IRRITABLE BOWEL SYNDROME (IBS)

• Irritable bowel syndrome (IBS) is a common chronic condition affecting the intestine presenting with recurrent, non specific changes in bowel movements and abdominal symptoms diffuse pain, bloating, diarrhoea, constipation and/or both
• The exact pathophysiology is unknown, but may involve changes in gastrointestinal motility, visceral hypersensitivity, and altered gastrointestinal permeability

• IBS is a functional gastrointestinal disorder without a specific organic cause

Constipation predominant IBS

• Faecal evacuation disorder and slow transit are the contributing physiological dysfunctions

Diarrhoea Predominant IBS 

• lactose & fructose intolerance, Bile acid mal absorption, non celiac wheat sensitivity, small intestinal bacterial overgrowth etc. are the contributing physiological dysfunctions

Risk factors

• Family history of IBS
• Anxiety, depression

Four different patterns are seen in the presentation of irritable bowel syndrome

• IBS‑D (diarrhoea is the predominant symptom)
• IBS‑C (constipation is the predominant symptom)
• IBS‑M (mixed diarrhoea and constipation)
• IBS‑A (alternating diarrhoea and constipation)

IBS is characterized by chronic abdominal pain and changes in bowel habits – both of which are typical, but not specific, symptoms

• Abdominal pain: Localization, intensity and Frequency generally vary widely from patient to patient
• Typically related to defecation : pain is often alleviated by defecation , but in few patients it may increase or remain unchanged
• Altered bowel habits: diarrhoea and/or constipation 

Other symptoms

• Passing of mucus, abdominal bloating
• Generalized pain or fatigue
• Disturbed sexual function
• Nausea, reflux, early satiety
• Increased urinary frequency and urgency

Differential diagnosis

• Crohn’s dsease
• Ulcerative colitis
• Colorectal carcinoma

Clinical diagnosis is done based on the patient's history

Rome IV criteria for IBS

Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months that is associated with 2 or more of the following criteria

• Pain related to defecation
• Change in stool frequency
• Change in stool form or appearance

• Lifestyle changes
• Plenty of fluid
• High‑ fibre foods 
• Avoidance of gas‑ producing foods, Fermentable, short‑chain carbohydrates , Lactose ,Gluten 
• Physical activity
• Stress management - relaxation therapy
• Cognitive-behavioural therapy

Internal medicines

• Kaidaryadi kashaya
• Kalasakadi kashaya
• Vilwadi gutika
• Bhuktanjari gutika
• Dadimashtaka choorna
• Kutajarishta
• Mustarishta
• Sudarshana choorna
• Changeryadi ghrita

Procedure

• Sneha vasti – Pippalyadi anuvasana
• Picha vasti