Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. (IBS) is a common disorder that affects the large intestine or colon. It is a group of symptoms commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation or change in pattern of bowel movements without any evidence of underlying damage.
IBS is a chronic condition that will need to manage long term as these symptoms occur over a long time, often years.
Irritable bowel syndrome (IBS) is one among the most well-known disease of the bowel (intestines). It can be said as an abnormal functioning (dysfunction)of the muscles of the visceral organs of the gastrointestinal tract or the nerves regulating the organs.
IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to a serious disease, such as cancer. Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, or even travel short distances.
Definition according to ayurveda
In ayurveda IBS or colitis has been described as grahani and has been widely described In the classic ayurvedic literature. It shows exactly the same clinical picture as chronic colitis.
Grahani defines as diseased condition, in which the integrity and the function of the small intestine, especially the early part called deudonem (known as grahani in Sanskrit) is compromised. Grahani is the principal seat of agni… the digestive fire. Normally, grahani holds up the meals, until it is digested and releases it from the site only, after the digestion is over. But when the function of grahani is compromised due to weakness in the digestive fire, it releases the ingested material even in undigested conditions. Grahani is a syndrome in which agni, the digestive power, is supposed to be at fault. When agni becomes depressed, ama dosha (undigested waste material) accumulates and is passed in the stools.
Grahani and Agni (the digestive–fire) are having deep relationship which has been described as Adhara-Adheya-Sambandha in Ayurvedic classics. Grahani ( early part of the large intestine) has been mentioned as an Agni Adhishthana means the site of the digestive fire, by the majority of the Ayurvedic philosphers. Mandagni (low digestive–fire) is the root cause of hampered digestion, which in turm leads to Ama (enteric toxins). Ama is the critical factor for the manifestation of the majority of the diseases. Among these diseases, Grahani is the prime- disease of the digestive tract and patients are often seen in clinical practice.

Causes
In Ayurveda, first part of the small intestine is known as grahani (anatomically known as the duodenum) as it grahans means hold up and absorbs the food or is the main site for the absorption of food. As it is the main site for the disease, hence the disease is also named after it as grahani or Some Ayurvedic texts have called it as sangrahani.
According to Ayurvedic classics, irregular dietary habits and continuous exposure to stress are contributing factors of the disease. Today we call this disorder as malabsorption as a process of absorption is hindered in the small intestine. According to modern medicine, the exact cause of the disease is not known.

Agni is deranged by fasting, eating during indigestion, over eating, irregularly eating, intake of unsuitable, heavy, cold, too rough and contaminated food, emaciation due to some disease, faulty adaptation to place, time and season, faulty administration of emesis, purgation and unction and suppression of natural urges. Agni thus deranged becomes unable to digest even the light food and the food being undigested gets acidified and toxic.
It’s not known exactly what causes irritable bowel syndrome, but a variety of factors play a role. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have irritable bowel syndrome, the contractions may be stronger and last longer than normal., causing gas, bloating and diarrhea. Or the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools.
Abnormalities in your gastrointestinal track, nervous system also may play a role, causing you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can make your body overreact to the changes that normally occur in the digestive process. This overreaction can cause pain, diarrhea or constipation.
Factors that may cause become common triggers for the IBS may include:

Foods. The role of food allergy or intolerance in irritable bowel syndrome is not yet clearly understood, but many people have more severe symptoms when they eat certain things. A wide range of foods has been implicated — chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol to name a few.

Stress. Most people with IBS find that their signs and symptoms are worse or more frequent during periods of increased stress, such as finals week or the first weeks on a new job. But while stress may aggravate symptoms, it doesn’t cause them.
Hormones. Because women are twice as likely to have IBS, it is believed that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.
Other illnesses. Sometimes another illness, such as an acute episode of infectious diarrhea (gastroenteritis) or too many bacteria in the intestines (bacterial overgrowth), can trigger IBS.
Some few more factors that may alter the gut morphology and may cause the disease to effect:

1• It is true that stress can affect bowel function. It has been demonstrated that the bowel can flush or become very pale in response to emotional reactions. Severe acute stress may cause diarrhea.
2• A close look at dietary factors is a must in evaluating the cause for an irritable bowel, one cause i.e. lactose intolerance is a very common problem. The inability to digest lactose sugar in milk and dairy products. The undigested lactose acts like a laxative and causes the symptoms of an irritable bowel.
3• Another and less common is gluten intolerance. Some individuals may have an allergic reaction to gluten protein, which is found in all cereals except rice and corn. This can cause diarrhea.
4• Fat may also be a cause of diarrhea, they stimulate strong contractions of colon contributing to pain and diarrhea.
5• Alcohol is another often-unrecognized cause for such symptoms, particularly diarrhea. The patient may not think that his or her alcohol habit can be the cause. Alcohol is a cellular poison. Its initial contact with the lining of the bowel may cause some cellular damage. As the alcohol in the blood is recirculated regularly and bathes the intestinal cells, it creates further damage. Damaged cells mean inadequate digestion, followed by diarrhea and IBS.
5• Coffee, tea, colas and chocolate are all can cause IBS, as they stimulate muscular contractions and acts as a causative factor in diarrhea.
5• Spices may also irritate the bowel. In some case it may be due to food allergies or food poisoning.
6• Diarrhea may also be a symptom of vitamin deficiency e.g. niacin, B-12 or folic acid.
7• Various infectious diseases may cause this but this is usually of short duration. Parasites may be a cause like Giardiasis.
8• The abuse of laxatives is a common cause, which is often overlooked.
9• Disease of the pancreas may cause large, frequent, fatty stools. The pancreatic enzymes needed for digestion and when these are in short supply symptoms follows.
10 • Diarrhea characteristically occurs in the morning, and almost never at night.
11 • Urge to defecate after meals.
12 • Pain in the lower abdomen, pain often occurs in attacks usually relived by defecation and sometimes provoked by food.
13 • Bowel habit is variable. All most all patients notice ribbon like stools with or without mucus.
14 • Sensation of incomplete emptying of the rectum.
15 • Abdominal distension, excessive flatus, dyspepsia, heartburn, increased urine frequency

Classification of IBS
IBS can be classified into 4 types as:
Diarrhea-predominant (IBS-D)
Constipation-predominant (IBS-C)
Alternating stool pattern (IBS-A)
Pain-predominant (IBS-P)

In some individuals, IBS may have an acute onset and develop after an infectious illness characterized by two or more of the following:
fever, vomiting, diarrhea, or positive stool culture. This post infective syndrome has consequently been termed “post infectious IBS” (IBS-PI).

According to ayurveda classification of IBS on the basis of Dosha predominancy:
Ayurveda Describes Four Different Types of Grahani.
Vataja grahani :-Malabsorption caused by vitiation of the vata dosha. In this type of grahani problem constipation, pain, bloating etc. are the main symptoms.
Pittaja grahani :-Malabsorption caused by vitiation of the pitta dosha. In pitta grahani, diarrhea is the predominant symptom along with burning sensation in epigastric region and in anal region, excessive thirst, sweating etc.
Kapha grahani ;-Malabsorption caused by vitiation of the kapha dosha. In kapha grahani, dysentery is the predominant symptom along with anorexia, heaviness in abdomen etc
Tridosha grahani: In this case, all the three doshas are involved and the symptoms are exhibited in mixed form.

The worst part of grahani is that in later stages, the human body refuses to absorb carbohydrates and minerals. Here, the disease tends to be chronic.

Some Other texts of ayurveda also mentioned two other varieties of grahani:
samgraha grahani (accrual malabsorption)
an incurable type called ghatiyanthra grahani (tympanitis predominant malabsorption).

Signs and symptoms
The primary symptoms of IBS are abdominal pain or discomfort in association with frequent diarrhea or constipation and a change in bowel habits. Symptoms usually are experienced as acute attacks that subside within one day, but recurrent attacks are likely. There may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus), bloating, or abdominal distension. In some cases, the symptoms are relieved by bowel movements. People with IBS, more commonly than others, have gastroesophageal reflux, symptoms relating to the genitourinary system, chronic fatigue syndrome, fibromyalgia, headache, backache, and psychiatric symptoms such as depression and anxiety. About a third of men and women who have IBS also report sexual dysfunction typically in the form of a reduction in libido.
Prodromal symptoms are – thirst, lassitude, debility, delayed digestion and heaviness in body. Thirst, anorexia, abnormal taste in mouth, excessive salivation and feeling of darkness, eructation’s have metallic or fleshy odor and bitter sour taste, edema on feet and hands, joint pain, vomiting and fever, cutting pain in abdomen, lassitude, debility, dryness in throat and mouth, burning in cardiac region and throat, patient passes stool as liquid, dried, thin & undigested with sound, broken, mixed with mucus and heavy. Frequent motions, which are of sometimes, dry & sometimes watery consistency is the classical symptom

The common and major signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are:
• Abdominal pain or cramping
• A bloated feeling
• Gas
• Diarrhea or constipation — sometimes alternating bouts of constipation and diarrhea
• Mucous in the stool.
• Abdominal pain or cramping that is often relieved by passing wind.
• A sensation that the bowels are not fully emptied after passing a motion.
• Nausea.

  • For most of the people, in the chronic condition, many times the sign and symptoms may worsen a lot and some times they improve or even disappear completely.
    • Symptoms that may indicate a more serious condition include:
    • Rectal bleeding
    • Abdominal pain that progresses or occurs at night
    • Weight loss
    • Malabsorption

The clinical features encountered in malabsorption are:
• Abdominal pain
• Anaemia
• Dehydration
• Depression
• Diarrhea with fatty stools
• Lethargy
• Loss of weight

Risk factor for IBS
The risk of developing IBS increases six-fold after acute gastrointestinal infection. Post infection, further risk factors are:
young age,
prolonged fever,
anxiety, and depression.
Psychological factors, such as depression or anxiety, have not been shown to cause or influence the onset of IBS, but may play a role in the persistence and perceived severity of symptoms.Nevertheless, they may worsen IBS symptoms and the patient quality of life.
Antibiotic use also appears to increase the risk of developing IBS.
Research has found that genetic defects in innate immunity and epithelial homeostasis increase the risk of developing both post-infectious as well as other forms of IBS.

Risk factors
Many people have occasional signs and symptoms of irritable bowel syndrome, but you’re more likely to have IBS if you:
Are young. IBS tends to occur in people under age 45.
Are female. Overall, about twice as many women as men have the condition?
Have a family history of IBS. Studies suggest that people who have a family member with IBS may be at increased risk of the condition.
Have a mental health problem. Anxiety, depression, a personality disorder and a history of childhood sexual abuse are risk factors. For women, domestic abuse may be a risk factor as well.
The influence of family history on IBS risk may be related to genes, shared factors in a family’s environment or both.

Diagnosis
No specific laboratory or imaging test can be performed to diagnose irritable bowel syndrome. Diagnosis involves excluding conditions that produce IBS-like symptoms, and then following a procedure to categorize the patient’s symptoms.
Ruling out parasitic infections, lactose intolerance, small intestinal bacterial overgrowth, and celiac disease is recommended for all patients before a diagnosis of irritable bowel syndrome is made.
In patients over 50 years old, they are recommended to undergo a screening colonoscopy. IBS sufferers are at increased risk of being given inappropriate surgeries such as appendectomy, cholecystectomy, and hysterectomy due to their IBS symptoms being misdiagnosed as other medical conditions.

Rule out conditions such as
• Food allergies or intolerances, such as lactose intolerance and poor dietary habits
• Medications such as high blood pressure drugs, iron, and certain antacids
• Infection
• Enzyme deficiencies where the pancreas isn’t releasing enough enzymes to properly digest or break down food
• Inflammatory bowel diseases like ulcerative colitis or Crohn’s disease
• Criteria for making a diagnosis

Because there are usually no physical signs to definitively diagnose IBS, diagnosis is often a process of ruling out other conditions. To help this process, researchers have developed two sets of diagnostic criteria for IBS and other functional gastrointestinal disorders — conditions in which the bowel appears normal but doesn’t work (function) normally. Both criteria are based on symptoms after other conditions have been ruled out.
Rome criteria. According to these criteria, you must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome. The most important are abdominal pain and discomfort lasting at least three days a month in the last three months, associated with two or more of following: improvement with defecation, altered frequency of stool or altered consistency of stool.
Manning criteria. These criteria focus on pain relieved by defecation, having incomplete bowel movements, mucus in the stool and changes in stool consistency. The more symptoms present, the greater the likelihood of IBS.

Your doctor will likely assess how you fit these criteria, as well as whether you have any other signs or symptoms that might suggest another, more serious, condition. Some red flag signs and symptoms that suggest a need for additional testing include:

  • New onset after age 50
    • Weight loss
    • Rectal bleeding
    • Fever
    • Nausea or recurrent vomiting
    • Abdominal pain, especially if it’s not completely relieved by a bowel movement, or occurs at night
    • Diarrhea that is persistent or awakens you from sleep
    • Anemia related to low iron

If you fit the IBS criteria and don’t have any red flag signs or symptoms, you may suggest a course of treatment without doing additional testing. But if you don’t respond to that treatment, you’ll likely require more tests.

Additional tests
Your doctor may recommend several tests, including stool studies to check for infection or problems with your intestine’s ability to take in the nutrients from food (malabsorption). You may undergo a number of tests to rule out other causes for your symptoms.
Imaging tests:

Flexible sigmoidoscopy. This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).

Colonoscopy. In some cases, especially if you are age 50 or older or have other signs of a potentially more serious condition, your doctor may perform this diagnostic test in which a small, flexible tube is used to examine the entire length of the colon.

X-ray (radiography). Sometimes doctors will use X-rays to obtain an image of your colon.

Computerized tomography (CT) scan. CT scans produce cross-sectional X-ray images of internal organs. CT scans of your abdomen and pelvis may help your doctor rule out other causes of your symptoms, especially if you have abdominal pain.

Lower GI series. In this test, doctors fill your large intestine with a liquid (barium)
to make it easier to see any problems on the X-ray.
Laboratory tests:

Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don’t produce this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhea. To find out if this is the cause of your symptoms, your doctor may order a breath test or ask you to remove milk and milk products from your diet for several weeks.

Breath tests. Your doctor may perform a breath test to look for a condition called bacterial overgrowth, in which bacteria from the colon grow up into the small intestine, leading to bloating, abdominal discomfort and diarrhea. This is more common among people who have had bowel surgery or who have diabetes or some other disease that slows down digestion.

Blood tests. Celiac disease is sensitivity to wheat, barley and rye protein that may cause signs and symptoms like those of irritable bowel syndrome. Blood tests can help rule out this disorder. Children with IBS have a far greater risk of celiac disease than do children who don’t have IBS. If your doctor suspects that you have celiac disease, he or she may perform an upper endoscopy to obtain a biopsy of your small intestine.

Stool tests. If you have chronic diarrhea, doctors may want to examine your stool for bacteria or parasites.

Investigations
Investigations are performed to exclude other conditions:
Stool microscopy and culture (to exclude infectious conditions)

Blood tests: Full blood examination, liver function tests, erythrocyte sedimentation rate, and serological testing for coeliac disease

Abdominal ultrasound (to exclude gallstones and other biliary tract diseases)

Endoscopy and biopsies (to exclude peptic ulcer disease, coeliac disease, inflammatory bowel disease, and malignancies)

Hydrogen breathe testing (to exclude fructose and lactose malabsorption)

How Is IBS Treated?
Nearly all people with IBS can get help, but no single treatment works for everyone. You and your doctor will need to work together to find the right treatment plan to manage your symptoms.
Many things can trigger IBS symptoms, including certain foods, medicines, the presence of gas or stool, and emotional stress. You’ll need to learn what your triggers are. You may need to make some lifestyle changes and take medication.

  • Learn to relax, either by getting more exercise or by reducing stress in your life.
    • Limit how much milk or cheese you eat.
    • Eat smaller meals more often instead of big meals.
    • Keep a record of the foods you eat so you can figure out which foods bring on bouts of IBS.
    Common food “triggers” are red peppers, green onions, red wine, wheat, and cow’s milk. If you’re concerned about getting enough calcium, you can try to get it from other foods, like broccoli, spinach, turnip greens, tofu, yogurt, sardines, salmon with bones, calcium-fortified orange juice and breads, or calcium supplements.
    Medications
    The following types of drugs are used to treat IBS:
    Antispasmodics can control colon muscle spasms, but experts are unsure that these drugs help. They also have side effects, such as making you drowsy and constipated, that make them a bad choice for some people.
    Antidiarrheal drugs, such as kutaja, bilwa may help with diarrhea.
    Laxatives can give short-term relief from constipation.
    Bulking agents, such as psyllium, wheat bran, and corn fiber, help slow the movement of food through the digestive system and may also help relieve symptoms.
    Antidepressants may also help relieve symptoms in some people.

Management
A number of treatments have been found to be effective including:
Diet: Symptoms most likely to improve from such a diet include urgency, flatulence, bloating, abdominal pain, and altered stool output.
The diet should, restricts various carbohydrates which are poorly absorbed in the small intestine, as well as fructose and lactose, which are similarly poorly absorbed in those with intolerances to them. Reduction of fructose and fructan has been shown to reduce IBS symptoms in a dose-dependent manner in patients with fructose malabsorption and IBS.

Fiber
Some evidence suggests soluble fiber supplementation (e.g., psyllium/ispagula husk) is effective. It acts as a bulking agent, and for many IBS-D patients, allows for a more consistent stool. For IBS-C patients, it seems to allow for a softer, moister, more easily passable stool.
However, insoluble fiber (e.g., bran) has not been found to be effective for IBS. In some people, insoluble fiber supplementation may aggravate symptoms.
Fiber might be beneficial in those who have a predominance of constipation. In people who have IBS-C, soluble fiber can reduce overall symptoms, but will not reduce pain. The research supporting dietary fiber contains conflicting, small studies complicated by the heterogeneity of types of fiber and doses used. It is found that soluble fiber reduced symptoms, while insoluble fiber worsened symptoms in some cases.

Medication: That includes
Laxatives, Antispasmodics, Herbal remedies, Psychological therapies
Stress relief therapies that includes:

  1. Relaxation techniques such as meditation, cooncentration etc
    2. Physical activities such as yoga
    3. Regular exercise such as swimming, walking, or running

Ayurvedic Treatment for Irritable bowel syndrome

Consistent with the Ayurveda the first line of IBS pain treatment is regulation of the digestive blaze and disposal of the undigested poisons. The medicine for heartburn, in particular fasting, administeration of digestives and carminatives are demonstrated. The point when the poisons are significant, it first must be wiped out through detoxitification.
In Ayurveda, detoxification is carried out through the Panchakarma with Vamana (emesis) and Virechana (purgation). These procedures complimented with internal medicines gives remarkable results in this condition.
When IBS is stress induced, Shirodhara, has very good calming effect on the mind.
With the right diet and lifestyle and with regular practice of Yoga and Pranayama, one can effectively manage the disease.
. So the aim of treatment should be to enhance the potency of agni, thereby reducing the formation of ama dosha.
Though ayurvedic medicines are capable of regularizing the agni to normalcy, yogic exercises, by virtue of their specificity, work as catalytic agents for stabilizing the agni at a higher level even if the medicines are withdrawn. This in itself is an Important achievement, as medicines cannot be used permanently. The disease can only be considered as cured when the agni is balanced without the use of any external medicine.

Home Remedies
• Aloevera juice 3 tbsp should be taken twice daily in the morning and evening, with equal water. Kumari (Aloe vera), the main ingredient in the formulation is effective in grahni caused by vitiation of the the pitta dosha.
• Half teaspoonful (2.5 g) of Bilwa churana thrice a day is prescribed with lukewarm water for grahani caused by vitiation of the vata and pitta dosha.
• Buttermilk is the mainstay of the treatment, take daily 50-100 ml of fresh buttermilk hels in relieving the symptoms.
• Dry roasted powdered seeds of cumin ( jeera) are found to be quite effective in the symptoms of grahani.
• Powder of four sours (Vrukshamla, Amlavetasa, Dadima and Badara) 640 gm, trikatu 120 gm (Pippali, Shunthi, Black Pepper), and five salts 160gm added with sugar 320gm should be used with vegetables, pulses, cooked cereals etc. It is efficacious in colic, indigestion, anorexia etc.
• Panchakola is to be added in cereal soup, Radish soups with black pepper are recommended as diet.
• Drink ginger tea or chew raw ginger to scale back inflammation caused by Irritable internal organ Syndrome.

Herbal formulation effective in relieving clinical as well as physiological symptoms in grahani/ IBS:
• Panchamrit parpati
• Hingwastak choorna
• Bilwadi choorma
• Chitrakadi vati
• Agnitundi vati
• Abhayariata
• Kutajarista
• Takrarista
• Kumaryasava

Herbal formulations effective in relieving psychological symptoms

  • Brahami vati
    • Sarpagandha vati
    • Manasmitra vatakam
    • Saraswatarista

Conclusion

Although Grahani is predominately a pitta disease, one must take care for other biological humours…vata and kapha. In addition, addressing the mind/body relationship is of prime importance alongwith health lifestyle and dietary choices.
Conclusion
1. Yoga and parpati is an ideal treatment for chronic ulcerative colitis.
2. No recurrence of symptoms was reported during a 2-8 year follow up.
3. Mild recurrences can be corrected and prevented by continued yoga practice.
4. No dependency is developed.
5. No side effects or toxic reactions occur.

Yoga Practices for the Relief of Digestive Disorder:

Yoga may be effective for some IBS patients, especially poses which exercise the lower abdomen.
Bhujangasana
“By practising this bhujangasana, dehagni- the heat of the body- increases, all diseases are destroyed and kundalini is aroused.”
Mayurasana
“Mayurasana soon destroys all the diseases caused by doshas (undigested material) in the stomach, and wards off gulmas (tumors of the abdomen). It kindles the jatharagni (gastric fire) and completely digests all the unwholesome and overeaten food- even poison.”
Paschimottanasana
“This paschimottanasana, foremost among the asanas, directs the passage of prana along the back. It kindles the gastric fire (jatharagni), reduces the belly and bestows health upon the aspirants.”
Matsyendrasana
“The practice of matsyendrasana, which stimulates the jatharagni (gastric fire) and is a weapon to destroy the diseases around the umbilicus, bestows upon those persons who practise it arousal of kundalini and stability of the chandra (mind).”
Sarvangasana
“The practice of sarvangasana increases the jatharagni (gastric heat) of a regular practitioner. One who practises it daily should procure (and eat) ample food. If he eats insufficient food, the increasing fire soon consumes his body.”
Pranayama
“A yogi should always practise the beneficial sitali kumbhaka. He will never suffer from indigestion and disorder of kapha (phlegm) and pitta (bile).”

Shatkarmas
In shatkarmas “Nauli, the crown of hatha yoga practices, stimulates the digestive metabolism and brings about a feeling of wellbeing.”

Panchakarma chikitsa

  • Vamana karma and Virechana karma are recomended
    • Basti karma especially picha basties are recommended
    • Shirodhara, especially takra dhara is recomended

Can this be prevented?
There are plenty of things that should be done to get rid of the, irritability of the bowels.

  1. Try changing your diet.
    2. Eliminate the use of milk and milk products from your diet. This should be simply to test and determine if you do have lactose intolerance. You should not eliminate milk or milk products on a permanent basis unless you make sure you have other adequate calcium sources.
    3. Avoid excess tea, coffee, alcohol, cola, and carbonated beverages.
    4. You should eat slowly and in a relaxed environment as possible, don’t eat during indigestion, or eating irregularly.
    5. Avoid intake of unsuitable food, heavy, cold, contaminated or too sweet food, which is heavy to digest. Ayurveda explains how to eat, when & what? So follow such rules.
    6. Omit strong spices; too oily i.e. fried food, fatty foods, and flatus alleviating foods.
    7. Tobacco should be eliminated entirely. Avoid all forms of tobacco, including smoking, chewing or snuffing.
    8. Diet adjustments are not enough to improve your bowel function and avoid IBS. It is important to eliminate nervous tension if possible. Relive your anxiety and stress by adjusting your life style. Most of those measures are the things we should all do for better health anyway.
    9. Train your bowel, as this is also an important part of managing irritable bowel symptoms, when the problem is mostly constipation.
    10. Don’t suppress the urge of urine & stool
    11. Take fiber rich diet in case of constipation only.

How ayurveda helps to curing the disease ibs/sangrahani
Ayurveda suggests warm water for drinking first, when morbidity is situated in grahani and is flared up with the half burnt food. Appetizers, lightening and digestive measures like liquid gruel etc followed by ghee mixed with appetizers, vata alleviating drugs and enema’s is then advise as a line of treatment. If you have this problem, you must consult your physician for proper treatment. Ayurvedic treatment is based on semi digested (sama) or properly digested (nirama) stool. According to this physician decides your treatment.

Dos and Don’ts

DO’S: Eat old rice, jawar, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, wood apple, Pomegranate, nutmeg, skimmed milk, buttermilk, hot water, complete rest, adequate sleep.

DON’TS: Eat wheat, maize, barley, pigeon pea, pea, cow pea, spiked dolichos, black gram, gram, Soya bean, saga, kidney bean, potato, sweet potato, navalkoal, onion, coconut, groundnut, chili, oily food, chicken, red meat, crabs, prawns, fish, leafy vegetable like sorrel, drum stick etc, mango, pineapple, apple, watermelon, cashew, pumpkin gourd, papaya, fig, jack fruit, excess milk, day sleep, awakening at night, tension, suppression of urges before bed.

Living with IBS

IBS is unpredictable. You may go for many months without any symptoms, then have a sudden flare-up.
The condition can also be painful and debilitating, which can have a negative impact on your quality of life and emotional state. Many people with IBS will experience feelings of depression and anxiety, at some point.
If the feelings of depression or anxiety are affecting your daily life, than should take an immediate action to sort out. These problems rarely improve without treatment. Treatments such as antidepressants or cognitive behavioral therapy (CBT), which can help to cope with IBS, as well as directly treating the condition.
With appropriate medical and psychological treatment, one should be able to live a normal, full and active life with IBS.
IBS does not pose a serious threat to the physical health and does not increase the chances of developing cancer or other bowel-related conditions.