Exploring the Role of Homoeopathy in Managing Irritable Bowel Syndrome

Abstract:

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a cluster of symptoms including abdominal pain, bloating, and altered bowel habits without any apparent structural abnormality. This review provides a comprehensive overview of the current understanding of IBS, encompassing its causes, clinical presentation, diagnosis, and management. Although the exact cause for IBS is not known, recent research has highlighted the role of gut-brain axis dysfunction, visceral hypersensitivity, altered gut microbiota, and low-grade inflammation in the pathogenesis of IBS. Its presentation varies widely among individuals. Rome IV criteria serve as the cornerstone for diagnosing IBS, emphasizing the importance of symptom pattern recognition and exclusion of organic diseases through appropriate investigations. Management of IBS involves a multidisciplinary approach such as lifestyle modifications, dietary interventions, probiotics, and psychological therapies. 

Introduction:

Irritable bowel syndrome (IBS) is a functional bowel disorder characterised by abdominal pain or discomfort and altered bowel habits in the absence of detectable structural abnormalities. No clear diagnostic markers exist for IBS; thus, the diagnosis of the disorder is based on clinical presentation.¹ In 2016, the Rome III criteria for the diagnosis of IBS were updated to Rome IV.

Rome IV criteria for IBS: Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:

1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with a change in the form (appearance) of stool

These criteria should be fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.²

IBS Types:

• Mostly diarrhoea and abdominal discomfort (IBS-D).
• Mostly constipation and abdominal discomfort (IBS-C).
• Alternating loose stools and constipation with abdominal discomfort (IBS-mixed).
• Undefined subtype (IBS-U) — symptoms vary.³

CAUSES:

The exact cause of IBS isn’t known. Factors that may contribute to the development of disease:

• Muscle contractions in the intestine. The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Contractions that are stronger and last longer than usual can cause gas, bloating and diarrhoea. Weak contractions can slow food passage and lead to hard, dry stools.
• Nervous system. Issues with the nerves in your digestive system may cause discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that typically occur in the digestive process. This can result in pain, diarrhoea or constipation.
• Severe infection. IBS can develop after a severe bout of diarrhoea caused by bacteria or a virus. This is called gastroenteritis. IBS might also be associated with a surplus of bacteria in the intestines.
• Early life stress. People exposed to stressful events, especially in childhood, tend to have more symptoms of IBS.
• Psychological factors Such as stress, anxiety, and depression have been implicated in the onset and exacerbation of IBS symptoms.
• Changes in gut microbes. Examples include changes in bacteria, fungi and viruses, which typically reside in the intestines and play a key role in health. Research indicates that the microbes in people with IBS might differ from those in people who don’t have IBS.⁴

CLINICAL FEATURES:

1. Abdominal Pain It varies in intensity and location. It is frequently episodic and crampy. 
2. Altered Bowel Habits It is the most consistent clinical feature in IBS. The most common pattern is constipation alternating with diarrhoea.
3. Gas and Flatulence 
4. Upper GI Symptoms Like dyspepsia, heartburn, nausea, and vomiting. ⁵

The Mind-Gut Connection

The relation between the mind and the gut has long been recognized in both traditional and modern medicine. The mind-gut axis represents bidirectional communication pathways between the central nervous system (CNS), which includes the brain and spinal cord, and the enteric nervous system (ENS), which governs the function of the gastrointestinal tract. These communication pathways involve neural, hormonal, and immunological mechanisms, allowing for constant interaction and modulation between the brain and the gut.

Gut-Brain Axis Dysfunction in IBS: 

Dysregulation of neurotransmitters, such as serotonin and gamma-aminobutyric acid (GABA), can affect gut motility, visceral sensation, and mood regulation. Moreover, changes in the gut microbiota composition, known as dysbiosis, have been observed in individuals with IBS, influencing both gastrointestinal function and brain health. This bidirectional communication imbalance between the gut and the brain can perpetuate IBS symptoms and exacerbate psychological distress.

Diagnosis:

There’s no test to definitively diagnose IBS.  Additional tests may be recommended to rule out other causes of your symptoms. Eg.Colonoscopy, CT scan, Upper endoscopy, Stool test.⁶

Homoeopathic Therapeutics⁷ 

1. Alumina: a very general condition corresponding to this drug is dryness of mucous membranes and skin. Stools are hard dry, knotty; no desire. Rectum sore, dry, inflamed, bleeding. Even a soft stool is passed with difficulty. Great straining. Diarrhœa on urinating. Evacuation preceded by painful urging long before stool, and then straining at stool.
2. Argentum Nitricum: in this remedy there is a lot of wind, with very loud and forceful belching or flatulence. There is nausea and indigestion associated with nerves or anxiety, especially when anticipating a stressful event like a job interview or exam.
3. Aloe Socotrina:  especially suitable to lymphatic and hypochondriacal patients. A lot of mucus, with pain in rectum after stool. Burning in anus and rectum. Constipation, with heavy pressure in the lower part of abdomen. Diarrhœa from beer.
4. Bryonia Alba: it affects especially the constitution of a robust, firm fibre and dark complexion, with tendency to leanness and irritability. Constipation. Stools hard, dry, as if burnt; seem too large. Stools are brown, thick, bloody; worse in the morning, from moving, in hot weather, after being heated, from cold drinks, every spell of hot weather.
5. Carbo Veg: the remedy is well-suited to older people or those suffering from general fatigue with stomach pains that are burning, sore or pressing. There are cramps which feel like the stomach is being contracted with a lot of bloating after eating. Butter, fats & rich foods can cause belching, heartburn and indigestion with weakness or faintness.
6. Lycopodium Clavatum: this is mainly prescribed for people with diarrhoea and gas. This drug acts specifically on the gastrointestinal tract. Diarrhœa. Inactive intestinal canal. Ineffectual urging. Stool hard, difficult, small, and incomplete. Hæmorrhoids; very painful to touch, aching.
7. Natrum Muriaticum: indigestion after too much starchy food with sour belching & terrible hiccough. There are painful stomach cramps, aggravated by touch. Strong emotions such as grief, or stewing in the past can aggravate the condition.
8. Nux Vomica: this drug is derived from a plant and has a positive effect on the digestive and nervous system, thereby being effective in the treatment of ibs. Constipation with frequent ineffectual urging, incomplete and unsatisfactory; feeling as if part remained unexpelled. Constriction of rectum. Irregular, peristaltic action; hence frequent ineffectual desire, or passing but small quantities at each attempt. Absence of all desire for defecation is a contra-indication. Alternate constipation and diarrhœa-after abuse of purgatives. Diarrhœa after a debauch, worse, morning. Frequent small evacuations. Constant uneasiness in rectum. 
9. Pulsatilla: it is effective in the cure of IBS with its remedying effect on the gastrointestinal tract. Rumbling, watery stools worse at night. No two stools alike. Blind hæmorrhoids, with itching and sticking pains. Dysentery; mucus and blood, with chilliness. Two or three normal stools daily.
10. Sulphur: it affects the digestive tract and is helpful in the treatment of intestinal gas and constipation. It is usually prescribed for individuals who are rather thin and physically weak. Frequent, unsuccessful desire. Stools are hard, knotty and insufficient. Redness around the anus, with itching. Morning diarrhœa, painless, drives out of bed, with prolapsus recti.

It is important to note that homoeopathic treatment is based on individualization, and medicine is selected on the basis of the uncommon, peculiar and characteristic symptoms of the patient. Moreover, it also emphasises changes in diet and regimen and stress management techniques as integral components of holistic healing for IBS.

Conclusion:

Living with Irritable Bowel Syndrome can be challenging, but by adopting a comprehensive approach that addresses the physical, emotional, and dietary aspects of IBS, individuals can better manage their symptoms and improve their overall quality of life. While the scientific evidence supporting the efficacy of homeopathy for IBS remains limited, many individuals report improvements in symptoms and overall well-being with homeopathic treatment.

Interest of Conflict: The author is solely responsible for the content and writing of the article. 

Financial Help– Nil

References:

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6. Irritable bowel syndrome |Diagnosis |Mayo Clinic| https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064
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