The Hard, The Loose, and the Painful

The Hard, the Loose and the Painful

PART 1: What is happening in constipation & diarrhoea

PART 2: IBS

PART 3: Herbal treatment for constipation, diarrhoea and IBS

1a.What happens in constipation – diet & lifestyle changes to reduce the occurrence

Constipation refers to infrequent or difficult defaecation and is caused by decreased motility of the intestines. Because the faeces remain in the colon for prolonged periods of time, there is excessive water absorption, and the faeces become dry and hard. Constipation may be caused by improper bowel habits, spasms of the colon, insufficient fibre in the diet, inadequate fluid intake, lack of exercise, and emotions.

·      Add fibre to the diet

·      Increase amount of exercise

·      Improve fluid intake

·      Address stressful emotions/fear

·      Use mild laxative herbs

·      Dietary fibre

 Adequate fibre [bulk or roughage] in the diet has several beneficial effects. Dietary fibre consists of indigestible plant substances, such as cellulose, lignin, and pectin found in fruits, vegetables, grains, and beans.

Fibre may be classed as insoluble which does not dissolve in water, and soluble which does dissolve in water.

Insoluble includes woody or structural parts of plants, fruit and veg skins, and bran coating around wheat and corn kernels. Insoluble fibre passes through GIT largely unchanged and speeds up the passage of material through the tract.

Soluble is found in beans, oats, barley, broccoli, prunes, apples, and citrus fruits. It has the consistency of a gel and tends to moisten the stool and ease the passage through the tract.

1b.What happens with diarrhoea – lifestyle & dietary changes to reduce the likelihood

Diarrhoea refers to the defaecation of liquid faeces. It is caused by increased motility of and decreased absorption by the intestines. When chime passes too quickly through the small intestine and faeces passes too quickly through the large intestine, there is not enough time for absorption. 98% of water or less is reabsorbed = more water left in stool. Frequent diarrhoea can result in dehydration and electrolyte imbalances. It may be caused by lactose intolerance, stress, nerves before an exam or test, microbes that can irritate the gastrointestinal mucosa, travellers tummy, parasites, food intolerances, alcohol, curries, hormonal change [before periods]

·      Reduce laxative foods [fibre rich eg apricots/prunes]

·      Adjust diet [eg go dairy free]

·      Reduce stressful emotions/fear

·      Antimicrobial herbs

  2. IBS – what is happening and why – lifestyle changes to reduce the likelihood

What is Irritable Bowel Syndrome?– Motility disorders involving the small intestine and large bowel associated with variable degrees of abdominal pain, constipation or diarrhoea largely as a reaction to stress in a susceptible individual [Merck]

There is a relationship between IBS and stress because our bodies respond to internal or external changes. This stress response, also known as the fight-or-flight response, allows us to respond to life-threatening situations in a way that would maximize our chances for survival. It involves our nervous and hormonal systems and it stimulates changes in a variety of body processes, including blood pressure, heart rate, muscle tension and bowel functioning. It is the changes in bowel functioning that tie the stress response and IBS together.

In response to a perceived stressor various parts of the brain begin to communicate with one another which triggers a response resulting in an increase in hormonal secretions, particularly the hormones cortisol, adrenaline and noradrenaline. These hormones cause cardiovascular, muscular and digestive system changes and directly affect the network of nerves found within the bowel, known as the enteric nervous system. This process, which starts with a perceived stressor, followed by a brain response, and resulting in stimulation along the two pathways down to the gut, illustrates the importance of looking at the stress response in trying to understand the dysfunction that manifests as IBS symptoms.

 [Various parts of the brain begin to communicate with one another, including the sensory cortex, the thalamus and the brain stem. This process then triggers a response along two major bodily paths. The first is the hypothalamic-pituitary-adrenal axis, resulting in an increase in hormonal secretions, particularly the hormone cortisol. The second path is the autonomic nervous system, which releases adrenaline and noradrenaline causing cardiovascular, muscular and digestive system changes. These two pathways directly affect the network of nerves found within the bowel, known as the enteric nervous system. ]

IBS is a common disorder characterised by cramping pain, gassiness, bloating and changes in bowel habits. Symptoms can include diarrhoea, constipation or alternate between the two.

A whole panoply of symptoms can occur in IBS, abdominal distress, erratic frequency of bowel movements. Mucus may be present in the stools. Often, unpleasant abdominal sensations include bloating and flatulence, but other symptoms like headaches and anxiety can be present. Just about anything that supports physiological activity or helps the individual feels at ease may be indicated. Diet is fundamental but identifying problematic foods can be a problem. Sit and eat, be at rest not on the hoof, chew properly, regular meals. Keep a journal to record foods and trigger symptoms, eat smaller meals.

 3. Herbal Treatment for Constipation, Diarrhoea and IBS

Constipation – There are many herbs that relieve the discomfort of constipation. Laxative remedies are obviously relevant but there are others to consider, like bitters because they cause a general stimulation of the digestive process.

Bulk laxatives are fibre rich foods and herbs that offer the only truly safe, long term treatment possible. They act slowly and gently and are best used by gradually increasing the dose taken every morning and evening until a softer stool is achieved. These agents can be used as supplements to dietary fibre are polysaccharides and celluloses derived from grains and seed husks and include bran, Psyllium seed, linseed and Slippery Elm if taken with a LOT of water due to its mucilage.

Indigestible carbohydrates which undergo complete or partial breakdown by intestinal flora physically stimulate activity through their bulking action, thus speeding the transit of material through the intestinal tract. Swelling agents can form mucilage or gel. The mucilaginous gels are usually taken as a medicinal supplement rather than as a food [eg Psyllium husks or slippery elm].

Bulk-forming laxatives have little effect on small intestine transit time but do affect colonic transit time.

They also stimulate bowel motility by modifying intestinal flora. The colon is inhabited by more than 400 species of bacteria, and the exact composition of the flora depends on the available substrate. Faecal bulk provides the bacteria with a substrate for proliferation which causes an increase in bacterial mass and therefore stool weight. It takes about 4-6 weeks to establish a more suitable intestinal flora.

Gas generated in the lower bowel may cause bloating and flatulence, and constipation may initially worsen when bulking agents are reduced. Generally, this is resolved once a new set of intestinal flora is established. It is important that bulk-forming laxatives be taken with plenty of water.

Anthraquinone laxatives exert their effect by irritating the lining of the colon which stimulates motility and inhibiting the reabsorption of water from the stool back into the intestinal mucosa. Short term use is perfectly safe but long-term use is not to ne recommended, no longer than 2-3 weeks. These are for use in difficult circumstances where evacuation is long overdue. They usually take about 8 hours to work so best taken at bedtime. Not advisable with IBS, but the milder ones OK in pregnancy.

Senna alexandrina, Cassia senna [senna pods], Rhamnus purshiana [cascara buckthorn]

Rheum palmatum [Turkey rhubarb], Rumex crispus [Yellow dock]

Figs contain soluble and insoluble fibre, plus sugars which are osmotic agents causing water to be retained in the bowel.

 Bitters have a general tonic action on the GIT, they stimulate all digestives secretions, they increase blood flow to the area, and increase the motility of the gut. You must TASTE the bitter to have an effect. Bitter taste receptors on the tongue send signals to the stomach to start producing secretions, increase motility and blood flow via the vagus nerve. Bitters also stimulate the release of the gut hormone gastrin which provokes the release of gastric acid in the stomach.

Pure bitters: Centaurium erythraea Centuary [mild], Gentiana lutea Gentian [strong]

Aromatic bitters: Acorus calamus, Sweet flag, Angelica archangelica, Angelica, Artemesia absinthium Wormwood, Mentha piperita Peppermint, Humulus lupus Hops.

Bitter tonics:  Cynara scolymus, Artichoke, Fumaria officinalis Fumitory

 Diarrhoea – Diarrhoea may be a temporary or chronic problem. Prolonged diarrhoea may cause dehydration, and rehydration salts should be taken. It may be a sign of other problems like ulcerative colitis or Crohn’s, so a proper assessment must be made by a practising herbalist especially if your stools contain blood.

Herbs that stop diarrhoea may be helpful in some cases, but they are not recommended for people with infections or parasites as stopping the diarrhoea will trap the organism in the intestines and prolong the problem.

Astringents – Many astringent herbs have a reputation as specific for diarrhoea. Filipendula ulmaria Meadowsweet may well be the best overall treatment for diarrhoea as it helps tone the lining of the small intestine. It is especially helpful for childhood diarrhoea. Agrimonia eupatoria, Agrimony, Alchemilla mollis Ladies Mantle, Geranium maculatum Cranesbill are other excellent gentle astringents. Stronger astringents such as Quercus robur, Oak bark should only be used as a last resort. Mostly used as a dried herb made into a tea, as will also help replenish fluid.

IBS – Herbs offer a wide range of therapeutic possibilities for the treatment of irritable bowel, and often have more to offer than other treatments. Herbal support of the whole digestive system is pivotal, as is help for the nervous system.

Primary actions:

• Astringents to stop the diarrhoea:   Bayberry
• Bitters often normalise bowel function: Peppermint
• Anti-inflammatories reduce localised mucosal reactions: Calendula
• Carminatives help with flatulence or colic: Chamomile, Fennel
• Antispasmodics if cramping is severe: Cramp Bark, Valerian    
• Nervines ease background stress: Chamomile, Lemon Balm   
• Laxatives be cautious with these as they may cause a rebound back to diarrhoea

Chamomile and Peppermint are both herbs that have a direct impact on IBS, with astringents like Bayberry and healing remedies like Calendula, anti-spasmodic herbs like Cramp Bark, and nervines like Chamomile and Lemon Balm to ease background stress.

Since about 80% of IBS is caused by SIBO [small intestinal bacterial overgrowth] then a SIBO test is advisable. These tests are just simple breath tests that can be organised by your Medical Herbalist or Naturopath and done at home. If you have a positive diagnosis of SIBO then certain dietary protocols can be followed to reverse symptoms and give you back energy without the bloating and cramping.