IBS

Doctors may be dismissive of it but, says GP, Janet Gray, for the sufferer it is a condition causing untold suffering, worry and inconvenience 

One of the problems most commonly seen by GPs is “tummy ache”. It is the  job of the GP to sort out those patients who may have a serious  disease, for example, stomach ulcers, diverticulitis, or, even worse,  bowel cancer, from those who “simply” have irritable bowel syndrome  (IBS).

There is no test for IBS – rather it is a diagnosis made by excluding  other diseases, which probably explains why doctors may have a rather  dismissive attitude to it. The patient may be told, “All your tests are  normal – it’s only IBS.” In actual fact, from the sufferer’s point of  view, it is a condition causing untold suffering, worry and  inconvenience. 

Nature of the condition 

IBS is a very common condition, affecting as many as 20 per cent of  the population, with more females suffering than males. It is  concentrated in the 20 to 40 year age group, but can occur at all ages.

It is a cluster of symptoms, (see below) rather than a pathological  disease, and is assumed to be due to disordered bowel motility, or  possibly increased sensitivity to gut sensation, which in turn may be  due to a variety of factors. These may include stress, food intolerance  or the after-effects of a tummy bug. Sometimes the condition seems to be  a consequence of simple constipation, or a sudden change in diet.

The bowel may also react to emotional states, such as anger or  anxiety. Such “gut reactions” appear to be especially likely in those  who find it difficult to share their feelings with others, expressing  mental distress through physical symptoms.

Food sensitivities or intolerances can cause IBS symptoms (as opposed  to true food allergy which occurs rapidly after ingesting very small  quantities of the food concerned, for example peanuts or shellfish).  Abnormal fermentation in the colon, following antibiotic usage and  candidal colonisation of the bowel, can also cause IBS symptoms.

Different types of IBS 

IBS is classified according to which symptoms are the most frequent.  Several classifications exist; the following one is used at the Central  Middlesex Hospital.

Spastic colon: 

Characterised by constipation and abdominal pain, which is most  often left-sided and relieved by opening the bowels. May be associated  instead with diarrhoea.

Functional diarrhoea: 

Characterised by attacks of diarrhoea, mostly in the mornings. The  first bowel movement is usually formed, followed by a rush of mushy or  watery motions. These may be explosive, and sufferers are often  toilet-bound for long periods of time.

Foregut dysmotility: 

Characterised by abdominal bloating and discomfort frequently after  eating. Visible stomach enlargement is often a problem and any pain is  more often experienced on the right side.

Extra-bowel manifestations: 

IBS sufferers often have other symptoms including lethargy, backache,  urinary symptoms (“irritable bladder”), pelvic pain and migraine.

Symptoms of irritable bowel disease

  • Abdominal pain associated with defecation.
  • Irregular pattern of defecation for at least two days a week.
  • Three or more of the following:

– altered stool frequency;
           – altered stool form (hard/loose);
           – altered stool passage (straining/urgency/ sense of incomplete evacuation); 
           – mucus per rectum;
           – bloating or feeling of abdominal distension.

Warning symptoms that need investigation:

  • Change in bowel habit.
  • Passing blood per rectum.
  • Weight loss.
  • Constant abdominal pain.

Conventional management

This is a syndrome that is not managed well with conventional treatment.

Symptomatic relief can be obtained with smooth muscle relaxants such as peppermint oil or mebeverine hydro­chloride.

Constipation can be managed with ispaghula bulking agents and diarrhoea with loperamide or codeine phosphate.

Dietary management is important with a trial of an exclusion diet to detect food intolerance, if indicated by the history.

However none of these conventional managements addresses the problem  as a whole – they just single out one symptom at a time to treat.

This is where homeopathy is so valuable as a therapy. It is truly a  holistic form of treatment, addressing not only the bowel symptoms, but  also the psyche and the other extra-bowel symptoms that may be present.

Case histories

The following cases show how IBS can be treated with different homeopathic medicines according to the underlying problems.

Take John, for instance. He was a 40 year-old engineer, happily  married with one daughter. However, his life was plagued by frequent  attacks of abdominal pain, with distension, wind and constipation. He  also suffered from heartburn, which woke him in the night.

It all seemed to start after several courses of antibiotics given for  severe pneumonia. He was now unable to eat bread (something he loved)  or fruit or curries or fatty food.

His own GP had investigated him thoroughly and ascertained that there  was “nothing wrong” other than IBS. He was treating him with the usual  anti­spasmodics and antacids, which helped each attack, but did nothing  to prevent a recurrence.

John was very upset that his GP appeared to be dismissive of him, and did not listen to him.

He was quite emotional while I was taking his history, and also told  me with tears in his eyes about the death of his father. Because of  this, and because of his food intolerances, I gave him Pulsatilla 30c,  and he was incredulous of the improvement. His heartburn stopped  completely, but he still had occasional attacks of left-sided abdominal  pain, causing him to bend double, and which were relieved with a hot  water bottle. He was still quite angry with his GP, so this time I gave  him Colocynth 30c, which resolved the problem.

Another man, Cyril, was a 60 year-old pipe fitter who had suffered  from IBS for ten years. It started when his wife was very ill and he had  had to nurse her until she died.

All his investigations were normal, and he was on conventional  medication, which was not really controlling his symptoms. He suffered  from lower abdominal pain, with a feeling he must rush to open his  bowels.There was no wind, but copious diarrhoea, and he was always  worried he may have an accident.

He was a chilly person who loved the heat. Food-wise, he had a sweet  tooth, and also desired cream, but was averse to fat, curries and  spices. He was a great worrier about little things, and was always  restless and agitated. He described himself as a “fuss-pot”.

On these characteristics I prescribed Arsenicum 30c, with the result  that he was gradually able to reduce his conventional medication, and  eventually come off it altogether.

Joan was incapacitated by diarrhoea, which drove her out of bed in  the mornings. She was a 37 year-old teacher who had developed problems  after a tummy upset 18 months previously, after which she never seemed  to settle completely.

She constantly felt the need to open her bowels and also suffered  from wind, gurgling and bloating. She described herself as a hot, sweaty  person, although she loved the hot weather. Foodwise she loved cream  and butter but was averse to salt. She adored her food and ate it very  quickly. Her personality projected itself as extrovert and bubbly and  she admitted to being untidy and not minding mess.

I gave her Sulphur 30c and her diarrhoea became a thing of the past.

Bob’s problems started when he had an attack of diarrhoea whilst on a  flight to the USA. He was a 40 year-old successful business man, but  this problem made him very anxious whilst travelling and when he knew he  was going to be involved in long meetings.

He was ambitious, with high standards, but his anxieties were holding  him back. Especially problematic were situations when he would be asked  to do a public presentation. Although he always did them well, it was  at tremendous personal cost.

He had a great desire for chocolate, which immediately disagreed with  his tummy, and he could only eat small meals because he became full  very quickly. He had abdominal pain on the right side, which was better  for opening his bowels and passing flatus. He always had a bad time at  4pm.

All these characteristics led me to prescribe Lycopodium 30c, to which he responded very well.

General Practice 

The vital point in the treatment of IBS is to prescribe on the  totality of the patient’s symptoms, rather than just on the local  abdominal symptoms.

The cases described above were patients who consulted me privately,  but in fact 80 per cent of my time is spent in General Practice. I am  therefore very well aware of the time constraints under which GPs work,  but I am still upset at the number of patients who feel that their GP  “hasn’t time” to listen to them. Our attitude to our patients is so  important, and it actually does not take very long to listen to the  patient’s story. Those of us who use homeopathy in General Practice know  that it is not always easy to spot the constitutional remedy quickly,  but it is made slightly easier by the fact that maybe as many as 30 per  cent of patients who develop IBS do, in fact, have have a Lycopodium  constitution. In other words, the typical Lycopodium person, who is  ambitious, sets high standards for him or herself, is highly anxious,  but is determined not to show it, is just the person who will develop  IBS when under stress.

Others who may develop such symptoms with anger will require remedies  such as Nux vomica or Colocynth, while others who develop symptoms  after grief may need Natrum mur or Ignatia.

In this way, homeopathy can be used to treat the root cause of the  IBS, leaving very satisfied customers, and not simply “paper over the  cracks”.

Janet Gray MA MBBChir MRCOG MFHom  DRCOG DFFP, a GP for over 20 years, has been using homeopathy in her  Bristol practice for the last 15 years. She lectures in homeopathy at  the Bristol Teaching Centre and has a small private practice near  Chippenham.