Irritable Bowel Syndrome (IBS) is also known as irritable colon. It is a gastrointestinal (GI) motility disorder for which there is no organic or structural cause.
The disease condition is called Grahani, which indicates the pathological state of function and integrity of the intestinal tract (mostly small intestine), a particular part of the GI system known as grahani in Sanskrit.Grahani is the seat of enzymes (agni). Normally, it holds up the food (until it is digested) and releases it from the side after it is digested. But when it is deranged due to weak digestive enzymes, it releases the ingested material even in undigested conditions.
A disorder characterized by abnormally increased motility of the small and large intestines, producing abdominal pain, constipation, or diarrhea, is also known as irritable colon, spasticcolon, or mucous colitis.
Food moves through the intestinal tract by synchronized wave like contractions called peristalsis. Irritable bowel syndrome occurs when these peristaltic movements become disturbed affecting the digestive process. It is not known what exactly causes peristalsis to become irregular however some of the reasons said to cause IBS are:
*Stress is said to be the primary cause of IBS
*Food sensitivities can cause digestive problems
*Overeating or binge eating can cause abdominal cramps
*Too much fat in the diet
*Sugar substitutes such as sorbitol and aspartame can cause diarrhea
*Tricyclic antidepressants can cause constipation
*Antipsychotics and sedatives can also cause constipation
*Antacids, morphine and codeine can cause stomach upsets
Sympoms of IBS (Grahani):
Ayurveda characterizes the disease by the passage of stools alternated with constipation or diarrhea and with undigested food particles. This disease is also associated with thirst, distaste, blackouts, pedal edema, pain in the bone, fever, and vomiting. It is a motility disorder involving the entire GI tract, causing recurring upper and lower GI symptoms, including variable degrees of abdominal pain, constipation and diarrhea, and abdominal bloating.
IBS is also associated with non gastrointestinal conditions such as headache, low back pain, arthritis, non cardiac chest pain, difficult urination, and fibromyalgia.
Types of IBS (Grahani):
Ayurveda indicates that there are four different types of IBS. They are
1] Constipation- predominant IBS (vata grahani),
2] Diarrhea-predominant IBS (pitta grahani),
3] Dysentery-predominant IBS (kapha grahani), and 4]Complex IBS (tridosha grahani).
4) All three dosas are involved (vata,pitta, andkapha).
Clinical features of IBS (Grahani):
1. Constipation-predominant IBS – This type of IBS presents the clinical features of dryness in skin, mouth, or throat; more constipation or alternating constipation and diarrhea; thirst; bloating; flatulence; and a cold feeling. It is also associated with back or groin pain, weight loss, debility, anal fissures, insomnia, and anxiety.
2. Diarrhea-predominant IBS – This type of IBS clinically shows the presence of heartburn, thirst, feeling hot, irritable or angry, inflammation, sweating and fever, fluid, and foul smelling stools and eructation.
3. Dysentery-predominant IBS – This type of IBS exhibits the presence of nausea, indigestion, and excess sputum in the pharyngeal region, heaviness in the chest and abdomen, bad-smelling eructation, lethargy, sluggish bowels, and mucus in the stools.
4. Complex IBS – This type reveals the combined signs and symptoms of all the above types. 5. Accrual IBS – This type of IBS presents the combined features of all the tridosas and is more chronic. It is specially diagnosed with clinical features of borborygmi, diurnal changes that the bowel movements are increased in the daytime and stop at night. The nature of the stool will be pastier and slimy, have undigested food particles, and be eliminated with pain. The pattern of the bowel movement will be accumulation of stools for some days followed by passage of loose stools for several days.
6. Tympanites-predominant IBS – In this type of IBS, the clinical symptoms are rumbling sounds heard in abdomen and increased bowel movements with lots of undigested food particles.
Prognosis of IBS (Grahani): According to Ayurveda, IBS is curable in children, difficult to treat in middle age, and incurable in older patients. The chronic accrual IBS is difficult to cure whereas tympanites-predominant IBS is incurable
PREVENTION OF IBS:
* Cut fat consumption and include fibre in your diet
* Exercise regularly – Brisk walking for 20 to 30 minutes stimulates the digestive tract. Yoga also helps tone and condition internal organs including the digestive tract
* Stress relief – Exercise, yoga, meditation and hobbies are good ways to relieve stress and help prevent IBS vigorous exercise Exercising, even walking for about 30 minutes outside in the fresh air and sunlight will add to physical and mental well being.
* Herbal remedies – Herbal remedies such as Triphala are excellent for digestive tract disorders such as IBS. Boswellia helps in reducing inflammation and Ashwagandha helps in stress relief.
AYURVEDIC WAY OF TREATING IBS
The Ayurvedic principle of the involvement of dosas is very helpful because it provides an understanding of the symptoms and how they vary from one type to another. It also provides a system of treatment specific to that particular dosa imbalance. Ayurveda utilizes not only diet and herbs, but also lifestyle advice so that treatment of IBS can be more specific and more successful.
Ayurvedic treatment is based on the nature of the stool with (sama) or without (nirama) enterotoxin stool.
The therapy process is highlighted as follows:
1. According to Ayurveda, dyspepsia and enterotoxin in IBS are important pathological processes that have to be treated effectively along with consideration of bowel movements with respect of stools with or without mucus discharge. When enterotoxin dominates this stage, it is treated with fasting and administration of digestives and carminatives. Use of warm water is highly recommended.
2. In constipation-predominant IBS, the first line of treatment is administration of digestives like chitrakadi vati and shankha vati to eliminate enterotoxin. It is recommended to follow the digestive with an administration of medicinal ghee preparations such as dashmuladi ghrita and thryushanadi ghrita.
3. Emesis (vamana) is the first line of treatment in diarrhea-predominant IBS, followed by the herbal bitters.
4. The first line of treatment for dysentery-predominant IBS is laxatives (virechana) followed by the administration of herbs with spicy and sour tastes.
5. Complex IBS is treated with the panchakarma line of treatment and supported by digestives and carminative preparations.
Diet in IBS (Grahani):
In general, a normal diet should be followed. Patients with abdominal distention and increased flatulence may benefit from dietary reduction or elimination of beans, cabbage, and other foods containing fermentable carbohydrates. Reduced intake of apple and grape juice, bananas, nuts, and raisins may also lessen the incidence of flatulence. Patients with evidence of lactose intolerance should reduce their intake of milk and dairy products. Bowel function may also be disturbed by artificial sweeteners like Sorbitol and mannitol
Generally, in the treatment of IBS, the use of Buttermilk (takra) is emphasized. The patient has to be kept on the diet of buttermilk, which is the treatment and nutrition in IBS. Buttermilk is digestive, astringent, and light to digest and helps in improving the consistency of the stool. Buttermilk is given along with asafetida, cumin, and rock-salt powder to control the bowel movements. It contains a good amount of lactobacillus bacteria, which helps restore the normal flora of the intestines.
When treating IBS, a light diet is advised. Indigestible foods such as bread; cheese; red meat; and cold, hard, and raw foods should be avoided. A light fast can be helpful taking only vegetable soups and a little basmati rice and green gram beans. Herbs like ginger, fennel, and cumin that stimulate enzyme secretions will improve digestion, absorption, and clear ama from the digestive tract.
Preferred food items are Eat old rice, jawar, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, wood apple, Pomegranate, nutmeg, skimmed milk, buttermilk, hot water.
Avoid foods items such as maize, barley, pigeon pea, pea, cow pea, spiked dolichos, black gram, gram, Soya bean, saga, kidney bean, potato, sweet potato, navalkoal, onion, coconut, groundnut, chili, oily food, chicken, red meat, crabs, prawns, fish, leafy vegetable like sorrel, drum stick etc, mango, pineapple, apple, watermelon, cashew, pumpkin gourd, papaya, fig, jack fruit
The following changes in lifestyle help to control IBS:
1. Identify and remove food intolerances — Because grains are a common culprit, an elimination diet should be tried.
2. Improve gut motility – Soluble fiber increases bowel transit, stools, and relieves constipation. Psyllium(Isabgol) is a good source of soluble fiber and is readily available. Sufficient water should be taken or fiber can have the opposite effect and result in greater constipation.
3. Restore a healthy balance of bacteria in the gut -Use of buttermilk ( takra) is emphasized.
4. Pancreatic enzymes – These enzymes help inhibit the growth of b acteria in the small intestine. They help improve protein digestion.
5. Mind–body therapy — To attain a balanced mind which indirectly helps to fight IBS, Ashwagandha churna, Brahmi churna, Aswagandharishta is helpful. Complete rest, adequate sleep is advisable and day sleep, awakening at night, tension, suppression of urges should be avoided.