Irritable Bowel Syndrome

IBS croppedIrritable Bowel Syndrome (IBS) is a functional (as opposed to structural) disorder of the gut. Typically, bowel habits alternate between diarrhea and constipation in the absence of other bowel diseases. It is estimated that between 10 to 20 percent of the U.S. population has IBS.

IBS commonly demonstrates altered bowel habits, abdominal pain, bloating and sometimes mucus in the stool. The change between the hard and loose phases may occur over days-to-weeks. There are types of IBS in which one phase predominates: one slow transit constipation, and the other frequent, diarrheal stools. Those with decreased intestinal mobility have fewer normally occurring intestinal contractions that move stool along (peristalsis) per minute; those with the diarrheal/loose symptoms have more. IBS patients tend to feel peristalsis (cramps) and intestinal distension from gas more strongly than those who do not have IBS, and thus may experience abdominal pain.

Commonly, women with slow transit IBS experience diarrhea, looser stool, or at least improved evacuation 1 to 3 days before or during menses. Some with IBS have the urge to defecate immediately after eating (hyper-stimulated gastro-colic reflex). In some patients, IBS onsets after a GI infection (post infectious IBS) and demonstrates intestinal inflammation on biopsy. Bowel bacterial overgrowth is finally emerging in the conventional literature a cause of IBS; fecal microflora patterns differ between those with and without IBS.[6],[7] Gluten sensitivity also appears to contribute to IBS: a small study in the journal Gastroenterology recently demonstrated improved IBS symptoms after gluten elimination in IBS patients without celiac disease (CD) but with CD genes.[5]

Some clinicians may rule out other serious diseases (like thyroid disease, inflammatory bowel disease or celiac disease) with stool cultures or blood work before diagnosing IBS, but testing is often not necessary to make the diagnosis.

Western Medicine now recognizes conditions associated with IBS that Traditional Chinese Medicine (TCM) has long recognized: heartburn, nausea/vomiting, poor libido, urinary frequency and urgency, worsening during the menstrual period or with emotional stress, fibromyalgia, miscarriage tendencies, and even depression/anxiety.

Western interventions include fiber supplementation (for both phases), decreasing gas-producing foods, water intake management, and caffeine avoidance. Most recommend some stress reduction measures, such as cognitive-behavioral therapy, or relaxation therapy. For more severe cases, anti-spasmotics, anti-cholinergics, anti-depressants, anti-diarrheal or laxatives may be used.[1]

As mentioned above, Traditional Chinese Medicine (TCM) has long recognized bowel patterns as an important part its of pattern diagnoses (TCM physiology/pathophysiology). The four forms of IBS are not linked in TCM as they are in conventional medicine. The classical IBS pattern of alternating constipation and diarrhea correlates closely to “Liver Qi Stagnation (Invading the Spleen System)” in TCM, and has the associated symptoms of nervous tension, irritability, depression, miscarriage tendency, and even later hypertension development.

In the diarrhea/loose stool IBS presentation, “Spleen Qi and Yang deficiencies leading to Dampness” are the root cause. This “Dampness” loosely correlates to mild inflammation (like that seen in post-infectious IBS) and presents with loose, dark, wet, sticky stools with or without mucus. When “Dampness” migrates from the GI tract to skeletal muscle, fibromyalgia could ensue.

During the 3 days prior to and the 3 first days of the menstrual period, “Kidney and Liver Qi decrease.” Since “Liver System controls Spleen System”, the result is that women with this pattern note diarrhea or looser/more frequent stool stool during this time. This stool is usually seen first thing in morning, occasionally waking the patient. This pattern is called “cock’s crow diarrhea” and would be associated increased urinary frequency/urgency and low libido–the symptoms now noted in conventional medicine as well. (The opposite pattern may also occur, with increased constipation prior to menses.)

As a result of the varying pattern diagnoses, acupuncture points and Chinese herbs are individualized to each patient’s presentation. Once the pattern diagnosis is correctly made, TCM addresses IBS rather effectively. Dietary modification is also recommended: gluten avoidance plays a role, especially in loose-stool presentations. Dietary modifications as recommended in Ayurveda (medicine of India) are valuable to repopulate the gut microbiome. Ayurveda teaches that eating tasty, easily digested food avoids overtaxing the digestive mechanism so that “Spleen Qi/Digestive Fire” remains strong, thus preventing bowel irregularities.[2, 3]

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These brief overviews of conditions represent distillations of basic and current medical reviews from the following sources:

[1]    Conventional Medical Sources

“Harrison’s Principles of Internal Medicine: Volumes 1 and 2, 18th Edition”. Dan Longo Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. McGraw-Hill Professional; (July, 2011)

Medscape eMedicine Physician’s online resource. Various review articles accessed March 2014

Irritable Bowel Syndrome
Jenifer K Lehrer, MD Attending Physician, Department of Gastroenterology and Hepatology, Aria Health System, Philadelphia

Inflammatory Bowel Disease
William A Rowe, MD  President, Gastroenterology Associates of Central Pennsylvania, PC; Manager, Endoscopy Center of Central Pennsylvania, LLC; Clinical Associate Professor of Surgery, Division of Colon and Rectal Surgery, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine

Gastroesophageal Reflux Disease
Marco G Patti, MD  Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine

Biliary (Gallbladder) Disease
Annie T Chemmanur, MD  Attending Physician, Metrowest Medical Center and University of Massachusetts Memorial Hospital, Marlborough Campus

 [2], [3]   

“Acupuncture Energetics: A Clinical Approach for Physicians”. Joseph M. Helms. Medical Acupuncture Publishers; 1st Edition. (1995)

  • “Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists”. Giovanni Maciocia. Churchill Livingstone; 2 Edition (July, 2005).
  • “Diagnosis in Chinese Medicine: A Comprehensive Guide”. Giovanni Maciocia. Churchill Livingstone; 1st Edition (January, 2004).

4. “Chinese Scalp Acupuncture”. Jason Ji-shun Hao, Linda Ling-zhi Hao and Honora Lee Wolfe. Blue Poppy Press; 1st Edition. (November, 2011)

5. Vazquez-Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, O’Neill J, et al. A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Gastroenterology. Jan 25 2013;[Medline].

6. Yamini D, Pimentel M. Irritable bowel syndrome and small intestinal bacterial overgrowth. J Clin Gastroenterol. 2010;44:672-675.

7 Kassinen A, Krogius-Kurikka L, Mäkivuokko H, Rinttilä T, Paulin L, Corander J, et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology. Jul 2007;133(1):24-33. [Medline].

8 Rioux JD, Xavier RJ, Taylor KD, Silverberg MS, Goyette P, Huett A, et al. Genome-wide association study identifies new susceptibility loci for Crohn disease and implicates autophagy in disease pathogenesis. Nat Genet. May 2007;39(5):596-604. [Medline]. [Full Text].

9 Evans PR1, Bak YT, Dowsett JF, Smith RC, Kellow JE. Small bowel dysmotility in patients with postcholecystectomy sphincter of Oddi dysfunction. Dig Dis Sci. 1997 Jul;42(7):1507-12.

10 Mohammad Reza Farahmandfar1, Mohsen Chabok, Michael Alade1, Amina Bouhelal, Bijendra Patel. Post Cholecystectomy Diarrhoea—A Systematic Review. Surgical Science, 2012, 3, 332-338 Published Online June 2012 (