IRRITABLE BOWEL SYNDROME (IBS)

STRESS INDUCED DIGESTIVE DISORDER - AN APPROACH TO IRRITABLE BOWEL SYNDROME (IBS)

   

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by mild to severe abdominal pain, discomfort, bloating and alteration of bowel habits. In some cases, the symptoms are relieved by bowel movements. Diarrhoea or constipation may predominate, or they may alternate.

IBS is diagnosed when a person has abdominal pain or discomfort at least three times per month for the last 3 months without other disease or injury that could explain the pain. The pain or discomfort of IBS may occur with a change in stool frequency or consistency or may be relieved by a bowel movement.

CAUSES:

The causes of IBS are not well understood. Researchers believe a combination of physical and mental health problems can lead to IBS. The possible causes of IBS include the following:

·         Brain-gut signal problems - Signals between the brain and nerves of the small and large intestines, also called the gut, control how the intestines work. Problems with brain-gut signals may cause IBS symptoms, such as changes in bowel habits and pain or discomfort.

·         GI motor problems: Normal motility, or movement, may not be present in the colon of a person who has IBS. Slow motility can lead to constipation and fast motility can lead to diarrhea. Spasms, or sudden strong muscle contractions that come and go, can cause abdominal pain. Some people with IBS also experience hyperreactivity, which is an excessive increase in contractions of the bowel in response to stress or eating.

·         Mental health problems: Mental health, or psychological, problems such as panic disorder, anxiety, depression, and post-traumatic stress disorder are common in people with IBS. The link between these disorders and development of IBS is unclear. GI disorders, including IBS, are often found in people who have reported past physical or sexual abuse. Researchers believe people who have been abused tend to express psychological stress through physical symptoms.

·         Bacterial gastroenteritis: Some people who have bacterial gastroenteritis—an infection or irritation of the stomach and intestines caused by bacteria—develop IBS. Researchers do not know why gastroenteritis leads to IBS in some people and not others, though psychological problems and abnormalities of the lining of the GI tract may be factors.

·         Small intestinal bacterial overgrowth (SIBO): Normally, few bacteria live in the small intestine. SIBO is an increase in the number of bacteria or a change in the type of bacteria in the small intestine. These bacteria can produce excess gas and may also cause diarrhea and weight loss. However, the studies were weak and more research is needed to show a link between SIBO and IBS.

·         Body chemicals: People with IBS have altered levels of neurotransmitters, which are chemicals in the body that transmit nerve signals, and GI hormones, though the role these chemicals play in developing IBS is unclear.

·         Food sensitivity: Many people with IBS report that certain foods and beverages can cause symptoms, such as foods rich in carbohydrates, spicy or fatty foods, coffee, and alcohol. However, people with food sensitivity typically do not have clinical signs of food allergy. Researchers have proposed that symptoms may result from poor absorption of sugars or bile acids, which help break down fats and get rid of wastes in the body.

·         IBS can occur at any age, but it often begins in the teen years or early adulthood. It is twice as common in women as in men.

STRESS AND IBS :

Stress can stimulate colon spasms in people with IBS. The colon has many nerves that connect it to the brain. These nerves control the normal contractions of the colon and cause abdominal discomfort at stressful times. In people with IBS, the colon can be overly responsive to even slight conflict or stress. Stress makes the mind more aware of the sensations that arise in the colon. IBS symptoms can also increase a person’s stress level. Some options for managing stress include

·         participating in stress reduction and relaxation therapies such as meditation

·         getting counseling and support

·         taking part in regular exercise such as walking or yoga

·         minimizing stressful life situations as much as possible

·         getting enough sleep

SYMPTOMS

Symptoms range from mild to severe. Most people have mild symptoms. Symptoms are different from person to person.

The main symptoms of IBS are abdominal pain, fullness, gas, and bloating that have been present for at least 3 days a month for the last 3 months. The pain and other symptoms will often:

·         Be reduced or go away after a bowel movement

·         Occur when there is a change in how often you have bowel movements

People with IBS may switch between constipation and diarrhea, or mostly have one or the other.

·         People with diarrhea will have frequent, loose, watery stools. They will often have an urgent need to have a bowel movement, which may be hard to control.

·         Those with constipation will have a hard time passing stool, as well as fewer bowel movements. They will often need to strain and will feel cramps with a bowel movement. Often, they do not release any stool, or only a small amount.

·         For some people, the symptoms may get worse for a few weeks or a month, and then decrease for a while. For other people, symptoms are present most of the time.

·         People with IBS may also lose their appetite.

TESTS:

There is no test to diagnose IBS, simple physical examinations and complete medical history is enough. The medical history will include questions about symptoms, family history of GI disorders, recent infections, medications, and stressful events related to the onset of symptoms.

Additional diagnostic tests may be needed based on the results of the screening blood test and for people who also have signs such as fever, rectal bleeding, weight loss, anemia, family history of colon cancer, irritable bowel disease. Additional diagnostic tests may include a stool test, lower GI series, and flexible sigmoidoscopy or colonoscopy. Colonoscopy may also be recommended for people who are older than 50 to screen for colon cancer.

MANAGEMENT:

The goal of treatment is to relieve symptoms.

Lifestyle changes can help in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms.

Dietary changes can be helpful. However, no specific diet can be recommended for IBS, because the condition differs from one person to another.

Large meals can cause cramping and diarrhea, so eating smaller meals more often, or eating smaller portions, may help IBS symptoms. Eating meals that are low in fat and high in carbohydrates, such as pasta, rice, whole-grain breads and cereals, fruits, and vegetables, may help.

Certain foods and drinks may cause IBS symptoms in some people, such as

·         foods high in fat

·         milk products

·         drinks with alcohol or caffeine

·         drinks with large amounts of artificial sweeteners, which are substances used in place of sugar

·         foods that may cause gas, such as beans and cabbage

People with IBS may want to limit or avoid these foods. Keeping a food diary is a good way to track which foods cause symptoms so they can be excluded from or reduced in the diet.

Dietary fiber may lessen constipation in people with IBS, but it may not help with lowering pain. Fiber helps keep stool soft so it moves smoothly through the colon. The Academy of Nutrition and Dietetics recommends consuming 20 to 35 grams of fiber a day for adults. Fiber may cause gas and trigger symptoms in some people with IBS. Increasing fiber intake by 2 to 3 grams per day may help reduce the risk of increased gas and bloating.

Therapies for Mental Health Problems

The following therapies can help improve IBS symptoms due to mental health problems:

Talk therapy. Talking with a therapist may reduce stress and improve IBS symptoms. Two types of talk therapy used to treat IBS are cognitive behavioral therapy and psychodynamic, or interpersonal, therapy. Cognitive behavioral therapy focuses on the person’s thoughts and actions. Psychodynamic therapy focuses on how emotions affect IBS symptoms. This type of therapy often involves relaxation and stress management techniques.

Hypnotherapy. In hypnotherapy, the therapist uses hypnosis to help the person relax into a trancelike state. This type of therapy may help the person relax the muscles in the colon.

Mindfulness training. People practicing this type of meditation are taught to focus their attention on sensations occurring at the moment and to avoid worrying about the meaning of those sensations, also called catastrophizing.

HOMEOPATHIC APPROACH TO IBS:

Homoeopathy is a remarkable resource for those dealing with digestive disorders. Homeopathic constitutional treatment based on the individual case is the most suitable and would aim to heal the underlying physical or emotional crisis causing digestive disorders. The unique physical, emotional and mental expression of illness is characteristic and is used to channel the course of Homoeopathic treatment. The remedies work by stimulating body’s natural ability to heal itself, acting as a catalyst for healing. Homoeopathy can be of assistance in retrieving normal motility and treating any psychological issues related to IBS. Homeopathic remedies can help rebuild mind, body and spirit as well as personal relationships for a balanced lifestyle. Homeopathy will reinforce and tone the body’s systems. Homeopathic remedies can help deal with anxiety, depression, and stress along with digestive problems. It will attend to nutritional problems and help the patient develop a healthier body image.

Argentum nitricum: Digestive upsets accompanied by nervousness and anxiety suggest the use of this remedy. Bloating, rumbling flatulence, nausea, and greenish diarrhea can be sudden and intense. Diarrhea may come on immediately after drinking water. Eating too much sweet or salty food (which the person often craves) may also lead to problems. A person who needs this remedy tends to be expressive, impulsive, and claustrophobic, and may have blood sugar problems.

Asafoetida: A feeling of constriction all along the digestive tract (especially if muscular contractions in the intestines and esophagus seem to be moving in the wrong direction) strongly indicates this remedy. The person may have a feeling that a bubble is stuck in the throat, or that a lump is moving up from the stomach. 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.The person may exhibit a strong emotional or “hysterical” element when this remedy is needed.

Colocynthis: This remedy is indicated when cutting pains and cramping occur, making the person bend double or need to lie down and press on the abdomen. Cramps may be felt in the area of the pubic bone. Pain is likely to be worse just before the diarrhea passes, and after eating fruit or drinking water. Problems tend to be aggravated by emotions, especially if indignation or anger has been felt but not expressed. Back pain, leg pain, and gall bladder problems are sometimes seen when this remedy is needed.

Lilium tigrinum: When this remedy is indicated, the 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. Hemorrhoids may develop. Constricting feelings are often felt in the chest. The person is likely to be worse from excitement and strong emotions, and may tend toward irritability or even rage.

Lycopodium: This remedy is often indicated for people with 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. Heartburn and stomach pain are common, and the person may feel better from rubbing the abdomen. Things are typically worse between four and eight p.m. Despite so many digestive troubles, the person can have a 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 are other indications forLycopodium.

Natrum carbonicum: This remedy is often indicated for mild people who have trouble digesting and assimilating many foods and have to stay on restricted diets. Indigestion, heartburn, and even ulcers may occur if offending foods are eaten. The person 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. The person may have cravings for potatoes and for sweets (and sometimes also milk, but has learned to avoid it). A person who needs this remedy usually makes an effort to be cheerful and considerate, but, when feeling weak and sensitive wants to be alone to rest.

Nux vomica: Abdominal pains and bowel problems accompanied by tension, constricting sensations, chilliness, and irritability can indicate a need for this remedy. Soreness in the muscles of the abdominal wall, as well as painful gas and cramps are common. Firm pressure on the abdomen brings some relief. 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. A person who needs this remedy often craves strong spicy foods, alcohol, tobacco, coffee, and other stimulants—and usually feels worse from having them.

Podophyllum: This remedy is indicated when abdominal pain 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. Things tend to be worse in the very early morning, and the person may feel weak and faint or have a headache afterward. Rubbing the abdomen (especially on the right) may help relieve discomfort. A person who needs this remedy may also experience stiffness in the joints and muscles.

Sulphur: This remedy is often indicated when a sudden urge toward diarrhea wakes the person early in the morning (typically five a.m.) and makes them hurry to the bathroom. Diarrhea can come on several times a day. The person may, at other times, be constipated and have gas with an offensive and pervasive smell. Oozing around the rectum, as well as itching, burning, and red irritation may also be experienced. A person who needs this remedy may tend to have poor posture and back pain, and feel worse from standing up too long.

HOMOEOPATHY IN INDIA

       HOMOEOPATHY IN INDIA

India is one of the biggest countries in whole world to have qualified practitioners and followers of Homoeopathy. In India it has become a household name due the safety of its pills and gentleness of its cure.  A rough study states that about 10% of the Indian population solely depend Homoeopathy for their Health care needs and is considered as the Second most popular system of medicine in the Country.There are numerous Homoeopathic associations, practitioners and followers who work in collaboration with each other for the benefit of Homoeopathy. Although Homoeopathy is not indigenous to India, it is the second most acceptable medical system after Allopathy in a majority of Indian states. Homoeopathy in India has been fully integrated in the public health and its practice is legal. India is a dreamland for those who wish to learn and undertake research in homoeopathy.

HISTORY

Homoeopathy came to India as early as 1810 when a Romanian traveler Dr. Honigberger who studied Homoeopathy under Dr. Samuel Hahnemann visited this country and began treating people with Homoeopathic medicine. Babu Rajendra Dutt is considered to be the father of Indian Homoeopathy and there are letters he wrote to his Homeopathic doctor friend asking for some clarifications to be made by Hahnemann himself, indicating that this was happening in the life of the Master. However the first recorded treatment of which historical details are available was of Maharaja Ranjit Singh in 1839 in Lahore by Johann Martin Honiberger of Romania of which he has chronicled in his book " Thirty five years in The East ".

Dr. John Martin Honigberger visited India. He was called in by the Maharaja Ranjit Singh of Lahore who was suffering from paralysis of the vocal cords with swelling of the feet. He treated the Maharaja dispensing “Dulcamara” in wine, in low potency. This medicine cured him. The Maharaja was also impressed when he treated his favourate horse of his ulcer of the leg. Dr. Honigberger became the chief physician of his court. Later on after the Maharaja’s death Dr. Honigberger shifted to Calcutta. In Calcutta, he was known as the “Cholera Doctor”.  He practised in Calcutta up to 1860.

In 1836 in Tanjoor, Dr. Samuel Brookling, a retired surgical officer, dispensed homoeopathic medicines to his civilians and army officers stationed at Madras.

In 1836-1867 Dr. Mahendra Lal Sircar, learned about Homoeopathy from a layman, Babu Rajen Dutta. The first qualified doctor to practice Homeopathy was Dr. Mahindra Lal Sarkar who was one of the first three Indian doctors to qualify for the post graduate degree of M.D. in medicine in the nineteenth century. Dr. Sircar wrote an article condemning allopathy titled “On the Supposed Uncertainity in Medical Science and the Relationship between Diseases and Medicine”. He was the first man to start a journal on homoeopathy – “India Medical Review” and to attend the first Homoeopathic National Congress conference under the chairmanship of Dr. C. Hering.Before the end of the last century, two Indian doctors studied in the erstwhile Homeopathic Institutions in the USA and one of them, Dr. B.K. Bose, was a direct disciple of the renowned Dr. James Tyler Kent.

In 1867 Dr. Salzar of Vienna was the founder of Homoeopathic education in India. He influenced two persons towards homoeopathy namely Dr. P. C. Majumdar and Dr. B. L. Bhaduri. Dr. Majumdar along with Dr. Roy, Dr. B. N. Banerjee and Dr. Younan established the first Homoeopathic college in India in the year 1878 under the name of “Calcutta Homoeopathic Medical College”.

In 1880 Father Augustus Mueller, a priest and teacher of a school founded by the Society of Jesus in Kankanady in Manglore, started dispensing free homoeopathic drugs.

In 1902 there was an epidemic of pneumonic plague and Father Augustus Muller treated most of the people successfully. He established a plague and leprosy clinic. Seeing this, the British presented him with the “Kaiser-e-Hind” award. He also wrote a book entitled “Twelve Tissue Remedies”.

Homoeopathy is even more popular in India as it received the support of Mahatma Gandhi who was reported to have said that “it cures a greater number of people than any other method of treatment”.

There was a progressively increasing public demand for homeopathic treatment that motivated the government to pass a resolution to form a Homeopathic Enquiry Committee in 1938. The most prominent doctors of both Allopathic constituted these Committee and Homeopathic disciples and luminous names such as Dr. J.N. Majumdar, Col. Amir Chand FRCP, Dr. M. Gururaju, Dr. L.D. Dhawale, Dr. P.N. Chopra and Dr. Diwan Jai Chand are mentioned in the list of members.

The committee finally presented its report in post independence India in 1949 which contributed to the recognition of this system of medicine by the by the Indian government.
The government of India had progressively increased its patronage of Homeopathy and given it a practical shape. Successive Presidents of the Indian Republic have had Homeopaths on their panel of Honorary Physicians. The Central Council of Homeopathy was established in 1973 to oversee the standards for homeopathic education and practice. The Government of India in 1978 set up the Central Council of Research in Homeopathy and its activities include clinical confirmation of proving, drug research, drug proving and literary research through its 51 centers in different parts of the country. A Homeopathic Pharmacopoeia was established in 1962 and the Homeopathic Pharmacopoeia Laboratory established in 1975 is recognized under the Drugs and Cosmetics Act. There are 132 Colleges in the country imparting Homeopathic education and there are 183,210 registered practitioners in Homeopathy attending to over 1 million illness episodes through 287 hospitals and private clinics. There are about 700 licensed Homeopathic Pharmacies in the country. In 1995, a separate Directorate for Homeopathy was established within the Ministry for Health and Family Welfare.

Three Congresses of the International Homeopathic Medical League have been held in India in the years 1967, 1977 and 1995. Dr. Diwan Harish Chand of New Delhi is the only Asian to have been honoured with the responsibility of the Presidency of the International League, a post which he held from 1979 to 1982 and he has subsequently been elected as the President of Honor of this organization.

HOMOEOPATHIC EDUCATION

The Homoeopathy Central Council Act that was passed by the Parliament of India in 1973 granted formal recognition of homoeopathic education and allowed the legalised registration of homoeopathic physicians at the Central as well as the State levels. In accordance with the provisions of this Act, the Government constituted the Central Council of Homoeopathy (www.cchindia.com) in the year 1974 to maintain the Central Register of Homoeopaths and to regulate Homoeopathic education in India.

With the approval of the Government of India, the Central Council formulated the Homoeopathy (Degree Course) Regulations, 1983 of 5 ½ years duration including one year compulsory internship; Homoeopathy (Post Graduate Degree Course) Regulations, 1989 and Homoeopathy (Minimum Standards of Education) Regulation, 1983 for setting up norms and standards of homoeopathic education. At present there are 186 homoeopathic colleges (including 36 also providing Post-Graduation) with an intake capacity of about 13,425 students every year. These institutions are affiliated to different Universities and provide uniform homoeopathic education according to these regulations.

Prior to the Central legislation and concurrently, some of the Indian states made their own contribution to homoeopathy by the enactment of State legislations for the registration of homoeopathic doctors and regulation of education. At present there are about 30 State legislations and State Boards/Councils for the control of clinical practice and to address any issue related to homoeopathy.

In the Indian society, the traditional systems- collectively recognized as AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy), are well established and widely accepted due to their historical and cultural significance. The Indian health care delivery system has a unique feature of medical pluralism wherein AYUSH systems are being given equal status with the Allopathic system of medicine. They also enjoy government patronage. A separate policy has been formulated to encourage these systems vertically in the field of education and research. A large number of hospitals, dispensaries, teaching institutions and registered practitioners are under the AYUSH system. In 2007, there were 3360 hospitals, with 68155 beds, 21765 dispensaries, 485 colleges and 725568 practitioners under AYUSH in the entire country, with considerable regional variations (AYUSH report 2007). Independent research councils and institutions of these systems have been established as autonomous organisations. The clinical practice is being integrated following a cafeteria approach in the Health sector, wherein the patient has an option of choosing a health system according to his conviction. Inter-system referrals are encouraged and adequate knowledge of these systems is provided to allopathic doctors and vice versa for proper co-ordination. It is expected that AYUSH will play a more significant role in the coming years.

RESEARCH & DEVELOPMENT

In India, the private as well as public sectors are striving hard to undertake organized research in homoeopathy. The Government of India has established an autonomous research council- The Central for Research in Homoeopathy (CCRH), for undertaking this task. At present various researches are being undertaken in India which can have a great impact on the prospects of Homoeopathy all over the world. Please visit CCRH official site at www.ccrhindia.org to know more about research activities in India in Homoeopathy.

According to the WHO, homoeopathy is the SECOND largest system of medicine in the world and is experiencing an annual growth of around 20 - 25%. It is estimated that by the year 2017, the world homoeopathy market would be equivalent to the current alternative health care market which is Rs 50 - 2000 cr. The homoeopathy market in India today is worth around Rs 630 cr, growing at roughly 20% per annum. In a certain survey, 82% of homoeopathy users would not switch to conventional treatments. Also if a person enrolls for homeopathic treatment in the early stages of his problem it is less likely that he would want to switch to conventional treatments.