Inflammation of the bowel

Dr Arien van der Merwe discusses natural treatment options and stress management tools to relieve inflammation of the bowel. This approach will of course alleviate symptoms of any disorder or disturbance in digestive tract function.

Irritable bowel syndrome (IBS) or spastic colon is a functional disorder affecting the bowel or parts of the gastrointestinal tract. After colds, IBS is one of the most common health problems. It has also been called nervous colon syndrome. It tends to be a chronic disorder, and the symptoms can come and go over many years. For some people IBS involves mild discomfort, while for others it is a disabling condition with the sufferer unable to work normal hours or attend social events. However, in many cases of IBS people are able to control their symptoms through dietary and lifestyle changes, stress management and prescribed or natural medicines. IBS is believed to be an overreactive response of the digestive system, especially the colon, to emotional triggers.

IBS can present with symptoms related to bowel function such as abdominal bloating, indigestion, cramping and wind, mucus in the stools, diarrhoea alternating with constipation, and irregular bowel habits. People suffering from IBS are often concerned that it could lead to colon cancer. The symptoms are related to abnormal muscle contractions in any part of the intestinal tract. A spastic colon does not adversely affect longevity or lead to more serious bowel diseases such as colon cancer, Crohn’s disease or ulcerative colitis (inflammatory bowel disease).

IBS is one of the most frequently diagnosed gastrointestinal disorders and accounts for almost one-third of all cases seen by gastroenterologists. Up to 15% of the general population have IBS, although only about 20% of this group will ever seek medical attention. Only a small percentage have chronic symptoms. The symptoms of IBS typically occur early in life and half of those affected experience the symptoms before they reach the age of 30.

IBS tends to be more common in the following people:

Those younger than 35 – if symptoms occur for the first time after this age, a diagnosis of IBS becomes unlikely
Those with panic and/or anxiety disorders
Those with a positive family history of IBS
Those with a history of physical or sexual abuse or other psychological trauma.

There is no known cause of IBS. Most symptoms are related to abnormal muscle movement or spasm of the lower part of the colon. Dietary, psychological, hormonal or genetic factors may play a role.

There is no specific diagnostic test for IBS, but a number of tests can rule out other conditions, such as food allergies, intestinal infections, parasites, diverticular disease, colon cancer, ulcerative colitis and Crohn’s disease. Accordingly, if you experience any of the listed symptoms, it is important to consult with your family doctor for a thorough medical examination and the necessary tests to confirm the diagnosis.

SYMPTOMS

Symptoms usually start during adolescence or early adulthood.
Symptoms appear over periods of days to weeks.
Abdominal pain and/or cramping occur. The pain can vary from mild to severe. It is usually felt in the lower abdomen, especially on the left side. The pain may be dull or sharp, and continuous or cramping in nature. Pain is relieved by passing wind or by defacation. It does not occur at night.
Constipation or diarrhoea develops shortly after meals, over a period of several weeks. Symptoms vary from person to person, and in one individual both constipation and diarrhoea, or either one alone, can occur.
There may be a bloated feeling, abdomi- nal distension, increased intestinal gas (flatulence) and belching.
Bowel movements differ in frequency or consistency from the person’s normal pattern. During constipation stools may be hard, small, pellet-like, and difficult to pass. A sense of incomplete evacuation may follow. Defacation may relieve the pain. The diarrhoea of IBS is usually small in volume, but occurs frequently. The first movement of the day may be normal, followed by loose bowel movements throughout the rest of the day. Bowel movements may be associated with extreme urgency and can be explosive. Mucus may be passed in the stools.
Symptoms usually get worse during times of stress.
Heartburn, nausea and vomiting can sometimes occur.
Loss of appetite may occur.
Some women have co-existent painful menstrual periods, and experience pain during sexual intercourse.
Symptoms rarely if ever occur at night and do not normally wake the person from sleep.

The following may cause or exacerbate symptoms:

Stress, anxiety and depression
Smoking
Alcohol
Food sensitivity (up to two-thirds of people with IBS might have a food intolerance, allergy or sensitivity), especially as people age
Overeating, binge eating, eating irregularly or too quickly
Too much fat in the diet
Lactose intolerance
Sugar substitutes such as sorbitol and aspartame
Certain antibiotics that alter the population of bacteria in the intestines
Morphine and codeine
Aluminium salts or antacids
Tricyclic anti-depressants
Some anti-histamines, mineral supplements bonded to mineral salts, diuretics, anti- psychotic drugs and sedatives
Sensitivity to intestinal sensations
Hormonal changes, for example during the menstrual cycle.

SEE A DOCTOR IF:

Your symptoms get worse, begin to disrupt your activities, or do not respond to natural treatment
You become increasingly tired
Your symptoms wake you frequently
You’ve been losing weight
Your appetite is poor
You experience abdominal pain associated with changes in bowel function or that is not relieved when you pass wind or a stool
You have a fever
Mucus suddenly appears in your stools
Blood suddenly appears in your stools.

As IBS does not have a specific underlying cause, treatment is intended to relieve the symptoms. Conventional drug treatment of IBS is aimed at controlling the symptoms through improving gut motility and reducing gut sensitivity, thereby alleviating abdominal pain, bloating and constipation. Other conventional treatments include the prescription of dietary guidelines, lifestyle modification, laxatives, anti-spasmodics, anti-depressants and tranquillisers.

NATURAL TREATMENT OPTIONS

The digestive tract is often called the second brain, as neurotransmitters are found abundantly along the whole tract. Neurotransmitters (90 have been identified so far, e.g. serotonin, the ‘feel-good’ neuropeptide), also called ‘molecules of emotion’ by Candace Pert, communicate in a two-way direction between the digestive tract and brain and vice versa. Your gut literally ‘feels’ the way you do. The most important ‘treatment’ therefore is stress management and relaxation training.

Certain foods may contribute to IBS by irritating the gastrointestinal tract. It is recommended that one consult a registered dietitian, nutritionist, or natural health practitioner to implement dietary changes and guidelines for your meal plans, since these guidelines could be as individual as the symptoms. To establish individual recommendations, a thorough history of eating habits relating to symptoms is very useful. It is recommended that you keep a journal of your symptoms along with your daily dietary intake. Add notes on your thoughts and feelings to this brew, and you will soon become aware if certain events, thoughts and feelings, together with certain foods, exacerbate the symptoms.

It may be necessary to cut the consumption of dietary fat, whether vegetable oil or animal fat, saturated or unsaturated. It has been found that intestinal contractions are exaggerated in people with IBS after eating a high-fat meal, such as deep-fried foods, or foods containing fatty meats and creamy sauces. It is therefore recommended that the fat content of the diet should be within normal healthy recommendations. Other known irritants are eggs and dairy products, spicy foods and coffee. Some people suffering from IBS seem to have fewer symptoms when intake of wheat products is reduced. This could be related to the fact that wheat starch is more difficult to digest than other starches such as that found in potato or maize.

Most people do not eat enough fibre. Include raw, unpeeled fruit and vegetables, or lightly cooked vegetables, jacket potatoes, fresh fruit juices, and dried fruit soaked overnight in hot water, eaten with live AB culture yoghurt.

Drink 4 to 5 glasses of water in addition to your normal fluid intake. Water helps dietary fibre to expand and provide bulk in the intestines, thus improving regularity. However, overdoing water intake can lead to low calcium, magnesium and potassium levels. Drink 8 glasses of water in total a day. At first the amount of intestinal gas may increase, but it should subside as your body adjusts. Try to eat smaller meals more often or eat smaller portions of foods during meals. Do not smoke as that in itself can irritate the bowel. Avoid excessive amounts of caffeine, for example in coffee, colas and chocolate.

Elimination diets are useful not only to relieve symptoms, but also to identify whether food intolerance or allergies exist. Do not eat a suspected food for 14 days. Then try it again and if you get an adverse reaction, avoid that food in future. Possible culprits include:

Dairy products (excluding organic live AB culture yoghurt)
Wheat products: possible wheat sensitivity and insoluble fibre
Fibre-enriched foods: high content of insoluble fibre
Skins and pips: brinjals, tomatoes, berries, figs, raisins, nuts and seeds, whole peas and corn
Intestinal irritants: citrus fruits, tomatoes, chilli and spicy foods, caffeine, and carbonated drinks
Smoked and processed foods: sensitivity to food additives
Gas-forming foods: lentils (whole), beans, onions, garlic, and cabbage-family vegetables. Include these one by one after the elimination period. The chances are that not all of them will be culprits
Alcohol.

Fructose, a natural sugar found in fruit, is often used to replace cane sugar. However, some people might have a fructose intolerance, characterised by diarrhoea, abdominal cramping and bloating after eating fructose-rich foods such as fruit, fruit juices or pure fructose. People with IBS should be careful with the use of fructose, because with a fructose intolerance their symptoms could be aggravated. Fructo-oligosaccharides such as found in asparagus can, however, be very beneficial for IBS.

Get regular exercise to help regulate bowel movements. There are many different types of gentle exercise which can help you not only to de-stress, but also get your bowel motions back to normal. Yoga is probably the most relaxing exercise regimen available. Join a yoga class that emphasises relaxation and deep breathing. Taking leisurely walks in the fresh air is also a good idea. Swimming gentle laps or dancing to mood music may help. Specific yoga asanas to try for symptoms of IBS include the cat pose, sun salute, pawanmuktasana series (raised leg pose, leg rotation, cycling while lying on the back, leg lock pose, rocking and rolling, abdominal stretch, universal spinal twist, boat pose), all forward bend asanas, and sitting in vajrasana (thunderbolt pose) for at least 10 minutes after meals.

Aromatherapy, therapeutic massage and reflexology are wonderful ways of getting rid of stress and making every part of your body, including your intestines, relax.

Natural anti-spasmodics, anti-diarrhoeals or laxatives can be used for short periods when the symptoms of cramps, diarrhoea or constipation are severe. If you are depressed or under excessive strain, you might consider a herbal anti-depressant such as St John’s wort. It is important to realise that depression and anxiety need more than a symptomatic approach. By all means use St John’s wort if symptoms are severe, but also go for psychotherapy or group therapy to address the deeper emotional or even soul issues underlying IBS.

NUTRITIONAL SUPPLEMENTS

Among the most helpful supplements are the beneficial bacteria Lactobacillus acidophilus and Bifidobacterium bifidus, used to restore normal gut flora and assist in digestion and absorption of food. These are found in powder and capsule form from most health shops. Be sure to get a product with 2.5 billion live organisms per gram and take 1 000 to 4 000 mg per day.
Digestive enzymes are also very helpful: these can be found in supplement combinations containing pancreatic enzymes (amylase, protease, sucrase, malt diastase, lipase, cellulose, and lactase), papain from paw-paw, bromelain from pineapple stem and cultured moulds from Aspergillus species.
Vitamin B-complex with vitamin C are important for a healthy nervous system. Lecithin is a natural source of choline and inositol, both important nutrients for nerve cells. Use in combination with an antioxidant formulation.

HERBAL REMEDIES

Peppermint (Mentha piperita) has a long history of use for intestinal problems including indigestion, cramping, bloating, infection, inflammation and pain. Mint tea is useful for tummy upsets, but the essential oil of peppermint is better for IBS. Take 1 to 2 capsules containing 0.2 ml of enteric-coated peppermint oil 2 to 3 times a day as needed, or dilute a few drops of the oil in 2 tablespoons of vegetable oil and rub over the area of discomfort. Do not use peppermint oil internally when there’s heartburn or oesophageal reflux.
Psyllium (Plantago ovata) is rich in fibre similar to that in oat bran, flaxseed meal and guar gum. Use up to 1 tablespoon of seed husks or 10 ml of powdered seed stirred into 250 ml water once a day. Drink another glass of water afterwards and don’t take it within 1 hour of eating or taking other drugs. Chamomile (Matricaria recutita) acts as a sedative, relieves wind, calms intestinal spasm and reduces inflammation. It soothes the gastrointestinal smooth muscle and helps with diarrhoea and constipation. Drink 3 to 4 cups of tea per day or take 10 to 40 drops of tincture 3 times per day. Avoid in cases of heartburn or allergy to plants in the aster family.
Dandelion (Taraxacum officinale) can help to relieve constipation. Drink as a tea 2 to 3 times a day or take in capsule form.
Valerian tea helps with anxiety and stress, enabling one to relax and sleep peacefully. Ginger is a well-known remedy for digestive disturbances such as indigestion, nausea, flatulence and colic. Drink tea made from fresh ginger 15 minutes before meals.
Ginger is a well-known remedy for digestive disturbances such as indigestion, nausea, flatulence and colic. Drink tea made from fresh ginger 15 minutes before meals.

AROMATHERAPY AND FLOWER ESSENCES

It is recommended that one consult a registered aromatherapist for the safe and optimal use of aromatherapy oils. Aromatherapy oils are extremely concentrated and should be diluted in carrier oils by using half the number of drops per the volume of carrier oil, for instance 5 drops of lavender oil could be used in 10 ml of sweet almond oil.

Lavender is well known for its relaxing and analgesic properties. Use 2 to 3 drops in an aromatherapy burner, or use diluted in a massage oil, applied to the abdomen.
Chamomile’s anti-spasmodic properties help to relieve abdominal cramping or discomfort. Use 1 to 2 drops in an aromatherapy burner, or diluted in a massage oil, applied to the abdomen.
Peppermint oil can be diluted in 2 tablespoons of vegetable oil and rubbed or massaged over the area of discomfort, or a few drops can be used in an aromatherapy burner.
Rescue Remedy helps to treat anxiety and stress. Use 3 to 4 times a day.

STRESS SOLUTIONS

The cause of IBS remains uncertain, but the following trends have been identified and may help people make sense of their symptoms:

They experience a lowered pain threshold. There exists a biological predisposition to respond to emotional stimuli with colon hypermotility (increased colon smooth-muscle contractions).
There are findings of mildly elevated test scores on depression, anxiety, and neuroticism.
There tends to be a preoccupation with physical symptoms.
Increased tension leads to an increase in symptoms.
Half of all patients report psychological loss or threat of loss preceding the first episode.
There is a perceived, subjective experience of stressful life events.
Family history shows a tendency for special treats during childhood illness – treats for illness becomes a learned response.

Mind-body issues: fear of letting go; insecurity; lack of self-confidence, selfesteem and personal power; tending to be easily intimidated by others, finding the expression of one’s own ideas and opinions very difficult.

SUCCESSFUL MIND-BODY TREATMENT OPTIONS

Self-awareness of stress triggers through stress assessments.
Coping-skills training for handling interpersonal conflicts positively.
Hypnotherapy, autogenic training, and biofeedback to control internal smooth-muscle contraction.
Relaxation training, including relaxercises, meditation and movement therapy.
Rest and massage.
Family therapy: the patient contracts to talk about IBS symptoms only with the health care practitioner, who should be sympathetic but not indulgent, while family members ignore any complaints at home.
Group therapy – lectures, discussions, relaxation training, and journal keeping.

CONCLUSION

IBS can seriously curtail quality of life. It is important that a medical doctor make a diagnosis before any treatment regimen is started. Knowing about all the natural therapies available can help you obtain a sense of control over your health, while improving your quality of life and sense of wellbeing. Adapt your diet and lifestyle, practise regular stress management and relaxation techniques, and make use of the natural remedies to help you cope with the symptoms!

Editor's note: We have published extensively on IBS and IBD: The Best Dietary Choices for IBS , Natural Solutions to IBS (Irritable Bowel Syndrome), IBS – The Internal Struggle, and Fodmaps & Gaps in the Management of IBS

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Inflammation of the bowel