Clinical Cases

Irritable Bowel Syndrome (IBS)

Last modified on June 15th, 2018

Written by Pankaja Katekari

Dr. Pankaja Katekari presented a case of Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS)

IBS is a group of symptoms—including abdominal pain and changes in the pattern of bowel movements without any evidence of underlying damage.

  • It has been classified depending on whether diarrhoea is common, constipation is common or both are common.
  • Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.
  • IBS is a functional gastrointestinal disorder.
  • We may see weight loss, blood in the stool.
  • The primary symptoms of IBS are abdominal pain or discomfort in association with frequent changes in bowel movements.
  • Tere may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus), bloating, or abdominal distension.
  • One of the symptoms of IBS is mucus – a yellowish whitecolour and sometimes clear.
  • People with IBS, more commonly than others, have gastroesophageal reflux, nausea, symptoms relating to the genitourinary system, chronic fatigue syndrome, fibromyalgia, headache, backache, and psychiatric symptoms such as depression and anxiety.
  • There is also mineral deficiency and anemia.
  • Stress reliefReducing stress may reduce the frequency and severity of IBS symptoms. Techniques that may be helpful include:

Relaxation techniques such as meditation

Physical activities such as yoga

Regular exercise such as swimming, walking, or running.

CASE REPORT

A 29 year old male patient, unmarried, currently not working as he was studying for his MBA came on 23rd  May  2017 with complaints of loose stools daily with urgency and frequency .

Stools  intermingled with blood and mucus.

Cramps in abdomen sometimes before or during stools.

Bloating sensation in abdomen

Had already tried allopathic treatment without any relief. < lying on left side (it increases desire for stool and the pain in abdomen)

Also  < from milk, curds, spicy food

Stools contained undigested food particles, especially after he has eaten green leafy vegetables.

Only small quantities passed, with unsatisfactory sensation after stools.

Greenish mucus and stools. Stools which are in liquid form in bits of pieces floating along with froth.

Burning sensation after stools.  Slight blood also visible on some occasions.

Nausea when unable to pass stool and has to control it.

Family History

  • Mother – Leucoderma
  • Father – Diabetes Mellitus
  • Sister – I.B.S was treated with Homoeopathy
  • Brother – healthy

Physical generals

  • Salt, recently he felt like eating slate
  • Thirst not very characteristic
  • Appetite was normal
  • Sleep disturbed d/t the complaints, as he had to sometimes wake up from sleep with the urge to pass stool, especially when lying on the left side.
  • Weight – 50kgs ( Had already lost 5 kgs)
  • Hb was 7- he had to take iron injections to increase Hb levels before visiting me.

Whenever he goes away from home for a long time he gets anxious as he fears he may have the desire to pass stools.

When he reaches close by his house the urgency to pass stools increases.

He was currently not working as he had plans to travel to New Zealand for further education. He had applied for his visa. He had plans to leave in a few months, so he wanted to get better before going there. This decision was not supported by his parents as they wanted him to stay back and work in India. As a result he was constantly taunted for not working. These comments from parents constantly disturbed him.

The actual statements of the patient when asked how does it make him feel…. “I feel tortured by my parents’ statements as they don’t understand my feelings. They have never supported me in my decisions and now also they are criticizing me for not doing a job and spending money to go to foreign lands. They don’t understand that I won’t get a good job unless I have a foreign degree”. He was planning to take a Logistics Management course for a year. Therefore he blames them for his career failure as he is not able to get a good job.  Has a lot of anger about his parent’s behavior towards him, but is unable to do anything about it. He would just walk out of his house for some hours whenever an argument took place.

Feels he has no one in the house whom he can share his feelings with.

The patient spoke slowly

COMMONCHARACTERISTIC
Bloating sensationDiarrhoea <n lying in left side
<n spicy milk, curdsLienteric stools
Burning sensation after stoolGreenish mucus and stools floating with froth
Blood present in stoolsDesires Salt
Nausea when unable to pass stoolForsaken feeling
Weight loss
Low Hb leading to ds for slate
Anxiety

  • I gave him Phosphorus 200, single dose with SL for 7 Days. (23/05/17)

Follow – up

  • 30/05/17 He felt slightly better. The urgency when reaching home remained the same but frequency was better. The abdominal pain had decreased, but the consistency and the passing of undigested stool persisted. The patient was sent back with SL for 15 days.
  • 14/06/17 Complaints better but spicy food and chapatti still < the complaints. Weight =52kgs
  • 28/06/17 Complaints better in regards to frequency but the urgency still persisted with the undigested food and slight cramps at night…..especially lying on the left side.
  • 11/07/17 The patient came back with same complaints since 3 days as he had taken antibiotics due to dental implants which was necessary before he left for his studies.

A dose of Phosphorus 1M single dose  (considering the antibiotics effects) was repeated with SL for 15 days.

  • 25/07/17 The patient felt much better, but no relief with the urgency and the consistency. Only the frequency had decreased.

Weight =54kgs. SL given for one month (as he was travelling) SOS powder of Phos 200  ( 3 doses) given in case of emergency.

  • He was travelling on 1st Aug 2017.

After reaching there I did not hear from the patient for many days …I thought  all well, but on 2nd Oct he messaged me saying that his complaints were not better ever since he reached there.

He managed for a few days without medicines but had to see an in-house doctor there. The doctor did some tests and prescribed antibiotics and iron supplements, but the patient did not take them.

I suggested he take a dose of the SOS powder I had given him.

Watsapp messages from the patient from New Zealand.

I asked the patient to call me so I could talk to him regarding his mental state, but he did not respond for few days.

He felt very lonely. When he spoke with his parents about his illness instead of consoling him they scared him more and made him more anxious. He felt very lonely and alone unable to cope with his anxiety and illness. So mad the decision to return to get better.

Reconsidering my repertory sheet once again:

I reaslised…….

Diarrhoea lying on left side aggravated is a common disease symptom of IBS.

So I tried to stress the rubrics covering the strong Forsaken Feeling.

  • ENGLISH DICTIONARY, defines someone who feels forsaken feels abandoned, given up by people who previously used to value him or her.
  • The feeling that he is not loved, that he has lost his friends. A fear of loneliness, of being left on one’s own in life’, expressed in a fear of the death of those closest to him.
  • We see a person who previously enjoyed the love of friends, and later lost it and feels alone, deserted, like a castaway. Therefore we may conclude that the key ingredient to feeling forsaken is an intense alone-ness.
  • Differentiating the remedies covering the forsaken feeling from the repertorisation….

Argentum Nit

In this patient the anxiety is not violent but is constant. Mostly this anxiety prevents the person from any type of performance. Thus the pressure to prove themselves adds a lot of stress and brings on the complaints. The patient is more of  a “worrier type ” and this is what leads to a state of constant anxiety. The patient that requires Argentum lives in a world full of fear, irrational impulses and has a forsaken feeling. Tormented by a forsaken feeling, or as if surrounded by unfriendly people

Merc sol

An aggressive, rebellious personality. Will fight back to prove his worth. He might feel misunderstood and alone in this world, as he feels different from the ‘average’person. Mercurius is in a condition, where he actually needs a friend more than ever, but he has no social skills and people have a hard time understanding him. Mercurius might take this so personally, that he    becomes suspicious of others.

Phosphorus

She is volatile emotionally and she tends to put out so much energy that she burns herself out and gets sick as a result.  In other words, she can be very emotionally intense.  Her emotional intensity and volatility makes her unpredictable, and when someone becomes unpredictable, the people in their lives tend to keep a safe distance; therefore, she gets a sense of isolation, and a feeling that nobody truly loves her.

Mag carb

The magnesium feeling is that the person doesn’t get the care, protection and nourishment that he needs. The dreams of Magnesium have a feeling of being alone, of having to face a problem alone “J. T. Kent discovered that this is the remedy for children who are abandoned by their parents, and then have to make an effort to adapt to life in an institution or adoptive family.”

Mag carb is fre­quently the remedy for children born into a war zone, children of unhappy homes, of quarrelling or divorced parents. They feel, consciously or uncon­sciously, abandoned, rejected, neglected and unloved and therefore unlovable and without worth, and are haunted by the fear that the family will break apart

  • A most striking condition of Magnesia carb. is green diarrhea stool, and the green part floats upon the watery portion of the stool.
  • The stool is often lumpy, and liquid.
  • The lumps lie in the bottom of the vessel, but floating upon the liquid portion of the stool is the green like the scum of the frog pond. This is recognized as one of the most striking features.
  • “Stools green, like scum on a frog pond; sour, frothy; with white floating lumps like tallow, bloody, mucous.”

RX: Mag Carb 1M single dose

The patient is till today on SL. With no repetition needed.

His current weight is 58 kgs.

He had been to New Zealand for a week but did not have any complaints.

Due to gap in studies he has decided to re take admission in July.

About the author

Pankaja Katekari

Dr. Pankaja Katekari received a BHMS from Lokmanya Homoeopathic Medical College in 1999 and M.D from Sonajirao Homoeopathic College, Beed in 2012. She has been Assistant Professor in Shree Fakhirbhai Pansare Homoeopathic Medical College for 12 yrs. She has taken part in and organized various seminars for students and interns and has had a number of articles published in both medical and non-medical journals. She also arranged camps for obesity and infertility, did a research project on psoriasis and worked in a specialized clinic for diabetes and hypertension.

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