You have a waste removal system in your house; you also have one in your car. Chances are, they work pretty well most of the time. But it’s also a pretty sure bet that the waste disposal system in your body doesn’t always work the way it’s supposed to. Nothing’s ever simple, is it?
Bowel problems trouble most people from time to time. But if your stomach starts to ache after almost every meal, if you have gas that’s painful, frequent, and/or uncontrollable, and you either have diarrhea or are constipated, you may have a bowel disease. Bowel diseases, including irritable bowel syndrome (IBS), ulcerative colitis, and Crohn’s disease, are responsible for nearly half of the visits to digestive tract specialists in the United States.
Functional versus chronic bowel disorders
IBS is a functional disorder—meaning that it’s defined by dysfunction, not by signs of disease or damage to organs themselves. In layman’s terms, IBS means your bowels aren’t working properly (no news flash for people who have the condition). In contrast, Crohn’s disease and ulcerative colitis form a cluster of chronic disorders that are characterized by inflammation or ulceration in the small and large intestines. These two conditions are also sometimes referred to as colitis, enteritis, ileitis, or proctitis, depending on the location of the symptoms. The term colitis simply means inflammation of the colon and is another term for inflammatory bowel disease.
More than five million Americans have IBS, and more than three and a half million office visits per year are devoted to it. Crohn’s disease and ulcerative colitis affect more than a million people in the United States and are responsible for more than 700,000 doctor’s office visits per year.
Together, three bowel diseases–irritable bowel syndrome, ulcerative colitis, and Crohn’s disease–affect up to six million people in the United States alone.
Interestingly, most bowel diseases are found to the greatest degree in developed countries; the higher the standard of living, the greater the occurrence of the disease. Ulcerative colitis is almost nonexistent in sub-Saharan African populations that consume a largely traditional diet. The few recorded cases were among urban individuals who ate a more typical Western diet. A 1998 Dutch study demonstrated that bowel disease is highly associated with a modern lifestyle.
Irritable bowel syndrome This common intestinal disorder produces constipation in some people and diarrhea in others. A third group experiences both symptoms. People with IBS may pass mucus with their bowel movements; they may have cramps and want to move the bowels but be unable to do so. But perhaps the most distressing thing about IBS is its notorious ability to cause symptoms that come and go. Attacks are frequently so unpredictable that patients fear to stray far from home.
IBS is known by many names—colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease—but this syndrome doesn’t involve inflammation and shouldn’t be confused with ulcerative colitis. Instead, experts call IBS a functional disorder because when they examine the colon of a person who has it, there’s usually no sign of disease. Although IBS is extremely uncomfortable and distressing to those who have it (symptoms can range from mildly annoying to disabling), the syndrome does no permanent injury to the intestines and does not cause intestinal bleeding or a serious disease such as cancer.
Symptoms of IBS usually occur after a trigger. Eating, distention from gas or food in the colon, particular medicines, or specific foods may trigger spasms. Among food triggers, frequent culprits include chocolate, milk products, fatty food, or alcohol. Women with IBS have more symptoms during their menstrual periods, implying that reproductive hormones may play a role. Many people have increased symptoms when they are under stress. Those with IBS are particularly likely to suffer loose stools from caffeine.
Treating irritable bowel syndrome
IBS is a vague and confounding disorder. To treat it effectively, herbalists usually examine the specific symptoms that a patient is suffering from. Those symptoms typically fall into three categories:
•diarrhea, frequently without pain.
•chronic abdominal pain, possibly with constipation.
•constipation alternating with diarrhea.
One of the most commonly recommended herbal remedies for IBS is enteric-coated peppermint oil. It helps relax the muscles of the intestinal wall, fending off cramps. The enteric coating on the capsule delays the release of the oil until the remedy reaches the lower digestive tract, where it’s most needed. In one clinical trial in Taiwan, four out of every five IBS victims experienced reduced symptoms when given enteric-coated peppermint oil. People who take peppermint in this way often experience relief of all their symptoms.
Caraway oil has similar properties, relaxing the gut wall and reducing diarrhea episodes. In 1999, a German study used peppermint and caraway oils on 223 IBS patients. The combination caused a significant reduction in pain. Another recent German study confirmed that a combination of peppermint and caraway oils effectively reduced the speed of intestinal movement. The subjects took the oils daily, not just when symptoms appeared. (It takes about four hours for the capsules’ contents to reach the large intestine.)
Depending on your symptoms, you may also want to explore herbs from each of the categories listed below. For example, you may need antispasmodic herbs to relax bowel cramps, antibacterial herbs, laxatives, antidiarrheal herbs, or others. Your best bet is to work with a qualified herbalist or naturopathic doctor to build a customized program.
I’ve also successfully helped people with IBS with an Ayurvedic remedy called triphala. A combination of the fruits amalaki, haritaki, and bibitaki, triphala works as a gentle internal cleanser. In low doses, (1 g per day), triphala slows diarrhea. In higher doses (up to 5 g per day) it treats constipation in a very slow, gentle way, toning the walls of the gut while it works. Triphala is a powder; it can be taken in capsules.
In addition, psyllium seed, a common bulk fiber laxative, can help balance bowel function and relieve pain in people with IBS. Psyllium’s capacity to absorb fluids means that it’s useful for treating diarrhea, a common IBS symptom. As it travels through the gut, psyllium also adds mucilage, which soothes irritation and may relieve cramping. Studies suggest that an optimum dose for IBS patients is 20 g per day.
Finally, check your diet. Evidence suggests that some people with IBS cannot absorb lactose, or milk sugar, properly. Lactose malabsorption can cause symptoms indistinguishable from those of IBS. Work with a nutritionist who can help you examine your diet. You’ll probably want to keep a food diary to help you identify what may be triggering attacks for you. Adding fiber to your diet—just enough so that you have soft, easily passed, and painless bowel movements—usually helps. So does eating more frequent, smaller meals.
Inflammatory bowel diseases are different from IBS in that they’re produced by inflammation and can result in actual damage to internal organs. And their symptoms are generally consistent and repeated. If you experience frequent diarrhea, bloody stools, or stools with mucus, cramps, and abdominal pain, see your physician to receive a diagnosis. Both ulcerative colitis and Crohn’s disease can mimic other bowel diseases, such as infectious conditions and irritable bowel syndrome. It’s important that you obtain a clear initial diagnosis.
Ulcerative colitis causes open sores and inflammation of the inner lining of the colon and rectum. The inflammation typically happens in the rectum and lower part of the colon, but it can affect the entire colon. This bowel disease seldom affects the small intestine except for the organ’s lower section, known as the ileum.The inflammation of ulcerative colitis causes the colon to empty frequently, resulting in diarrhea. Where the inflammation has killed cells, ulcers form, producing pus and mucus.
People with ulcerative colitis often have other health problems, including joint pain, eye inflammation, liver dysfunction, osteoporosis, skin rashes, anemia, or kidney stones. No one knows exactly what the connection between the conditions or symptoms is. Some experts think these complications occur because the immune system is triggering inflammation in other body parts in addition to the digestive tract. Such symptoms are usually mild, however, and clear up when the ulcerative colitis is treated.
Patients whose ulcerative colitis is spread over much of the colon have a greater risk of colon cancer, but they can reduce this risk by taking folic acid.
About one in four ulcerative colitis patients eventually undergoes surgery for removal of the colon because of massive bleeding, chronic debilitating illness, perforation of the colon, or the risk of cancer, usually after medical management of the disease has failed.
Drug or surgical treatment for emergency ulcerative colitis—cases involving life-threatening blood loss and fluid loss from diarrhea—is often necessary. But such treatments can usually only partially heal the disorder and frequently involve major side effects. Because of these limitations, many ulcerative colitis sufferers lean on natural medicine.
Crohn’s disease is distinguished by inflammation that extends deeper into the layers of the intestinal tissue. Crohn’s disease most often affects the small intestine, typically the ileum. In any individual, however, it may also involve the colon, mouth, esophagus, stomach, duodenum, appendix, or anus. It tends to produce sharp, severe pain in isolated areas of the gut.
Crohn’s disease is a chronic condition. It often recurs at intervals during a lifetime. Patients can have long periods of remission, living symptom free, some for years. There is no medically accepted method to predict when a remission may take place or when symptoms will recur.
Crohn’s disease affects males and females equally and seems to run in some families. About one in five Crohn’s disease patients has a blood relative with some form of bowel disease. Smoking makes Crohn’s disease worse.
There is no medical cure for Crohn’s disease, although several medications are used to control symptoms. The goals of conventional therapy usually are to correct nutritional deficiencies, control inflammation, and relieve abdominal pain, diarrhea, and rectal bleeding.