IBS Treatment Options
Here we provide information on IBS from both Western and Eastern perspectives, comparing diagnostic and treatment approaches. We hope this will be an aide for making informed decisions about treatment options.
Western Perspective on IBS
IBS is a condition which presents in a variety of ways. In 1996 the American Gastroenterological Association issued a Position Statement for diagnosing and treating IBS. The Statement defines IBS as:
“a combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities, which is attributed to the intestines and associated with symptoms of pain and disturbed defecation and/or symptoms of bloatedness and distention.”
Diagnosis of IBS
Diagnosis is based on the ROME Diagnostic Criteria for Irritable Bowel Syndrome and is applied after testing is performed to rule out other potential diagnoses with similar presentations.
The ROME criteria are:
At least three months of continuous or recurrent symptoms of:
Abdominal pain or discomfort
relieved with defecation, or
associated with a change in frequency of stool, or
associated with a change in consistency of stool
Two or more of the following, at least on one-forth of occasions or days:
altered stool frequency*
altered stool form
altered stool passage (straining, urgency, sense of incompleteness)
passage of mucus, or
bloating or feeling abdominal distention
*for research purposes altered may be defined as more than three bowels movements each day or less than three movements each week
The Position Statement highlights the role which stress plays in IBS, noting that “[p]psychological stress exacerbates gastrointestinal symptoms in everyone, but to a greater degree in patients with IBS.”
Treatment of IBS
The recommended treatment strategy is dependent on the severity of the condition. In the case of mild symptoms, the recommendation is education to implement dietary and lifestyle changes.
In more severe cases of bloating and pain, medications such as anti-spasmodics, tricyclics or SSRIs may be prescribed. Increased dietary fiber and use of laxatives are suggested for constipation pre-dominant cases, and loperamide is suggested for the diarrhea pre-dominant patients.
The Statement also addresses the use of cognitive-behavioral treatment, hypnosis, relaxation, and biofeedback, noting that research has seen these to be effective in reducing pain and diarrhea in some patients.
Chinese Medical Perspective
Diagnosis of IBS
From a Chinese Medical perspective, IBS is not a single syndrome with a single cause. It is actually a number od distinct conditions, each with different causes, requiring different treatments. The distinct conditions are referred to as patterns. Some of the more common patterns with symptoms similar to IBS are Liver invading Spleen, Damp Heat, and Deficiency of Kidney and Spleen Yang. These patterns have many similar primary symptoms, however, they have very different causes and associated symptoms.
For instance, the Liver invading Spleen pattern often has its origins in excessive anger or stress. This emotional imbalance then causes the liver to become stressed. Over time the liver becomes overactive and aggravates related organs, such as the spleen. The constant aggravation of the spleen weakens it thus effecting the entire digestive process. (In Chinese medicine the spleen is the center of the digestive process).
The associated symptoms for this pattern include episodes of alternating diarrhea and constipation with emotional events preceding the onset of the episodes, emotional outburst and irritability, bitter taste in mouth, and a sensation as though food were stuck in the throat.
In contrast, the pattern of Spleen and Kidney Yang deficiency has a much different origin. Its causes are things like overwork and chronic illness which tax the kidneys and weaken the kidney yang. Over time this deficiency gives rise to a Spleen Yang deficiency, because Kidney Yang is the source of Spleen Yang. The associated symptoms are cold hands and feet, excess urination and sore back and knees.
As this comparison illustrates, while the primary symptoms for each pattern are very similar, the illnesses are quite different and require distinct treatment plans.
Treatment of IBS
To treat these conditions, it is necessary to devise point and herbal prescriptions aimed at addressing the underlying conditions. So while a practitioner might choose points that relieve stomach pain to treat both conditions, treating the liver condition will require the selection of points points that soothe the liver and points that boost kidney yang would be chosen in treating the Kidney/Spleen pattern.
The herbal formulas would also be distinct. For the liver invading pattern, a likely formula would be Tong Xie Yao Fang Tang. For treating the kidney/spleen pattern, formulas such as Si Shen Wan or Fu Zi Li Zhong might be prescribed. These formulas are very different and the use of the wrong one could easily worsen the patients condition.
The primary differences between the Western and Eastern approaches is in the view of the disorder as a single disease or multiple diseases. In Chinese Medicine, IBS-like conditions are viewed as being distinct diseases, with distinct origins. As such, treatment is tailored for each of the possible patterns of the disease. This approach recognizes that each patients’ situation is unique and that a one size fits all treatment approach will often not be effective.