lactose, wheat, caffiene, legumes and artificial sweeteners such as sorbitol from diet also help to relieve from IBS.
IBS- Ayurvedic view
IBS is one of the most common encountered in clinical practice but one of the least understood . IBS is psychosomatic disease condition where motility of intestines is disturbed , altered bowel habit, lower abdominal pain, distention which is relieved by defeacation.
There is no detectable organic pathology in this disease . These symptoms are markedly influenced by psychological factors and stressful life style. Psychic factors involves Kama(desire), Krodha(Anger), Bhaya(fear),Shoka(grief), Irshya(envy) etc.
Though it is difficult to have correlation between IBS and any perticular disease in Ayurveda, but many diseases described in Ayurveda resembles symptoms commonly found in IBS. A careful review of clinical pictures of various Annavah strotas vyadhis desribed in Ayurvrda , reveals that some of the disorders definitely have some clinical symptoms observed in patients of IBS. e.g. Vataja and kaphaja Atisar, sangrahani, Pravahika, Pakvashayagata vat etc.
Differential diagnosis of IBS according to Ayurveda
1. Atisar- patients of vataja atisar passes stool in little quantity, sound, pain and froth, cutting pain in anus or increased frequency of watery stool with associated mucus. All this signs and symptoms of vataj atisar are characteristics of IBS. Incomplete evacuation which is sign described in kaphaja atisar is typical of IBS. But main point of difference is that IBS is of chronic nature while Atisar is of acute onset.
2. pravahika- In pravahika tenesmus during defeacation , increased frequency of small amount of faeces, mucus are partially resembling clinical features of IBS.
3. Sangrahani- The signs and symptoms of Sangrahani are similar to pravahika. Sangrahani is chronic in nature and difficult to cure. It is characterised by aggravation of all symptoms during day time and subsides during night which is almost similar to IBS. But little differance between both is that, in Sangrahani , site of disease is at Grahani(Duodenum ) while IBS is disorder of gastrointestinal tract.
4. pakwashayagat vat- Vitiated vat dosha is located in large intestine producing gargling sound in intestine, colic , difficulty in passing urine and stool , hardness in bowel. It has quite similarity but IBS is disorder of GI tract having wide spectrun of symptoms.
Ayurvedic management of IBS
IBS is most frustating and less understood psychosomatic disorder. So while treating IBS by Ayurvedic treatment , the medicines with Dipana, Pachana, Grahi, vedanasthapan, krimighna properties can be used. (e.g. kutaj avaleha, parpati kalpa etc. ) but after considering the psychological factors , it is necessary to use the medhya dravyas along with above medicines.
We have seen that IBS patients have psychological disturbance and stress results in hypervigilance to body sensation at CNS level and visceral hypersensitivity to gut level. So if Medhya dravyas are used it will help to break this aetiology. As per Ayurvedic texts, Majjadhara kala means pittadhara kala . Hence it will helps to prove our conclusion that use of Medhya dravyas along with dipana, pachana, grahi drvyas will give bettet result in IBS. (In modern medicine, antidepressant drugs and reassurance therapy is used.) There is great scope for further literary and clinical research in IBS.
1. Davidson's principles and practise of medicine.
2. Charak samhita.
3. Sushrut sanhita.