Vatika Pravahika Written by Kapil Thakur

Vatika Pravahika The Modern Day Irritable Bowel Syndrome

Till few years back IBS was not much reported by patient or treated by physicians. Dietetic indiscretion and psychological factors have come together now in modern life to increase the incidence of this, psychosomatic ailment, which is commonly associated with, frequent unclear stools mild tenesmus & increased duration of defecation. Though not a fatal disease IBS has got significant morbidity, and causes financial loss to sufferer.

What is “Irritable Bowel syndrome”

Irritable Bowel syndrome is made up of three words i.e.
Irritable - Means abnormal sense of stimulus
Bowel - Means Intestine
Syndrome - Means a group of symptoms.
IBS is conceptualized as a “Cluster of intestinal symptoms” in which intestine is irritable or hypersensitive to emotional mechanical or chemical stimuli most of all emotional.
IBS is a gastro intestinal disorder characterized by altered bowel habits and abdominal pain in the absence of detectable structural abnormalities.
IBS is one of the most common conditions encountered in clinical practice but one of the least well understood. No clear diagnostic markers exist for IBS; so all definitions of the disease are based on the clinical presentations.

Epidemiology

Although IBS is recognized widely as one of the most commonly encountered gastro intestinal disorder, yet reliable data about prevalence is not available because the disease is not fatal, not reportable, is widespread in general population and over 90% of the patients never get hospitalized. Population surveys show that it is the second most common cause of absenteeism from work after common cold; also there is evidence that 15% of general population has some symptomatology suggestive of IBS but they do not seek medical attention. In fact only 20% of patients who qualify for the diagnosis seek medical advice for the same IBS is the most common cause of referral to gastroenterologists accounting for 20-50% of all referral patients.

Clinical Features

(a) Abdominal Pain
1. Abdominal pain in IBS is highly variable in intensity and location.
Pain in IBS in localized to :
The Hypogastrium - 25%
The Epigastrium - 10%
The Right Side of Abdomen - 20%
The left side of Abdomen - 20%
2. Pain is often described as vague, bloating, crampy, burning, dull, aching, knife like sharp or steady pain.
3. Pain is often exacerbated by eating or emotional stress and relieved by passage of flatus or stool.
(b) Altered Bowel habits – Alteration in bowel habits in the most consistent clinical features in IBS. Symptoms usually begin in adult life.
Constipation – At first constipation may be episodic but eventually it becomes continuous and increasingly intractable to treatment with laxatives.
i) Stools are usually hard in consistency. 
ii) Most patients also experience a sense of incomplete evacuation. Thus leading to repeated attempts at defecation in short time interval.
Diarrhea
i) Usually consists of small volumes of loose stools and patients have stool volumes of Less than 200ml.
ii) Evacuation is often preceded by extreme urgency or tenesmus
iii) Nocturnal diarrhea does not occur in IBS
iv) Diarrhea may be aggravated by emotional stress or eating.
(C) Gas and Flatulence: Patients frequently complain of abdominal distention and increased belching or flatulence
(D) Mucus in Stool
i) Stool may be accompanied by passage of large amounts of mucus but this mucus is just an exaggeration of normal.
ii) Bleeding is not a feature of IBS unless hemorrhoids are present.
(E) Upper Gastrointestinal symptoms: About 25-50% patients complain of dyspepsia, heartburn, nausea and vomiting.

Pathophysiology

The pathogenesis of IBS is poorly understood although roles of factors mentioned below have been proposed.
a. Abnormal gut motor and sensory activity 
b. Central neural dysfunction 
c. Psychological disturbances and stress 
d. Colonic myoelectrical and motor activity under stimulated conditions are generally normal but abnormalities are more prominent under stimulated condition in IBS 
e. IBS patients may exhibit increased rectosigmoid motor activity for up to 3hr after eating.
f. Provocating stimuli also induce exaggerated colonic motor responses in IBS patients compared to healthy volunteers.
g. As with studies of motor activity, IBS patients frequently exhibit exaggerated sensory responses to visceral stimulation. Postprandial pain has been temporally related to entry of food bolus in to the caecum in 74% of patient. 

Treatment 

- Patient counseling and Dietary alteration
- Reassurance and careful explanation of the functional nature of the disorder and how to avoid obvious food precipitants are important first step in patients counseling and dietary change. Information related to the disease might help patients with IBS to perceive less pain and more vitality and there by he may experience a higher quality of life.
- A course of instruction for patients with IBS may be of benefit for the patients and could be a part of a multicomponent approach in the treatment of IBS .
- Occasionally a meticulous dietary history may reveal substances (Such as coffee disaccharides legumes and cabbage) those aggravate symptoms.

Drugs useful in IBS

Single drug - In management of IBS the single drugs like Kutaja, Bilva, Dadima, Kapittha, Ajmoda Ahiphena etc are useful and effective.
Compound drugs - compound drugs and formulations, which are useful and most effective, are Balbilvadi, Khanda, Balbilvadi Leha, Bilvamajjadi yoga, Pravahika Sunthyadileha, Aprajitakhanda, Kutjavleha, Changeri Ghrita, Massoor Ghrita, Pippali, Marich Kalka, Gangadhar, Churna etc.

Pathya

- Laghu Deepan and Snigdha food particles are indicated in IBS 
Khada (a type of soup) prepared with equal quantity of paste of bilva and tila paste mixed with curd should be given.
- Oil prepared by the drugs of vidarigandhadi gana with salt should be used in the preparation of foods and drinks.
- The use of milk duly boiled and cooked with the mixture of  Trikatu and Vidarigandha should be given.

APATHYA

- The patient should avoid Kama, Krodha, Moha, Lobha, Bhaya, Shoka, Anxiety etc.
- The patient should have a regular diet in their routine.
- The patient should avoid the use of Eggs Pulses, Rajma, Cheese, Basan, Meda Based Food etc.
- The patient should avoid spicy and fried food.
- The patient should avoid the heavy diets which is difficult to digest.

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