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IBS/IBD

What are IBS and IBD?

Up to 20% of Americans are affected by digestive disorders such as Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD).(1) Although these two conditions have many similar symptoms, they are significantly different.

While IBD is a chronic disease that causes inflammation of the colon and small intestine, IBS is a collection of gastrointestinal symptoms with no evidence of a cause, such as inflammation or tumors. IBS and IBD share the symptoms of cramping, abdominal pain, bloating, diarrhea, constipation and mucous in the stools.

Genetic connections have been found in those who suffer from IBD. The two major types of IBD are Crohn’s disease and ulcerative colitis. Serious IBD symptoms include vomiting, bleeding from the colon/intestines, joint pain, fevers and weight loss.

Symptoms may vary day to day with IBS. However, those with IBD have periods of exacerbating flares and live in fear of a continuous worsening of their symptoms leading to hospitalization and possibly surgery. Living a normal life is difficult for either condition. Eating, sleeping, working and having a normal social life are significantly compromised.

IBS is a diagnosis of exclusion, which means that the symptoms, including IBD, need to be ruled out before this diagnosis is given. IBD is diagnosed by clinical symptoms as well as imaging, colonoscopy and biopsy results. Some blood tests may be abnormal from those suffering from IBD, as well. These diagnostic tools help rule out other gastrointestinal disease that can mimic symptoms of IBS/IBD, such as mal-absorption syndromes, lactose intolerance, celiac disease, infectious colitis, colitis related to medications, diverticulitis and colorectal cancer.

Conventional Treatment

Causes remain unclear for IBS; therefore, treatment is aimed at symptom management to prevent symptoms from interfering with daily life. Conventional treatments aim at managing pain and decreasing diarrhea and constipation.

IBD treatment focuses on getting the patient into remission. There is no conventional cure for IBD. The only “remedy” for IBD is removing the part of the intestine that is producing the symptoms.

Unfortunately, the medications used to treat both IBS and IBD can have dangerous side effects and are not always effective. In fact, no single medication is known to have long-term lasting effects for the treatment of IBS specifically.

Anticholinergics are used as the first line therapy for IBS. While they slow the spasms of the abdomen and decrease pain, they are not particularly effective. Patients with liver or kidney problems, severe ulcerative colitis or GERD cannot use these drugs.

Another common medication given in both IBS and IBD is an antidiarrheal. This medication slows the production of diarrhea, but may also produce something termed a toxic megacolon – a medical emergency when the bowel becomes paralyzed and is unable to excrete feces. This medication should be used with extreme caution in patients with IBD and cannot be used if the person exhibits bloody diarrhea. The side effects of both of these drugs include more gastrointestinal problems, such as dry mouth, gastrointestinal disturbances, nausea, vomiting, constipation and diarrhea.

Tricylic antidepressants are other medications used in IBS to decrease abdominal pain and diarrhea. Since these drugs affect brain chemistry, they can produce side effects of suicidal ideation, insomnia and worsening of depression. They must be used with caution for patients who have cardiovascular risk, since these drugs may cause symptoms of arrhythmias, heart attack and stroke (in those at risk of heart disease). They can also cause unintended weight gain.

Other drugs that can be used include bile acid binding agents, stimulant laxatives, stool softeners, antispasmodics, anti-anxiety agents and other anti-depressants.

Stronger medications are reserved for IBD including suppositories, immunosuppressive drugs and steroids. Then, there is surgical removal of the colon or parts of the small intestine. Sulfasalazine suppositories are used in the treatment of IBD that is particularly flared in the anal area. This suppository includes components in aspirin to decrease inflammation in this area. It is useful in soothing the area, and can allow those with disease limited to this area to go into remission. However, it can produce allergic reactions that are similar to the symptoms of flares. Side effects include diarrhea, nausea, and rash.

Oral and IV steroids are used during flares of IBD to decrease inflammation and bleeding. Although steroids are very useful in the short-term treatment of IBD, they are not well tolerated for long-term use. They can cause immune suppression, depression, risk of suicide and exacerbate osteoporosis. Side effects of steroid use include mood changes, diarrhea, nausea, yeast growth, weight gain, hair growth and growth suppression in pediatric patients.

Immunosuppressants are reserved for disease that does not respond to other medications, as they are the most dangerous. These drugs suppress the immune system so that the body will not mount an inflammatory response, thus eliminating inflammation. Patients taking these drugs require weekly blood monitoring due to potential for bone marrow and liver damage. Use of these drugs can also increase infection rate, cause hair loss, weight loss, vomiting, mouth ulcers and inflammation of the esophagus.

At least 30% of patients with ulcerative colitis end up having surgery to remove all or part of their colon. Some have to live with a colostomy bag, while others will have an internal pouch in place of the colon, which is then connected to parts of the small intestine and anus. While this retains fecal function, it commonly becomes inflamed. Sixty percent of people who have this surgery suffer from pouchitits regularly, which causes symptoms of increased stool frequency, infection from bacterial overgrowth, cramping, fever, and rectal bleeding.

Homeopathic Treatment

Few people know there are other options to treat IBS and IBD. Homeopathic medicines are types of natural medicines that are used to treat disease. They are selected for very specific reasons based on the expression of each individual’s symptoms. Symptoms unique to an individual are used to determine a specific homeopathic medication that covers all of the symptoms in the case related to the disease condition, as well as those related to the individual as a whole.

Homeopathic medicine is given to decrease the susceptibility to the disease and to prevent recurrences. Homeopathy works by triggering your body to self-heal, therefore treating the underlying predisposition to developing IBD. For example, people who suffer from IBD/IBS may react to different foods and stress. However, these conditions result from an imbalanced body. With successful homeopathic treatment, over time, the body will be less reactive to stress and foods. With continued homeopathic therapy, the person becomes healthier, and fewer medications, supplements and diet changes are needed to remain symptom free.

It’s important for people who to understand that different from conventional treatments, there are natural, even herbal, remedies for IBS and IBD. Successful diet plans can be created for individuals that aim to decrease the symptoms of IBS and IBD, some of which may include natural supplements. Ask your natural doctor for a complete plan to assist in healing your body.

Other Treatments

Other natural support may be used to treat IBS/IBD – to decrease inflammation, help repair tissue, decrease abdominal spasms/pain and help regulate the stool. Sufferers of IBS and IBD usually find that certain foods trigger their symptoms. Many have to make adjustments in their diet, especially in the beginning of treatment. Sometimes people may have sensitivities to unusual foods that are determined with a simple blood test. Because those with IBD, specifically, have so much inflammation, they also have greater intestinal permeability. In other words, the lining of the gut allows larger proteins and bacteria in and out. This permeability and inflammation of the small intestine or colon, can lead to impaired absorption of important nutrients and vitamins. Outcomes of this problem, such as anemia and nutrient deficiencies (like B1, folic acid and vitamin D) should be evaluated, so replacement of those nutrients can be initiated.

Other natural support to modify inflammation includes Probiotics and essential fatty acids, including fish oil. Studies show that Probiotics are as effective as some prescription drugs in treating IBD(2); and decrease gas, bloating and abdominal pain in IBS.(3) Enteric coated Peppermint Oil can also decrease abdominal pain relating to spasms of the abdomen.(4 & 5)  Additionally, stress and anxiety are triggers that exacerbate symptoms in both diseases. Stress management including therapy, music, reading, meditating and praying can be effective in decreasing the aggravation of symptoms. Hypnotherapy has demonstrated symptom reduction in IBS.(6) In patients with constipation predominant IBS, psyllium fiber can be used to bulk the stool and stimulate activity of the colon.(7)

Self-Care for IBS/IBD

If you or someone you know suffers from IBS or IBD, there are some things that they can start to do, which may help:

  • Make sure you are not suffering from lactose intolerance. Lactose intolerance mimics symptoms of IBS and is treated entirely with dietary modification. Try eliminating all dairy products and see if symptoms abate.
  • Stress management: Managing stress appropriately can decrease symptoms of IBS and help reduce flares of IBD. Some ways to manage stress include calming exercises such as stretching, walking and yoga. Relaxation techniques, like deep breathing exercises, guided imagery and meditation may be used. Take time out of your day to check in with yourself. Take a bath, listen to music or read. Allow your mind to decompress, decreasing the biochemical responses to stress that lead to increases in symptoms.
  • Maintain a healthy diet: A clean diet avoids aggravation. Those who suffer from IBS and IBD are predisposed to gastrointestinal symptoms. They have to be much more careful in their diet than the average person is. Eating organic, unprocessed foods is a key. Avoid aggravating foods such as dairy, wheat, artificial sweeteners, fatty, fried foods, caffeine and alcohol. In flares of IBD, it is common to eat very bland foods to avoid additional abdominal upset.
  • Exercise regularly: Low impact exercise, especially with IBS, is important in the reduction of symptoms. Exercise provides an outlet for stress, as well as overall well-being. However, during flares of IBD exercise should be minimal to avoid added stress on the body.
  • Avoid NSAIDs, such as ibuprofen. While they may decrease pain, these medications put undue stress on the stomach and will increase symptoms in the long term.

Case Study on IBS

Homeopathy has been successful in treating both IBS and IBD in our office. “Janet” is a 30-year old woman who came to see me in the middle of a flare of her ulcerative colitis. She was diagnosed with this disease 10 years previously via colonoscopy and biopsy. Her most recent colonoscopy showed ulcers and inflammation present in the colon. She was presenting with symptoms of abdominal pain, bloating, diarrhea, blood in the stools and weight loss. She was already on aminosalicylate suppositories and oral steroids. Janet was continuing to have severe symptoms, despite the high dose of steroids. She was desperate to stop the bleeding and return to normal daily living.

The first thing we did was supportive therapies, using high doses of probiotics and fish oils, as well as putting her on a hypoallergenic diet. Some improvement occurred within a week. Mostly, the frequency of the diarrhea decreased and the stool became more formed.

The following week, we began homeopathic treatment. She had some individual symptoms that indicated the appropriate remedy. Her diarrhea was very specific in that it drove her out of bed every morning at 5AM, and was burning in nature. She also described her abdominal pain as burning. In homeopathy, it is not just the symptoms of that disease that are considered, but all individualizing aspects of the person as well. Therefore, the fact that she was a very warm individual, so warm that she stuck her feet out of the covers at night was useful in prescribing. These symptoms lead to the remedy – Sulphur. Sulphur can be used for many concerns, including eczema, menstrual irregularities, and back pain, as well as GI problems. Once this remedy was prescribed for Janet, she immediately began to see results. One week after this remedy was given, her stools normalized, the bleeding lessened significantly and her abdominal pain was gone! Janet stayed on this remedy for several weeks with increasing improvement.

Most patients with chronic disease may need to change remedies several times until they are healed. Janet was no exception. After about a month on this remedy, the improvements began to plateau. Janet’s symptoms in her case also began to change. She was no longer having diarrhea, but she was still having bouts of minimal bleeding, which was bright red in color. Also, she suddenly became more thirsty than usual, especially desiring ice-cold beverages. She also began to worry about her condition – more than she had in the past, despite the fact that her symptoms where greatly reduced. Finally, Janet no longer wanted to be alone. She stated that she felt much better physically and emotionally when she was around her boyfriend.

These new symptoms lead to the new remedy prescription of Phosphorus, which I gave her in daily doses. By the next follow up, her bleeding had cleared up and she had no residual symptoms of the flare. After her symptoms were gone, Janet went in for a follow up colonoscopy. It showed that the ulcers had healed and there was much less inflammation. This was two years ago.

Janet has been on increasing potencies of Phosphorus since this time. Because ulcerative colitis comes in “flares”, you always want to be on the lookout for any worsening of symptoms. Only three times in that two-year period did she exhibit some abdominal pain, which cleared up by increasing the potency of her remedy.  Janet is forever grateful that she gave homeopathy a chance.

References:

2. W Kruis, P Frič, J Pokrotnieks, M Lukáš, B Fixa, M Kaščák, et al. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut. 2004 November; 53(11): 1617–1623.

3. Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of Probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010; 59:325-32.

4. Lesbros-Pantoflickova D, Michetti P, Fried M, Beglinger C, Blum AL. Meta-analysis: The treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;20:1253-69.

5. Quartero AO, Meineche-Schmidt V, Muris J, Rubin G, de Wit N. Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2005:CD003460.

6. Hypnotherapy for functional gastrointestinal disorders. Drug Ther Bull. 2005;43:45-8.

7. Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ. Systematic review: the role of different types of fiber in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;19:245-51.