Category: IBS

ABSTRACT

Irritable Bowel Syndrome (IBS) is the most prevalent functional gastrointestinal disorder noted in the general population worldwide. It is a chronic condition that can substantially reduce quality of life and work productivity. It is characterized by recurrent abdominal discomfort in association with alternate episodes of diarrhea and constipation. Its chronic nature, signs and symptoms which vary periodically from mild to severe have many negative effects on the quality of life. The exact cause of IBS is not known. IBS is a disorder that is not confirmed by a specific test. Instead, diagnosis is based on specific symptoms. The symptoms occur with no structural pathology of the Gastrointestinal tract. Physiological, behavioral and psychosocial factors are responsible for IBS. Herbal Ayurvedic medicines have been used widely in the treatment of irritable bowel syndrome (IBS) patients. Ayurveda emphasizes the use of herbal remedies for IBS management and dietary changes. In this article we will discuss the IBS causes, symptoms, and ayurvedic approach to Irritable bowel syndrome (IBS).

INTRODUCTION

IBS (Irritable Bowel Syndrome) is a chronic gastrointestinal disorder and also psychosomatic disorder that affects so many people worldwide. People with IBS experience symptoms such as abdominal pain and cramps. With IBS, you may also have frequent diarrhea, constipation or both. IBS doesn’t cause tissue damage in your GI (gastrointestinal) tract. The diagnosis of irritable bowel syndrome can be made by performing a careful review of the patient’s symptoms, taking a thoughtful history (e.g., diet, medication, medical, surgical, and psychological history). In 1988, a group of international experts met in Rome to discuss functional gastrointestinal disorders (FGIDs), and introduced the Rome criteria for diagnosis of functional gastrointestinal disorders (FGIDs). In 2016 Rome criteria IV was released with some specific key changes. Rome IV described IBS as a functional disorder of bowel in which abdominal pain is associated with defecation and changes in bowel habits.

TYPES OF IRRITABLE BOWEL SYNDROME (IBS)

Rome IV describes IBS with its subtypes, they are as follow:

1. Constipation Predominant (IBS-C) – It is characterized primarily by chronic constipation. With associated symptoms of abdominal pain and discomfort, chronic constipation, bloating and gas, straining during bowel movements, incomplete evacuation.
2. Diarrhea Predominant (IBS-D) – It is characterized primarily by chronic diarrhea. Its symptoms are frequent, loose, or watery stools, abdominal pain and cramping, urgency, bloating, bowel movement frequency.
3. Mixed or alternating pattern (IBS-M) – It is defined as alternating episodes of constipation and diarrhea, with people experiencing both symptoms over time. Its symptoms are abdominal pain and cramping, alternating bowel habits between constipation and diarrhea, incomplete evacuation, mucus in stool.
4. Unclassified (IBS-U) – It is a subtype of IBS that’s diagnosed when symptoms don’t fit into the other three subtypes.
5. Post-Infectious (PI) IBS – This occurs after an episode of infectious gastroenteritis. The symptoms are similar to IBS.
6. Tympanitis Predominant IBS – In this type of IBS, the clinical symptoms are rumbling sounds heard in the abdomen and increased bowel movements with lots of undigested food particles.

CAUSES OF IRRITABLE BOWEL SYNDROME

The exact cause of IBS isn’t known. These conditions, also called disorders of the gut-brain interaction. Although what causes IBS is not known, multiple factors have been proposed to lead to the condition. Such as alterations in gut motility, infections including small intestinal bacterial overgrowth, stressful life event, or an intestinal infection.

SYMPTOMS OF IRRITABLE BOWEL SYNDROME

Symptoms of IBS can appear frequently. Or, they may occur during flare-ups. In other words, you don’t always experience symptoms. Instead, symptoms may go away (and you’ll have normal bowel movements). At other times, symptoms may return.

Symptoms of IBS include:

• Diarrhea, constipation or alternating between the two.
• Excess gas and bloating.
• Abdominal pain or cramps.
• Mucus in stool.
• Some extra intestinal symptoms can be there, such as sleep disturbance, anxiety, depression, fatigue, pain during menstruation.
• Discomfort in the upper stomach area.
• Feeling like you haven’t finished a bowel movement.

COMPLICATIONS OF IRRITABLE BOWEL SYNDROME

Complications of irritable bowel syndrome (IBS) can include:

• Hemorrhoids
• Malnutrition
• Sleep disturbances
• Migraine headaches
• Depression and anxiety

DIAGNOSIS OF IRRITABLE BOWEL SYNDROME

The exact diagnosis of IBS has proved extremely difficult. IBS can be diagnosed based on a good understanding of the symptoms. Some criteria to diagnose IBS are as follow:

• The Rome IV diagnostic criteria for IBS states that those with IBS have certain symptoms that must have been present for the past three (3) months and started at least six (6) months before.
• Blood Tests: IBSchek and IBS-Smart – these tests are done for the diagnosis of irritable bowel syndrome with mixed bowel habits (IBS-M) or with predominant diarrhea (IBS-D) in adults.
• Stool Tests: To check for bacterial infections and inflammation, a stool sample is taken.
• Additional tests to diagnose IBS can include:
  1. Colonoscopy
  2. CT scan
  3. Upper endoscopy

All these imaging tests are done to evaluate the possibility of some other underlying disease.

TREATMENT OF IRRITABLE BOWEL SYNDROME

There are several medications that can be used in the treatment of IBS, such as:

• Antidiarrheal medications
• Laxatives
• Low-dose antidepressants
• Probiotics

Some therapies can be used such as:

• Psychotherapy
• Therapeutic massage
• Meditation
• Yoga

The goal of IBS treatment is to provide relief from the symptoms.

AYURVEDIC CONCEPT

In Ayurveda, Irritable bowel syndrome (IBS) can be correlated with Grahani on the basis of its clinical manifestation. Grahani is a disease of the gastrointestinal tract which is produced due to weakness of Agni (digestive fire), causing food to be partially digested, leading to the formation of Ama (toxins). Irritable bowel syndrome (IBS) can be managed by managing the agni (Digestive fire) and ama (toxins) in the body. It is the derangement of dosha (humor) that causes different diseases based on the site of their aggravation and localization. In Ayurvedic classical texts, we get references for Grahani as Agni Adhishtana (position of digestive fire), which is the site for Agni (Digestive fire). The word Grahani is taken from Grahana which means to hold or to retain something. Thus it does the karma (action) of Annagrahana (the process of retaining uncooked food). The function of Grahani is similar to the functions of stomach and duodenum. The basic pathophysiology (Samprapthi) is found at the Grahani and Pakwasaya levels, due to Agnidushti (disturbance in digestive fire). Therefore, medicines that contain Deepana (appetizer), Pachana (digestant), Anulomana (regulation of movement), or Grahi (hold ingested food) qualities are ideal for the treatment of IBS (Grahani). Psychological issues are also involved, therefore the Satwavajaya Chikitsa (psychotherapy) is beneficial, as well as exercises and relaxation techniques, and can help with management.

TYPES OF GRAHANI (IBS)

IBS is mainly a functional motility disorder, and the movements and the absorption are mainly undertaken by vata dosha. In the Atisara phase (diarrhea) of IBS, the chala (moving), laghu (light) gunas of vata and sara (mobility), drava (liquid) gunas of pitta are involved. In the Vibandha (constipated) phase of IBS, the ruksha (dry) and sita (cold) gunas of vata are mainly involved. Due to the imbalance of three doshas (vata, pitta, kapha), Grahani (IBS) is divided into different types. They are as follows:

• Vataj Grahani – Frequent attacks of pain in the sides, thighs, groins and the neck, dryness of throat, gastrointestinal irritation, emaciation, craving for all kinds of tastes, bloating which increases on an empty stomach and relieved by taking food, dyspnoea and cough.
• Pittaja Grahani: Yellow colored loose stool containing undigested food material, burning sensation in the cardiac region and throat, excessive thirst and anorexia.
• Kaphaja Grahani – Chronic rhinitis, nausea, vomiting, sweet taste in the mouth, cough, numbness and heaviness in the abdomen, low libido, eructation with foul smell and sweet taste, no emaciation but feeling of weakness.
• Tridoshaja Grahani – The mixed symptoms of Vataja, Pittaja and Kaphaja Grahani can be seen.
• Amaja Grahani – Constipation, pain, burning sensation, salivation, heaviness and anorexia are the associated symptoms of Grahani with Ama.
• Sangraha Grahani – Liquid, solid, sticky stool passed with sound and mild pain, bowel irritation, symptoms appear with the gap of 1 month, 15 days, 10 days or daily, symptoms aggravates at day time while relieved at night time, difficult to treat and is chronic.
• Ghatiyantra Grahani – A chronic type of irritable bowel syndrome (IBS) that produces sounds while passing stool, similar to pouring water from a pot.

AYURVEDIC PATHOPHYSIOLOGY OF IRRITABLE BOWEL SYNDROME (IBS)

Due to weak digestive fire, grahani releases the ingested food even in unripe condition. Agni (digestive fire) is deranged by fasting, overeating, eating during indigestion, irregularly eating, intake of unsuitable, heavy, cold, too rough and contaminated food, faulty adaptation to place, time and season, faulty administration of emesis and purgation. Thus deranged agni (digestive fire) becomes unable to digest even the light food and the food being undigested gets acidified and toxic. This Agnimandyamay (depletion of digestive fire) is due to psychological factors or local bowel factors. It leads to defective absorption of Rasa Dhatu (fluid content of the body). Due to this the function of other dhatus (elements) will be impaired. This will cause weakness in the body and it will create ama (toxic) condition in the body. Ama (toxins) disturbs the normal flora of GI tract and weakens the muscles and acid fluid configuration of GI tract. Thus leading to symptoms such as loss of appetite, chronic abdominal pain, incomplete evacuation, irregular bowel habit, constipation, diarrhea, etc. The factors which play a significant role in most of the digestive disorders are malfunctioning of Agni (digestive fire) and Vata Dosha along with psychological stress.

The samprapti (pathology) ghatak (components) of Grahani (IBS) are as follows:

• Dosha (humors) – Sannipataja (mixed) (Vathadhikya)
• Dushya (affected) – Rasa (nutrient fluid)
• Agni (digestive fire) – Jatharagni (digestive fire)
• Srotodushti (vitiated channel) – Atipravritti (excessive flow), Sanga (obstruction)
• Srotas (channels) – Purishvahasrotas (channel carrying fecal matter)
• Utbhavasthana (site of origin) – Pakvasaya (large intestine)

PREVENTION STEPS

Don’ts:

• Avoid sleeping during the day and awakening at night.
• Don’t take stress.
• Avoid oily food, spicy food, sugary beverages.
• Avoid dairy products.
• Avoid eating soya bean, saga, kidney bean, sweet potato and potato.
• Avoid citrus fruits like pineapple, mango, apple, etc.

Do’s:

• Adequate sleep.
• Drink lukewarm water.
• Fruits like pomegranate juice, banana, ripe papaya.
• Eat vegetables such as bottle gourd, pumpkin, round gourd, zucchini, carrots, etc.
• Meditation.
• Breathing exercises.

TYPES OF IRRITABLE BOWEL SYNDROME (IBS)

Rome IV describes IBS with its subtypes, they are as follow:

1. Constipation Predominant (IBS-C) – It is characterized primarily by chronic constipation. With associated symptoms of abdominal pain and discomfort, chronic constipation, bloating and gas, straining during bowel movements, incomplete evacuation.
2. Diarrhea Predominant (IBS-D) – It is characterized primarily by chronic diarrhea. Its symptoms are frequent, loose, or watery stools, abdominal pain and cramping, urgency, bloating, bowel movement frequency.
3. Mixed or alternating pattern (IBS-M) – It is defined as alternating episodes of constipation and diarrhea, with people experiencing both symptoms over time. Its symptoms are abdominal pain and cramping, alternating bowel habits between constipation and diarrhea, incomplete evacuation, mucus in stool.
4. Unclassified (IBS-U) – It is a subtype of IBS that’s diagnosed when symptoms don’t fit into the other three subtypes.
5. Post-Infectious (PI) IBS – This occurs after an episode of infectious gastroenteritis. The symptoms are similar to IBS.
6. Tympanitis Predominant IBS – In this type of IBS, the clinical symptoms are rumbling sounds heard in the abdomen and increased bowel movements with lots of undigested food particles.

AYURVEDIC TREATMENT OF IRRITABLE BOWEL SYNDROME (IBS)

In Ayurveda, the first step in the treatment of IBS is the reduction of Ama (undigested toxins). This will detoxify the body and bring doshas (humors) into balance. Here are a few therapies that can help:

Agnidipana

In this process, the regulation of the digestive fire (Jatharagni) is done by reducing ama (undigested toxins) from the digestive tract. Some herbs that help in Agni Deepana (stimulation of digestive fire) are Bilva (Aegle marmelos), Dhanyak (Coriandrum sativum), Jirak (Cuminum cyminum), Ela (Elettaria cardamomum), Musta (Cyperus rotundus), Twak (Cinnamomum zeylanicum), etc. These herbs have properties of Deepana (appetizer), Pachana (digestant), Grahi (hold ingested food), Vatanulomana (regulation of movement of vata in the right direction), and Vibandhahara (relief from constipation) which pacify the symptoms of IBS.

Vatanulomana

This process involves correction and balancing out Vata dosha. Some Vatanulomana (regulation of movement of Vata in the right direction) drugs that can be used in IBS are Sunthi (Zingiber officinale), Dhataki (Woodfordia fruticosa), Saunf (Foeniculum vulgare), Dhanyak (Coriandrum sativum), etc.

Manonukulata

In some cases, the symptoms of IBS flare up when people experience stress and undergo psychological issues. This process involves relaxing and calming mental stress.

Panchakarma Procedures

Panchakarma therapy for IBS includes:

• Abhyanga: Abhyanga helps in pacifying excess doshas and loosening toxins.
• Sarvang Vashpa Svedana: Svedana opens the pores to help sweat out all toxins from the body.
• Shirodhara: It is a warm oil therapy on the head. This process helps in relaxing the body and mind, thus reducing stress.
• Nirooha Basti and Anuvasan Basti: Basti is the introduction of herbal decoctions and medicated oils into the colon through the rectum. It fulfills the purpose of eliminating Dosha, and nourishing and rejuvenating Dhatu.

HERBAL REMEDIES FOR IRRITABLE BOWEL SYNDROME (IBS) BY PLANET AYURVEDA

Planet Ayurveda provides the best herbal remedies, such as the IBS Care Pack, for natural treatment of IBS. These herbal remedies are formulated using the best quality herbs and strictly follow the principles mentioned in Ayurveda. These are free from chemicals, additives, and preservatives. All these herbal remedies of Planet Ayurveda are natural, vegetarian, and 100% pure.

1. Sanjivani Vati
2. Pitta Balance
3. Kutajghan Vati
4. Digestion Support

Products Description

1. Sanjivani Vati

A herbal preparation made with 9 Ayurvedic herbs such as Vidanga (Embelia ribes), Pippali (Piper longum), Haritaki (Terminalia chebula), and Vacha (Acorus calamus). It has properties like Deepana (appetizer), Pachana (digestant), Anulomana (regulation of direction), and Amahara (removal of undigested toxins). It cures diseases caused by Mandagni (digestive impairment).

Dosage: 2 tablets, twice a day with lukewarm water after a meal.

2. Pitta Balance

Made of various herbs such as JaharMohra Pishti (Natural Calcium Compound), Giloy Satva (Tinospora cordifolia), and Mukta Pishti (Natural Calcium Compound from Pearls). It balances Pitta dosha and helps maintain good digestive health.

Dosage: 1 capsule, twice a day with lukewarm water after a meal.

3. Kutajghan Vati

Made of the herb Kutaja (Holarrhena antidysenterica), it is used for treating Atisara (diarrhea), Pravahika (amebiasis), and improving digestion.

Dosage: 2 tablets, twice a day with lukewarm water after a meal.

4. Digestion Support

Capsules made of 7 Ayurvedic herbs such as Haritaki (Terminalia chebula), Amla (Emblica officinalis), and Sounf (Foeniculum vulgare). It helps in stimulating the secretion of digestive juices and strengthens the digestive system.

Dosage: 1 capsule, twice a day with lukewarm water after a meal.

CONCLUSION

In this article, we have concluded about Irritable Bowel Syndrome (IBS), discussing its causes, symptoms, and Ayurvedic treatment. In Ayurveda, undigested food leads to the formation of Ama (undigested toxins), which is responsible for producing various disorders of the digestive system. Symptoms of IBS are correlated with those of Grahani. Due to our poor eating habits, Grahani Roga is related to food absorption and digestion. Weak digestion can lead to the accumulation of toxins (Ama). All major symptoms of IBS can result from these toxins. Ayurvedic treatments for IBS provide effective results. Treatment must consider various aspects like Agni, Ama, and psychiatric problems, along with Pathya and Apathya Ahara (food) and Vihara (lifestyle).