Dr Arien van der Merwe discusses natural treatment options and stress management tools to relieve irritable bowel syndrome. This approach will help 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 gastro-intestinal tract. After colds, IBS is one of the most common health problems. 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, most people with IBS are able to control their symptoms through dietary and lifestyle changes, stress management and prescribed or natural medicines. IBS is believed to be an over-reactive 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. The symptoms are related to abnormal muscle contractions in any part of the intestinal tract. People suffering from IBS are often concerned that it could lead to colon cancer, but a spastic colon does not adversely affect lifespan 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 gastro-intestinal disorders and accounts for almost one-third of all patients seen by gastro-enterologists. Up to 15% of the general population has IBS, although only about 20% of this group will ever seek medical attention. Only a small proportion have chronic symptoms. The symptoms of IBS typically start early in life, in half of those affected before they reach the age of 30. Among adolescents, 5% of males and 14% of females are affected by IBS, while among adults 19% of males and 24% of females are affected.
There is no known cause of IBS. 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. If you experience any of the symptoms of IBS, it is therefore important to consult with your family doctor for a thorough medical examination and the necessary tests to confirm the diagnosis.
ARE YOU LIKELY TO BE AFFECTED?
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 is 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.
DO YOU HAVE IBS?
- Symptoms usually start during adolescence or early adulthood.
- Symptoms appear over periods of days to weeks.
- Abdominal pain and/or cramping can vary from mild to severe. The pain is usually felt in the lower abdomen, especially on the left side, may be dull or sharp and continuous or cramping, and is relieved by passing wind or by defaecation. Pain 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 you may have both constipation and diarrhoea, or either one alone.
- You may experience a bloated feeling, abdominal distension, increased intestinal gas (flatulence) and belching.
- Bowel movements differ in frequency or consistency from your normal pattern. During constipation stools may be hard, small, pellet-like, and difficult to pass. A sense of incomplete evacuation may follow. Defaecation 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.
- You may have painful menstrual periods, and experience pain during sexual intercourse.
- Symptoms rarely if ever occur at night, and don’t normally wake you from sleep.
The following may cause or exacerbate IBS:
- Stress, anxiety and depression
- Not doing enough physical exercise
- Food sensitivity (up to two-thirds of people with IBS 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 of antacids
- Tricyclic antidepressants
- Some antihistamines, mineral supplements bonded to mineral salts, diuretics, antipsychotic 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.
TREATMENT OF IBS
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, antispasmodics, antidepressants and tranquillisers.
NATURAL TREATMENT OPTIONS
The digestive tract is often called the second brain – your gut literally ‘feels’ the way you do. The most important ‘treatment’ of IBS is therefore stress management and relaxation training.
Certain foods may contribute to IBS by irritating the gastro-intestinal tract. It is recommended that you consult a registered dietitian, nutritionist or natural health practitioner to implement dietary changes and guidelines for your meal plans, since these can 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 your symptoms.
Fats and other irritants. It may be necessary to cut your 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, foods containing fatty meats or 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.
Fibre. Most people do not eat enough fibre. It is therefore recommended that you gradually include the following one by one into your daily diet, while carefully monitoring your symptoms:
- Gradually increase the amount of fresh fruit and vegetables, whole grains and oat bran in your diet.
- Take one tablespoon of bran over your breakfast cereal, in salads, stews, soups, or stirred into a glass of fruit juice or water every day.
- Take one tablespoon of soluble fibre such as psyllium or guar gum in a glass of cold water or juice once a day.
- Include whole-wheat or brown bread, minimally processed cereals such as brown rice, unsifted maize meal, sorghum porridge (Maltabella), bran-rich breakfast cereals, and products such as muffins made with bran cereal and/or wheat bran (obtainable from your local health shop, or make them yourself).
- Include raw, unpeeled fruit and vegetables, or lightly cooked vegetables, baked potatoes, fresh fruit juices, and dried fruit soaked overnight in hot water, eaten with live AB culture yoghurt and All Bran flakes.
- Include legumes such as dry beans, peas and lentils, and products made from legumes or soy. Try them one by one to see if any one tends to increase intestinal gas or abdominal discomfort.
However, wheat bran, also known as digestive bran, is controversial in the treatment of IBS. The possibility that it causes or aggravates inflammation is being investigated. Some people suffering from IBS also 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 those found in potato or maize.
Fluid intake. Drink 4 – 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 eight 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.
Fructose intolerance. Fructose, a natural sugar found in fruit, is often used to replace cane sugar. However, some people have 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 fructose intolerance can aggravate their symptoms. Fructoligosaccharides such as found in asparagus can, however, be very beneficial for IBS.
Elimination diets are useful not only to relieve symptoms, but also to identify food intolerance or allergies. Do not eat a suspect 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, as you may be sensitive 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.
Regular exercise helps regulate bowel movements. There are many different types of gentle exercise that not only help you 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.
Relieving stress and depression Aromatherapy, therapeutic massage and reflexology are wonderful ways of alleviating stress and making every part of your body, including your intestines, relax.
If you are depressed or under excessive strain, you might consider a herbal antidepressant 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 your symptoms are severe, but also go for psychotherapy or group therapy to address the deeper emotional or even soul issues underlying IBS.
Natural antispasmodics, antidiarrhoeals or laxatives can be used for short periods when the symptoms of cramps, diarrhoea or constipation are severe. Herbal remedies like peppermint help to relax the muscles of the intestinal wall, while soothing abdominal pain associated with flatulence. Fresh peppermint leaves can be steeped in boiled water and then taken as a tea with some fresh ginger grated into it, adding some raw honey. The leaves can be added to salads and cooked dishes. Peppermint oil can also be taken in capsule form. To relax the intestines, teas or tinctures made from combinations of wild yam, chamomile, marshmallow, goldenseal and peppermint, can be taken 4 – 6 times a day. Cinnamon and ginger may help for windiness and bloatedness. Aloe vera or aloe ferox juice or capsules can be taken to relieve constipation. (See also ‘Herbal remedies’ below.)
Nutritional supplements and natural or complementary remedies
- 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 available from most health shops in powder and capsule form. Be sure to choose a product with 2.5 billion live organisms per gram and take 1 000 – 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.
- 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 – 2 capsules containing 0.2 ml of enteric-coated peppermint oil 2 – 3 times a day as needed, or dilute a few drops of the oil in 2 tablespoons of vegetable oil and rub clockwise over the area of discomfort. Do not use peppermint oil internally if you have heartburn or oesophageal reflux.
- Psyllium (Plantago ovata) is rich in fibre similar to that in oat bran, flax seed 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 gastro-intestinal smooth muscle and helps with diarrhoea and constipation. Drink 3 – 4 cups of tea per day or take 10 – 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 – 3 times a day or take in capsule form.
- Valerian tea helps with anxiety and stress, enabling you 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.
Aromatherapy oils and flower remedies
It’s a good idea to 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 – 3 drops in an aromatherapy burner, or dilute it in a massage oil and rub it on the abdomen.
- Chamomile’s antispasmodic properties help to relieve abdominal cramping or discomfort. Use 1 – 2 drops in an aromatherapy burner, or dilute it in a massage oil and rub it on the abdomen.
- Peppermint oil can be diluted in 2 table- spoons 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 – 4 times a day.
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.
IBS can seriously affect 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 use natural remedies to help you cope with the symptoms!
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