A Comprehensive Guide to Irritable Bowel Syndrome Treatments in Ayurveda

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a cluster of symptoms including abdominal pain, bloating, and changes in bowel habits without any evidence of structural abnormalities. It affects millions of individuals worldwide, significantly impacting their quality of life. In this comprehensive guide, we will delve into the definition, causes, symptoms, treatments, home remedies, and prevention strategies for IBS.

Definition of Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome, often abbreviated as IBS, is a functional gastrointestinal disorder that primarily affects the large intestine (colon). It is a chronic condition characterized by abdominal discomfort or pain, bloating, and altered bowel habits, including diarrhea, constipation, or both. IBS is diagnosed based on symptoms and by ruling out other medical conditions through a thorough medical history, physical examination, and diagnostic tests.

Causes of Irritable Bowel Syndrome (IBS)

The exact cause of IBS remains unknown, but several factors may contribute to its development:

1. Abnormalities in Gut Motility: Disrupted or irregular contractions of the intestinal muscles can lead to symptoms such as diarrhea or constipation.
2. Visceral Hypersensitivity: Individuals with IBS may have heightened sensitivity to pain originating from the internal organs, particularly the intestines.
3. Intestinal Inflammation: Low-grade inflammation in the intestines might play a role in triggering symptoms of IBS.
4. Altered Gut Microbiota: An imbalance in the gut microbiota (dysbiosis) has been implicated in the pathogenesis of IBS.
5. Psychological Factors: Stress, anxiety, and other psychological factors can exacerbate symptoms of IBS, although they do not directly cause the condition.

Symptoms of Irritable Bowel Syndrome (IBS)

The symptoms of IBS can vary widely among individuals and may include:

1. Abdominal Pain or Discomfort: This is often relieved by bowel movements.
2. Bloating and Gas: Excessive gas production and bloating are common complaints in individuals with IBS.
3. Diarrhea: Some individuals experience frequent episodes of loose or watery stools.
4. Constipation: Others may have difficulty passing stools or experience infrequent bowel movements.
5. Alternating Bowel Habits: Some people with IBS may alternate between episodes of diarrhea and constipation.
6. Mucus in Stool: Passage of mucus along with stools is another common symptom.
7. Urgency: There may be a sudden urge to have a bowel movement.
8. Feeling of Incomplete Evacuation: Even after passing stools, individuals with IBS may feel like their bowels are not empty.

Irritable Bowel Syndrome Treatments (IBS Treatments)

While there is no cure for IBS, various treatment approaches aim to manage symptoms effectively. These include:

1. Dietary Modifications: Certain dietary changes, such as increasing fiber intake, avoiding trigger foods (such as dairy, gluten, or gas-producing foods), and following a low-FODMAP diet, can help alleviate symptoms.
2. Medications: Depending on the predominant symptoms, medications such as antispasmodics, laxatives, anti-diarrheal drugs, or antidepressants may be prescribed to manage symptoms.
3. Stress Management: Techniques such as relaxation therapy, cognitive-behavioral therapy (CBT), and mindfulness-based stress reduction can help reduce stress and improve symptoms.
4. Probiotics: Some individuals find relief from symptoms by taking probiotic supplements to restore the balance of gut bacteria.
5. Physical Activity: Regular exercise can help regulate bowel movements and reduce stress levels, thereby improving symptoms of IBS.
6. Hydration: Drinking an adequate amount of water is essential to maintain proper bowel function and prevent dehydration, especially in individuals with diarrhea-predominant IBS.
7. Acupuncture: Some people with IBS report symptom improvement with acupuncture, although more research is needed to confirm its efficacy.
8. Prescription Medications: In severe cases where other treatments have failed, healthcare providers may prescribe medications such as alosetron or lubiprostone, but these carry potential risks and side effects and are typically reserved for specific situations.

Home Remedies for Irritable Bowel Syndrome (IBS)

In addition to medical treatments, several home remedies may provide relief from IBS symptoms:

1. Peppermint Oil: Peppermint oil capsules have been shown to reduce symptoms of IBS, particularly abdominal pain and bloating.
2. Ginger: Ginger tea or supplements may help alleviate nausea and promote digestion.
3. Heat Therapy: Applying heat to the abdomen, such as using a heating pad, can relieve abdominal discomfort and cramping.
4. Proper Chewing: Chewing food thoroughly and eating slowly can aid digestion and reduce the risk of bloating and gas.
5. Herbal Teas: Chamomile tea, fennel tea, and other herbal teas with digestive properties may provide relief from IBS symptoms.
6. Regular Meal Times: Establishing regular meal times and avoiding large meals can help regulate bowel function and reduce discomfort.
7. Avoiding Trigger Foods: Identifying and avoiding foods that exacerbate symptoms can help prevent flare-ups of IBS.
8. Stress Reduction Techniques: Engaging in stress-reducing activities such as yoga, meditation, or deep breathing exercises can help manage symptoms.

Prevention of Irritable Bowel Syndrome (IBS)

While IBS cannot be completely prevented, certain strategies may help reduce the risk of developing symptoms or alleviate their severity:

1. Maintain a Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support digestive health and reduce the risk of IBS symptoms.
2. Stay Hydrated: Drinking plenty of water throughout the day helps maintain proper hydration and supports optimal bowel function.
3. Manage Stress: Finding healthy ways to cope with stress, such as exercise, relaxation techniques, or counseling, can help prevent stress-related exacerbations of IBS symptoms.
4. Avoid Trigger Factors: Identify and avoid factors that trigger or worsen symptoms, such as certain foods, medications, or stressful situations.
5. Regular Exercise: Engaging in regular physical activity promotes overall health and can help regulate bowel function.
6. Limit Alcohol and Caffeine: Alcohol and caffeine can irritate the digestive system and exacerbate symptoms of IBS, so it’s advisable to consume them in moderation.
7. Get Adequate Sleep: Prioritize good sleep hygiene and aim for seven to eight hours of quality sleep each night to support overall well-being, including digestive health.

Irritable Bowel Syndrome (IBS) – Ayurvedic View

Irritable bowel syndrome (IBS) is a chronic bowel disorder characterized by recurrent abdominal discomfort associated with alternate episodes of diarrhea and constipation in the absence of structural and biochemical abnormalities.

Irregular bowel habits, urge to defecate after the melas, diarrhea usually occurs in the morning, pain in the lower abdomen that gets relieved by defecation and sometimes provoked by food, the sensation of incomplete emptying of the rectum, abdominal distension, excessive flatulence, dyspepsia, heartburn are some of the symptoms of IBS.

The symptoms of the clinical condition mentioned in Ayurveda called ‘Grahani’ are correlated with the symptoms of irritable bowel syndrome. Grahani is referred to as an anatomical structure and a disease as well. Anatomically in Ayurveda, Grahani is the sixth Pittadhara Kala located between the Amashaya (stomach) and Pakwashaya (large intestine), or a part that is nourished by the Agni (digestive fire) and is situated above the Nabhi (umbilicus).

So, it receives the food for digestion and releases the food into the next part of the abdomen. It is explained as a disease and is one of the Mahagada (considered as a dreadful disease). So, when there is a disturbance in the Agni, Grahani gets vitiated and causes Grahani Dosha.

Etiopathogenesis

The etiology of Grahani dosha is Abhojana (skipping the meals or excess fasting), Vishamashana (untimely intake of food), Atibhojana (over-eating), Ajeerna (indigestion), Atiruksha bhojana (eating excess dry food items), dushita bhojana (eating stale or contaminated food), guru and sheeta bhojana (food that is heavy for digestion and is cold in nature), Vegadharana (suppression of natural urges), Rutu-Kala-Desha vaishamyata (following the regimen that is contradictory to the season-habitat),. These are the common etiological factors mentioned for Grahani dosha. Specific etiology is described for the specific type of Grahani.

• Vataja Grahani – eating an excess of Katu (pungent), Tikta (bitter), and Kashaya Rasa (astringent) food, Atiruksha bhojana (eating excess dry food items), Vishamashana (untimely intake of food), Pramitashana (eating less quantity of food), Dushita bhojana (eating stale or contaminated food) Vegadharana (suppression of natural urges), Atimaithuna (indulging in excess sexual intercourse) are the causes for Vataja Grahani.
• Pittaja Grahani – eating an excess of Katu (pungent), Amla (sour), and Lavana Rasa (salt) food, Ajeerna (indigestion), Vidahi anna (eating an excess of spicy food that causes a burning sensation in the chest and abdomen) are the causes of Pittaja Grahani.
• Kaphaja Grahani – Guru and Sheeta bhojana (food that is heavy for digestion and is cold), Atisnigdha bhojana (excess eating of oily foods), Atibhojana (over-eating), Bhukta Matra Swapna (sleeping immediately after taking the meals), etc. are the causes of Kaphaja Grahani.   

The etiology impairs the digestion of an individual along with the specific dosha that is predominant during the pathogenesis, causing the formation of Ama (undigested food material) in the gastrointestinal tract, and thereby Grahani dosha occurs.   

Signs and symptoms

Premonitory symptoms

• Alasya (lethargy)
• Trishna (excess thirst)
• Kayasya gauravam (heaviness in the body)
• Pakashcha chirat (delayed digestion)
• Anna daha (burning sensation in the chest and abdomen)
• Bala kshaya (weakness)

Generalized symptoms

• Trishna (feeling of excess thirst)
• Vairasya (bitter taste in the mouth)
• Arochaka (anorexia)
• Praseka (excess salivation)
• Malapravrutti Atisrishtam ­– Vibaddha-Drava (bowel movements are sometimes excess in quantity- sometimes constipated – sometimes watery)
• Tamapravesha (darkness in front of the eyes)
• Pada-kara shoona (edema of the feet and hands)
• Asthiparva ruja (pain in the bones and joints)
• Jwara (fever)
• Chardi (vomiting)
• Tikta-Amla Udgara (bitter-sour belchings)

Signs and symptoms of different types of Grahani

• Vataja Grahani – flatulence during and after the digestion, presence of the froth in the stools, sometimes hard stools, and sometimes watery stools.
• Pittaja Grahani – fetid and sour belchings, watery, undigested stools that are yellowish colored.
• Kaphaja Grahani – feeling of heaviness in the abdomen, rigid abdomen, stools are not well-formed, mixed with mucoid.
• Sannipataja Grahani – the signs and symptoms are combined with Vata-Pitta-Kapha.
• Sangrahani – the disease is aggravated during the daytime and gets relieved in the night hours, it occurs once a day / once in ten days/ once in 15 days/ once in a month, there is the presence of intestinal gurgling sounds, stools are passed with the sounds and is watery and froth present in it.
• Ghatiyantra Grahani – sounds produced while defecation resembles water being poured from the pot.
• Raja Grahani – occurs in people who lead a sedentary lifestyle.
• Kshataja Grahani – occurs when Grahani is injured, as a complication of Atisara (diarrhea) and Pravahika (dysentery).

Irritable Bowel Syndrome Treatments in Ayurveda

Treatment of Grahani (IBS) in Ayurveda aims to increase the Agni that is impaired and eliminate the Ama. Deepana and Pachana Karma (appetizers and digestives) are used to stimulate the digestive power and digest the undigested food material.

Purification procedures (panchakarma treatments) like Virechana (purgation), Niruha, and Anuvasana Basti (decoction and oil enema therapies) respectively help treat pittaja and vataja types of Grahani.

Administration of takra (buttermilk) is the ancient method in Ayurveda as a part of the treatment of irritable bowel syndrome.

Medicines used should possess the properties viz, Deepana, Pachana, Vatanulomana (that relieve the flatulence), and the drugs that act on specific types of dosha involved in the pathogenesis.

Diet and lifestyle

A diet that is light for digestion, an old variety of rice, jowar, lentils, gourd, coriander leaves, vegetables, curds, buttermilk, skimmed milk, hot water, vegetable soup, green gram soup, black pepper, dried ginger, nutmeg, fruits viz, pomegranate, wood apple, papaya, orange, lemon, etc. food items are to be consumed.

Foods that are avoided are wheat, maize, pigeon pea, cowpea, soya bean, kidney beans, potato, Kohlrabi, chilies, meat, seafood, mango, pineapple, watermelon, jackfruit, fig, cashew, excess milk, etc.

Lifestyle modifications viz, following daily and seasonal regimen as mentioned in the classics of Ayurveda, fixed time for breakfast, lunch, and dinner, proper sleep, timely sleeping and waking, physical exercise, meditation, yoga, and pranayama, are some of the factors of lifestyle that are to be followed.

Daytime sleeping, staying awake at late night, excess grief, worry, stress, over-thinking, negative mindset, less or absence of physical exercise, etc. are to be avoided.

Conclusion

In summary, Irritable Bowel Syndrome emerges as a multifaceted entity, characterized by a diverse array of symptoms and etiological factors. By elucidating the intricate interplay between physiological, psychological, and environmental influences, healthcare providers and individuals alike can navigate the complexities of IBS with greater understanding and efficacy. Through a comprehensive approach encompassing tailored treatments, complementary interventions, and preventive measures, individuals with IBS can aspire to attain optimal symptom management and enhance their overall quality of life. As research continues to unravel the enigmatic nature of IBS, the pursuit of personalized, patient-centered care remains paramount in the quest to alleviate the burden of this pervasive gastrointestinal disorder.

Irritable bowel syndrome is a condition with repeated abdominal discomforts and episodes of diarrhea. The condition called Grahani in Ayurveda can be delineated as irritable bowel syndrome. The main pathology is the impaired Agni, formation of Ama causing vitiation in the structure called Grahani leading to the disease Grahani. Virechana and Basti are the purificatory treatments advised. The drugs that possess Deepana, and Pachana, properties help relieve the symptoms of Grahani and restore Agni.

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References

1. https://www.researchgate.net/publication/330507770_Ayurvedic_Treatment_for_IBS_Irritable_Bowel_Syndrome.
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3. AYURVEDA TREATMENT IN IRRITABLE BOWEL SYNDROME, Journal of Traditional Medicine and Clinical Naturopathy, 2023, Volume 12, Issue 4, page. 1-2.
4. AYURVEDIC MANAGEMENT OF GRAHANI (IRRITABLE-BOWEL SYNDROME) – CASE REPORT, World Journal of Pharmaceutical and Medical Research, 2024, Volume 10, Issue 1, page. 245-248.
5. AYURVEDIC REVIEW OF GRAHANI WSR TO IBS, World Journal of Pharmaceutical and Medical Research, 2021, Volume 7, Issue 4, page. 138-143.
6. GRAHANI ROGA MANAGEMENTBY AYURVEDA PRINCIPLES AND LIFESTYLE MODIFICATION, World Journal of Advanced Research and Reviews, 2022, Volume 16, Issue 3, page. 1053-1057.