Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Irritable bowel syndrome is characterized by a change in bowel habits, abdominal pain, and the absence of detectable organic disease. Gas, nausea, lack of appetite, bad breath heartburn, bloating, backache, weakness, faintness, and palpitations may also be present. About 20% of people with irritable bowel syndrome have rectal bleeding. Irritable bowel syndrome seems to be a product of western civilization, as it is unknown in countries where our refined diet is not consumed. Irritable bowel syndrome affects from 50-75% of the population at some time during their lifetime. It is more common in women. Symptoms usually begin when patients are in their 20s or 30s; after age 50 the onset of irritable bowel syndrome is very rare.

In this condition, the bowel is generally structurally normal; the symptoms are due to an abnormality in function rather than anatomy. Instead of contracting in a coordinated way, as in normal people, the colon muscles of people with irritable bowel syndrome contract in uneven spasms. This causes food to move through the gastrointestinal tract either too rapidly or too slowly. When it passes through too slowly too much water is absorbed, causing hard, dry stools. When it passes through too rapidly too little water is absorbed resulting in watery stools or diarrhea.

There are three basic types of irritable bowel syndrome: (1) constipation, pain (2) painless diarrhea with mucus, and (3) alternating constipation and diarrhea. Diarrhea frequently occurs immediately upon rising, and following breakfast. It may be accompanied by a feeling of urgency. The patient may be "constipated" for the remainder of the day. Nighttime diarrhea is rare. Some patients report pasty "pencil-like" stools rather than diarrhea. Basic electrical rhythm studies have demonstrated waves of either 3 or 6 cycles per minute. Irritable bowel syndrome patients have a significantly higher proportion of 3-cycle-per-minute waves under basal conditions than do normal persons.‍

Treatment

For abdominal pain:

• Heating pad, hot water bottle, and fomentations applied to the abdomen. Moist heat may be more effective than dry heat, as moist heat penetrates farther.
• In severe cases hot applications should be used for an hour, removed for an hour and applied again for an hour throughout the day.
• Lukewarm tap water enemas administered slowly may be very effective.

For gas relief:

• Avoid gas-forming foods to decrease discomfort
• Chew with the mouth closed to reduce air swallowing
• Keep well hydrated to discourage trapping of air bubbles in thick, tenacious saliva
• Chewing gums, carbonated beverages, smoking, sucking hard candies, etc. should be avoided.
• Charcoal powder or tablets will relieve gas or bloating, but do not take it daily or it might cause constipation in some persons.

To prevent diarrhea:

• Treat with carob: Mix 1-3 tablespoons carob powder in enough water to make a paste or put in your oatmeal at breakfast. Take 3 times a day at meals.
• Treat with charcoal: Mix 1-3 tablespoons in a jelly jar almost filled with water. Shake it well to mix in the charcoal and drink. This can be done 3 times a day, but NOT at meal times.

Avoid the following:

• Xanthine-containing foods such as coffee, chocolate, tea
• Spicy foods, and cold liquids
• Milk products
• Cigarette smoking (it irritates the bowel)
• Laxatives (as these may induce colonic dysfunction), and antacids
• Drug therapy, if possible: antibiotics, corticosteroids, cholestyramines (Questran), sulfasalazine (Azulfidine)
• Refined flour, sugar, and sugar substitutes (sorbitol, etc.)

To reduce food allergies (a possible relationship to irritable bowel syndrome):

• Keep a written record of foods eaten within a 24-hour period. Patients on an elimination diet may add one new food every three to four days while watching carefully for the onset of symptoms such as nausea and gas. Milk, eggs, pork, wheat products, honey, seafoods, cabbage, cheese, chocolate, and berries are common offenders. (The Elimination and Challenge Diet is available from Uchee Pines.)
• Eating on a regular schedule encourages the bowels to move regularly.
• Eat slowly; chewing food well will stimulate the colon to move the food along.
• Avoid overeating, as it places an additional burden on the colon.
• A high fiber-diet has been shown quite helpful in irritable bowel syndrome. The patient should take 2 teaspoons of bran (ideally oat bran) three times daily for the first two weeks. This may be increased gradually until the patient can pass stools without straining. Coarse bran is better than fine bran.
• Use ground flax seed in soy milk.
• Put at least five hours from the end of one meal to the beginning of the next to allow the interdigestive phase to cleanse the bowel and encourage healing of irritability.
• Do not eat before going to bed (wait two or three hours after eating before lying down).

Exercise and Rest:

• Regular, moderate, out-of-doors exercise serves as a nerve sedative and relaxes the nervous system, a condition of great value to those suffering from irritable bowel syndrome. Exercise neutralizes stress
• The person should have very regular hours for retiring and arising.

Massage:‍

Massage over the abdomen may be helpful to induce healing. During periods of constipation slow, light, continuous stroking is useful when abdominal muscles are weak and the colon is spastic. Occasionally deep pressure with kneading and rolling may be helpful.‍

Supplements and Herbal Remedies:

• An acidophilus combination offers mild digestive help (3 capsules or 1 teaspoon).
• Folic acid and other B vitamins are helpful in promoting proper digestive system functioning.
• If excess fungi are in the bowel, supplement with grape seed extract over four to six weeks. Grapefruit seed extract is also a good anti-fungal supplement. Put 4-8 drops of the grapefruit seed extract in each glass of water taken in.
• Garlic capsules, besides being anti-fungal, are also effective against parasites or germs.
• Peppermint oil (1 drop in 1/2 cup water), once daily, inhibits gastrointestinal smooth-muscle contraction and excessive gas.
• Add crushed psyllium seeds to the diet, 1/2-3 teaspoons stirred in water, as tolerated.
• Take 1/2 cup Aloe vera juice three times daily on an empty stomach

Alfalfa, slippery elm, wild yam, and fenugreek are very good. The following herbs are also useful in this condition: chamomile, rosemary, balm, bayberry, gentian, skullcap, ginger, goldenseal, lobelia, marshmallow, Pau d' Arco, rose hips, and valerian