IBS (Mucous colitis)

                                                      Irritable Bowel Syndrome 
                           (IBS, Mucous colitis, Spastic colitis)

      It is an idiopathic disorder including chronic recurrent variable gastrointestinal symptoms mainly, which cannot be explained by the anatomical or biochemical abnormality. This is an extremely common condition which is seen common in adults
(25%). 

There are four variants of IBS:

·         IBS-A (alternating constipation and diarrhea).

·        IBS-C (primarily constipation)

·         IBS-D (primarily diarrhea)

·         IBS-M (a mixture of constipation and diarrhea).

Pathogenesis:

   Though the exact explanation is far from clear the following factors are mostly responsible: 

Abnormal intestinal motility:

  Myoelectrical and motor abnormalities have been found in the small and large gut but whether these are primary or secondary to psychic stress is difficult to assess. 

Increased visceral nociception:

  Visceral pain threashold is low on these subjects and hence the low volume of colonic gas may produce symptoms of abdominal distension and pain. 

Psychosocial stress:

  More than 50% of cases of this disease will have anxiety, depression or somatization, These will ultimately influence the development of symptoms. 

Clinical Features:

  Onset is acute to chronic: 


Age: Younge adults but the disease runs throughout life. Four important symptoms should be present to make a diagnosis of IBS. 

1. Bloating of distension of abdomen,
2.Diffuse abdominal pain which is relieved after an adequate bowel movement. 
3Incresed frequency of stool with the onset of pain, and
4.Loose stool with the onset of pain. 

  More than 90% of the patients will have these symptoms though in different proportions and these symptoms must be present for at least 3-6 months before a diagnosis is made. Bloating of the abdomen is a very important symptom though this is not alway clinically evidenced. Abdominal pain is diffuse, cramps, intermittent and mostly located in the lower abdomen. Constipation, loose stool, frequent stool or even alternate constipation and loose stool all commonly seen. But whatever may be the character of stool mucus is always present, so the character of stool mucus is always present, so the other name is "Mucous colitis". 
   Fever, weight loss, blood in stool or nocturnal diarrhea will not be present and should arouse suspicion for the presence of organic disease. Similarly, when these symptoms start at later life organic cause in the background should be suspected. On examination, nothing remarkable should be suspected. On examination, nothing remarkable is found but slight abdominal tenderness may be present. As there is anxiety in the background anxious facies may also be present. But all organic causes should be searched during clinical examination.  

diagnostic criteria:

   Abdominal distension (bloating).

      Diffuse lower abdominal pain noticed, particularly in the lower left quadrant. Pain is usually reported as a constant dull ache with occasional episodes of acute sharp pain. Eating may precipitate this pain and it’s often relieved by defecation. For diagnostic purposes, the pain described here should have been present for at least 3 days per month during the previous 3 months.

·         Altered bowel habits, consisting of constipation, diarrhea, or an alternation between the two, including defecation urgency, particularly after a meal.

Special Investigations: 

  Blood, stool and biochemical examinations reveal no abnormality. The endoscopic examination also reveals normal features. 

The orthodox medical management of IBS commonly consists of the use of dietary fiber, polycarbophil compounds, anticholinergics, antispasmodics, antidepressants, a FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) exclusion diet, as well as a lactose and fructose exclusion diet.

Natural medicine practitioners commonly advise clients with IBS to use probiotics, glutamine, psyllium, melatonin, curcumin, Vitamin D, Aloe vera, peppermint oil, Brahmi, Cat’s claw, Artichoke leaf or Slippery elm, and similar dietary restrictions to those referred to above.

The homeopathic treatment of a person with IBS is typically based on the use of a homeopathic medicine that’s been selected on the basis of a similarity between the signs and symptoms of the client, and the homeopathic proving symptoms of the medicine. This medicine selection process, otherwise known as homeopathic repertorization, is designed to guide the prescriber to a very specific medicine prescription yet it often brings up one or more of a recurring group of medicines, and a brief discussion of each of these medicines follows.

homeopathic therapeutics:

Sulphur

Sulphur is often useful in cases where the person suffers from diarrhea with an urgent need to pass stools soon after waking in the morning, often at around 5 a.m. A difficulty in passing stools may occur at other times of the day, with hyperacidity, abdominal colic after drinking, offensive flatulence and offensive belching, often reported. There may be anal and other pruritis, with most symptoms having a burning character. Dry skin and red orifices may also be present. The person requiring Sulphur will typically desire sweet foods, have adverse reactions to milk, be irritable, forgetful, experience back pain and appear to have bad posture. Most ailments are inclined to relapse. Symptoms are worse when standing for prolonged periods, and better from lying on the right side or drawing in the legs.

Colocynthis

The Colocynthis type of person often appears to be angry or irritable. In this instance, diarrhea, abdominal distension, and severe cramping or cutting lower abdominal pain that’s relieved by pressure or bending double, may be noted. A bitter taste in the mouth may be reported, along with great hunger, muscular cramping (particularly of the calves), twitching, gallbladder disturbances and back pain. Symptoms are worse from suppressed anger or irritability, a bowel movement, from eating fruit or drinking water, anger or irritation, and better from hard pressure and warmth.

Argentum nitricum

A watery, flatulent, offensive, diarrhea which occurs immediately after eating or drinking, or which is associated with emotion, is usually seen here. Anxiety or ailments from mental exertion are often associated with these issues and the sufferer may have a marked desire for sweet food. The person may appear to be nervous, fearful, forgetful, hurried and impulsive. Nausea, vomiting of mucoid materials, belching, abdominal distention, lower left quadrant abdominal pain, flatulence, a sense of an epigastric “lump”, and bloating may be found, and disorders of blood sugar may be present. One of the characteristics here is that pains increase and decrease slowly. Symptoms are worse from warmth, cold or sweet food or at night, and are better from pressure, cold and belching.

Lycopodium

In this case, constipation and diarrhea are frequently alternating. There may be indigestion, heartburn, borborygmi, nausea, as well as abdominal pain and distension that’s worse at the end of, and immediately after, eating. The abdominal pain and distension are not relieved by the passage of flatus. Pain tend to travel from right to left and come and go suddenly. There’s often a sense of heaviness in the abdomen after eating and a dislike of tight clothing. The person is usually thirstless with a dry mouth and halitosis and may appear to be sensitive, apprehensive and forgetful. There may be a history of liver or kidney disorders, poor circulation and digestive weakness, a desire for hot food and drink as well as sweet foods, and the appetite may be increased to the point where the person may remark on having to get out of bed in the middle of the night to eat. Symptoms are worse on the right side, from heat, between the hours of 4 and 8 p.m., and from consuming beans, cabbage or onions. Symptom improvement may occur with rubbing the abdomen, consuming warm drinks, exposure to cold, or being uncovered.

Nux vomica

Nux vomica can be useful for those reporting constipation with the passage of small quantities of stool, colicky abdominal pain that occurs an hour after eating, flatulence, cramping, heartburn, bitter belching, and abdominal distension that occurs after eating. There may be insomnia, a history of liver congestion, overeating, stress, or overwork. The person in question may appear to be irritable, chilly, impatient, and sensitive to light, odors, and noise. There’s often a desire for alcohol, coffee, cigarettes, spicy foods, and stimulants generally. Symptoms are worse from eating, from stress, anger, alcohol, stimulants and spicy foods. Symptoms are improved by strong pressure, from a nap, from consuming hot drinks and passing flatus.

Natrum carbonicum

The pointers to Nat carb include indigestion, heartburn, belching, abdominal distension, flatulent diarrhea, dairy intolerance and a bitter taste in the mouth. There’s often a sudden desire to pass stool and the sufferer may express a craving for potatoes and sweet foods. The person may present as mentally and physically weak, sensitive, and depressed. Symptoms are worse from milk, sitting, mental exertion or a change in the weather, and better from physical movement.

Natrum muriaticum

The usefulness of Nat Mur is often indicated by constipation with straining to evacuate the bowel, dry, crumbling stools, indigestion, heartburn, abdominal cutting or cramping pain, abdominal distension, fatigue, dry mucous membranes, hiccoughs and a hypersensitivity to external stimuli. The person may be excessively thirsty, with a dry mouth and a salty or bitter taste, and have a desire for salty or starchy foods. Feeling of incomplete evacuation may be described.  There may be a history of fluid retention or endocrine disorders. The person may appear to be quiet, shy, sensitive, irritable or depressed. Symptoms may be worse mid-morning, lying down and from mental exertion. Symptom improvement may arise from lying on the right side, tight clothing, exposure to open air or cold bathing.

Aloe

The need for Aloe may be indicated by the presence of uncontrolled flatulent diarrhea which is worse after eating or drinking, an accelerated gastrointestinal transit time, abdominal pain particularly around the umbilicus, bloating, nausea, belching, a bitter or sour taste in the mouth, and flatulence after eating. The abdominal pain often occurs before and during a bowel movement but diminishes after the event. A bearing down sensation in the rectum may be reported and there may be a feeling of a loss of muscular power in the anus. The stool is often watery or mucoid. There may be a history of liver congestion and fatigue. Symptoms may be worse in the early morning and from eating or drinking, and better from cold.

China:

  China will frequently be of use where there is a thin liquid diarrhea of undigested food, fatigue, vomiting of undigested food, abdominal distension, flatulence and belching, borborygmi, and darting, flatulent colicky abdominal pain. The digestive processes in this instance are often quite slow. Symptoms are periodic and there may be a bitter taste in the mouth. Symptoms are worse from fruit, beer or tea, at night and after eating, and from a light touch. Symptoms are better from warmth, hard pressure or bending double.

Repertorial approach:

Complete repertory:

Abdomen, DISTENSION,General: 3Acon, 3Aloe,3Arg-n,3Ars,3Calc, 3Carb-v.3Carbn-s,3Chin, 3 Cic, 3Cocc,3Colch,3Graph, 3Hep, 3Kali-c,3Lach, 3Lyc, 3Mag-c,3Merc,3Nat-c,3Nat-p, 3Ph-ac, 3Phos, 3Ptel, 3Raph, 3Sulph, 3Ter. 

Abdomen, PAIN, general eating agg-after: 3Graph, 3Staph,3Verat, 2All-c, Alum, ars, calc-p, carb-v, cham, chin, cocc, coloch, coloc, ferr, gran, kali-c, kali-p, lyc, mag-c, nat-c, nat-m, nux-m, nux-v, ph-ac, phos, pitu-a, psor, puls, rhod, Rhus-t, sars, stann, stront-c, sul-ac, sulph, thuj, zinc.


Rectum, CONSTIPATION, alternating with diarrhea: 3Ant-c, 3Chel, 3Nit-ac,3Nux-v, 3Olnd, 3Op, 3Podo, 2abrot, arg-n, ars, aur, aur-i, aur-s, bry, carb-ac, cord-n, cimic, cob, coll, con, cupr, dig, ferr-i, hep, hydr, ign, iod, kali-c, lac-d, lach, lact, lyc, manc, mang, nat-m, nat-s, nux-m, phos, plb, ptel, puls, ruta, sulph, tab, tub. 

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