IBS

For safe use of over-the-counter medicines, herbal remedies and supplements, consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
– if you have a serious medical condition
– if you are breast-feeding, pregnant or planning to become pregnant
– if you suffer from allergies.

Registered herbal medicines (bearing the THR logo) will have a package insert. Read this before taking the product.

Avoid taking the product if you think you may be allergic to any of the ingredients.

Do not combine over-the-counter medicines, remedies or supplements with prescribed medicines unless you have first checked with your prescriber or a pharmacist.

Seek advice from your doctor or pharmacist:
– If your symptoms do not get better
– if your symptoms get worse
– if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

Many modern drugs started as medicinal plants and people have been using herbs to treat illnesses for thousand of years. Some of these remedies have been tested against the toughest health conditions, and plants with the strongest reputations across many cultures deserve a close look.

From the way they have been described in old texts, and from what we now know of the action of many plant constituents, it is possible favourite plant remedies work particularly by nudging better function in digestion, circulation, and eliminatory processes: helping the body help itself rather than directly attack a disease. Women also favoured plants in managing their health and childrearing needs.

Researchers are now discovering that many herbal medicines have useful benefits for the body, including in healing and repair, in stabilising hormonal responses (including stress hormones, insulin and sex hormones), and in reducing long-term inflammation.

See below for varios ways herbs have been used to help people with IBS.

A number of medicines may help with IBS. Which ones to choose depends on which symptoms you find most troublesome. It would be worth discussing this with your doctor or pharmacist.

An antispasmodic, such as Colofac (mebeverine), can help with colicky abdominal pain. For people with constipation, a bulk-forming laxative is best (such as ispaghula or sterculia). Lactulose is not advisable for IBS. If there is diarrhoea, an antimotility drug such as Imodium (loperamide) can be useful. Your pharmacist will advise you on what to try and the right dosage. The aim is to produce a soft, well-formed stool.

Spices have been highly prized for centuries. Before we had refrigerators to keep food fresh, spices were used to flavour food, and to help settle the digestion and relieve stomach aches and colic, flatulence and indigestion. Many spices contain oils that are known to relax the muscles of the digestive system. Since spices are foods, they are safe in reasonable amounts and there are few risks in trying them out at home (unless you are one of the very few people with allergies to certain spices).

Each spice has its own properties and each person will respond differently to them, so it’s best to try them one by one, made into tea with hot water, to see which might work for you. Fennel, ginger, cardamom, cinnamon and aniseed are most widely used for these purposes. Herbs like camomile, peppermint and lemon balm are traditional home remedies for upset stomach and colic and are also safe to try as teas.

Summary
Laxatives can help relieve constipation but the more active versions (for example based on senna or cascara) should only be taken for a few days at a time. Soluble-fibre laxatives, such as ispaghula powder, can be taken long-term and can help with diarrhoea as well as constipation.

Evidence
Laxatives are helpful for constipation.

Safety
Always read the package insert before taking any medicine. Avoid if you think you may be allergic to the product. Do not take anything with other medicines, remedies or supplements unless you have checked with a qualified person (for example a pharmacist). There is usually a maximum time limit on the label for taking stimulating laxatives: do not exceed this without talking with a qualified health professional. People with IBS should avoid taking lactulose.

Cost
Laxatives can be bought for relatively low cost from most pharmacies. Your GP may prescribe them for you.

Summary
Antispasmodics such as mebeverine hydrochloride (e.g. Colofac) work on the muscles that move the contents of the intestines along. These muscles have to contract and relax in time with one another. If muscles in one part of the intestine tense up in a spasm, the intestine nearby will tend to get stretched, as the contents back up. People who get IBS feel this as cramps and bloating.

Evidence
There is research to show that antispasmodics ease the pain from cramps and may also help with bloating.

Safety
Always read the package insert before taking any medicine. Avoid if you think you may be allergic to the product.
Do not take anything with other medicines, remedies or supplements unless you have checked with a qualified person (for example a pharmacist).

Cost
Bowel relaxing medicines can be bought for relatively low cost from most pharmacies. Your GP may prescribe them for you.

Summary
Medicines like Imodium or loperamide are safe for short-term use to control diarrhoea if you are certain the cause is IBS.

Evidence
Research studies have shown that loperamide can be useful in diarrhoea where there is no pain.

Safety
These medicines are safe for short-term use if you are certain the cause is IBS. Always read the package insert before taking any medicine. Avoid if you think you may be allergic to the product.

Do not take anything with other medicines, remedies or supplements unless you have checked with a qualified person (for example a pharmacist).

Cost
Medicines that stop diarrhoea can be bought for relatively low cost from most pharmacies. Your GP may prescribe them for you.

Summary
Peppermint is a common flowering plant that grows all over Europe and North America. Some small studies suggest that peppermint’s fragrant oil (which relaxes the intestine muscles) may improve IBS symptoms. Avoid peppermint oil if you think you are allergic or hypersensitive to peppermint or menthol. 

Evidence
Research suggests that peppermint oil (taken in a capsule designed to reach the colon) can help with cramps and bloating.

Safety
Peppermint is safe in non-allergic adults, unless you have gall bladder disease or are known to have G6PD deficiency. Always read the package insert before taking any medicine. Avoid if you think you may be allergic to the product.
Do not take anything with other medicines, remedies or supplements unless you have checked with a qualified person (for example a pharmacist)

Cost
Peppermint oil capsules can be bought relatively cheaply online. Do you a reputable manufacturer or retailer to avoid poor quality products.

Summary
IBS is a modern diagnosis, used when bowel diseases and observable damage have been eliminated. However as outlined in the tab on spices above, the symptoms of IBS are very familiar through the ages.

Spices and digestion-settling herbs were the first treatment of choice. The advantage is that in the form of teas the effects are seen within hours and so it is possible to find the herbs or spices that suit your condition very quickly.

There are however other insights from tradition. IBS was sometimes associated with liver and bile upsets (the sort we mostly associate with intolerance to fatty foods and alcohol but also seen in various liver problems like infective or non-infective hepatitis). We know that the bile, which the liver secretes into the bowel, has laxative properties and can sometimes be more irritating to the bowel, with symptoms that could easily be called ‘IBS’.

There are many approaches that have been used to flush out irritating bile. Simply drinking more water will help, as will eating more vegetables and soft fibre foods. Correcting constipation should be an early priority as shortening the transit time through the bowel will reduce re-absorption of bile. Among herbs often used to help are the following.

Dandelion root (Taraxacum officinale). This is used as a bile-cleansing remedy all over the world and can be a useful adjunct to a herbal tea for IBS.

Artichoke leaf (Cynara scolymus). A popular remedy in France where the liver (foie) is culturally more often implicated in digestive problems: it is sometimes said to be useful for crise de foie (liver crisis)! People often report that more bile comes through as yellow colouring in the stool when it is taken.

Safety
It is also advisable not to buy herbs online unless from suppliers with prominent reputation (they will be concerned to protect this by ensuring quality for their products). Unfortunately there are few controls on herbal sales and many cases of adulterated or wrong products. It is always a good policy to look for a registered herbal medicine, with the THR logo on the pack. This will have its quality independently assured.

A good approach in choosing traditional herbal approaches for depression is to see a qualified herbal practitioner. You will find well trained practitioners from a number of traditions from the website of the main umbrella body the European Herbal and Traditional Practitioners Association. This will entail extra costs but will allow you to have herbs you might not find elsewhere, and tailored to your needs.

Cost
Most herbs should be inexpensive and can be bought from specialist suppliers. A registered herbal medicine (THR) if available, will cost more – round £15 per month.  Seeing a practitioner may cost around £50 for a first visit.