Journal of Medicinal Plants Research Vol. 5(32), pp.

6934-6938, 30 December, 2011

Available online at http://www.academicjournals.org/JMPR
ISSN 1996-0875 ©2011 Academic Journals
DOI: 10.5897/JMPR11.1224

Review

Herbal treatment of irritable bowel syndrome:

A review
M. Akram1*, Muhammad Irfanullah Siddiqui2, Naveed Akhter3, Muhammad Khurram Waqas4,
Zafar Iqbal 3, Muhammad Akram5, Aubid Allah Khan3, Asadullah Madni3, H.M. Asif3
1
Shifa ul Mulk Memorial Hospital, Hamdard University, Karachi, Pakistan.
2
Department of Community Medicine, Faculty of Medicine, Umm Al-Qura University, Saudi Arabia.
3
Department of Pharmacy, The Islamia University of Bahawalpur, Pakistan.
4
Department of Pharmacy, The University of Faisalabad, Pakistan.
5
Department of Pharmacy, University of Sargodha, Pakistan.
Accepted 14 November, 2011

Irritable bowel syndrome (IBS) is a disabling disorder that affects most of the population in all over the
world. Symptoms of irritable bowel syndrome include recurrent abdominal pain, altered bowel habits,
and bloating. Irritable bowel syndrome is part of a broader group of disorders known as functional
gastrointestinal (GI) disorders. Herbal medicines have been used in Unani system of medicine for a
long time. Most of the patients are beginning to receive herbal medicines. The aim of this study is to
review the usage of herbal medicine in irritable bowel syndrome.

Key words: Irritable bowel syndrome, herbal medicine, treatment of irritable bowel syndrome.

INTRODUCTION

Irritable bowel syndrome (IBS) is defined as chronic or
recurrent abdominal pain, altered bowel habits, and
bloating, with the absence of structural or biochemical
abnormalities to explain these symptoms. Irritable bowel
syndrome is part of a broader group of disorders known
as functional gastrointestinal (GI) disorders. The colon
(large intestine) is responsible for packaging and
eliminating stool. As food moves through the colon it
absorbs water while forming stool. Muscle contractions
(squeezing motions) in the colon push the stool toward
the rectum (the lower five inches of the large intestine)
(Francis et al., 1997). These contractions are controlled
by nerves, hormones and by electrical activity in the
colon musculature and result in defecation or bowel
movement (Mertz, 2003). Normal bowel function varies
widely from person to person, normal bowel function
ranges from three stools a day to three each week. A
normal movement is one that is formed but not hard,
contains no blood, and is passed without cramps or pain
(Thompson et al., 1999). However, when colonic nerves
become irritated the muscle contractions may become
too hard (causing abdominal pain), may stop (causing
constipation and bloating), or may accelerate (causing
diarrhea and an urgency to have a bowel movement).
Irritated colonic nerves also make the colon very
sensitive to distention which may also cause pain.
Emotional factors such as stress, anxiety or depression
are not necessary to cause disease but still may play a
role in IBS by worsening symptoms and interfering with
the ability to cope with symptoms (Talley et al., 1996).
Though IBS can cause a great deal of discomfort, it can
almost always be managed and does not lead to any
other serious diseases. With attention to proper diet,
stress management, and sometimes prescription
medications, most people with IBS can keep their
symptoms under control (Mayer, 2008).

PATHOPHYSIOLOGY
*Corresponding author. E-mail: makram_0451@hotmail.com.
Tel: 92-021-6440083. Fax: 92-021-6440079. The pathophysiology of irritable bowel syndrome is not

well understood, but likely factors include: altered
gastrointestinal motility, increased gut sensitivity, and
increased intestinal contractions. Proposed mechanisms
include: stress as an aggravating factor because of
corticosporin releasing factor, gastric emptying delay, and
accelerated colonic transit; visceral hypersensitivity, with
a decreased threshold after exposure; abnormal brain
activation; altered colonic motility and disturbed motor
function; response to eating as a stimulus to colonic
activity; abnormal gas propulsion and expulsion; dietary
intolerance, most commonly to wheat and dairy products;
and inflammation, with production of prostaglandins,
bradykinins, nerve growth factors, adenosine, and 5-
hydroxytryptamine (Maxwell et al., 1997).
Symptoms of irritable bowel syndrome
Abdominal pain, bloating, and discomfort are the major
symptoms of irritable bowel syndrome. However,
symptoms can vary from person to person (Okhuysen et
al., 2004; Marshall et al., 2006). Some people have
constipation, which means hard, difficult-to-pass, or
infrequent bowel movements (Mitchell et al., 1987). Often
these people report straining and cramping when trying to
have a bowel movement but cannot eliminate any stool,
or they are able to eliminate only a small amount. If they
are able to have a bowel movement, there may be mucus
in it, which is a fluid that moistens and protect passages
in the digestive system. Some people with IBS
experience diarrhea, which is frequent, loose, watery,
stools. People with diarrhea frequently feel an urgent and
uncontrollable need to have a bowel movement. Other
people with IBS alternate between constipation and
diarrhea. Sometimes people find that their symptoms
subside for a few months and then return, while others
report a constant worsening of symptoms over time
(AGA, 2002).
Diagnosis
In the past it was thought that the diagnosis of irritable
bowel syndrome (IBS) relied on a diagnosis of exclusion
(Olden, 2003). That is, if one cannot find a cause then
IBS is the diagnosis. Currently the diagnosis of irritable
bowel syndrome relies on meeting Rome II inclusion
criteria (updated by Rome III criteria) and excluding other
illnesses based on history, physical examination, and
laboratory testing. Although, the Rome II and Rome III
criteria were not designed to be a management guideline,
it is currently a gold standard for the diagnosis of IBS.
Unfortunately an IBS diagnosis in an adult patient is still
only useful as a tool to rule out more serious problems
unless further investigation is employed to discern an
addressable condition (Spiller, 2007; Manning et al.,
1978)
Akram et al. 6935
Treatment of irritable bowel syndrome
Irritable bowel syndrome is an intestinal disorder which
may occur at any age. The common symptoms are
bloating and abdominal pain, constipation or diarrhea,
changes in bowel habits, fatigue, headache, decreased
appetite and increased thirst (Ringel et al., 2001).
There are a number of causes for irritable bowel
syndrome or IBS. The major causes are irregular food
habits, unhealthy diet and lack of physical exercise
(Camilleri et al., 1992). There are different natural
remedies for irritable bowel syndrome. These natural
remedies for irritable bowel syndrome can be used
effectively to cure the symptoms without many side
effects (Vincent, 1990; Smart et al., 1986). The following
are some natural remedies for irritable bowel syndrome:
1. Ginger: It reduces inflammation. But it should be
avoided by pregnant women.
2. Peppermint: Peppermint oil is a good natural remedy
for irritable bowel syndrome.
3. Flax seed: This is an effective natural remedy for
irritable bowel syndrome. It cleans the stomach.
4. Pomegranate: Another natural remedy for irritable
bowel syndrome is to take pomegranate seeds with black
salt.
Chamomile
Chamomile tea is also a good natural remedy.
Traditionally considered a ‘cure all,’ chamomile tea has
been recommended for a host of afflictions involving the
central nervous system, respiratory system, the digestive
system, the urogenital system, the musculoskeletal
system, and topical preparations for various skin
conditions (Hadley et al., 1999). It is currently used for
nausea, irritable bowel syndrome, peptic ulcer and colic,
as well as disorders of the nervous system and
dysmenorrhea.
Cinnamon
It can be used to prevent diarrhea and other symptoms of
irritable bowel syndrome.
Generally, people who live a sedentary lifestyle suffer
from irritable bowel syndrome. So another natural remedy
is to perform regular exercise.
Peppermint
Peppermint is obtained from dried leaves and flowering
branch tips of Mentha x pipertia. The oil contains more
than 100 components, including menthol (29 to 48%),
methyl acetate (3 to 10%), menthone (20 to 31%),
6936 J. Med. Plants Res.
caffeic acid, azulene, and flavonoids. It exerts
antibacterial and antiviral actions, as well as spasmolytic
effects on smooth muscles. When taken as enteric-
coated capsules, peppermint oil may have antispasmodic
effects on smooth muscle of the intestines, its
antispasmodic activity results from the calcium antagonist
effect of menthol. Flavonoids may cause its bile-
stimulating effect. Azulene may have anti- inflammatory
and antiulcer action. Peppermint is available as an
essential oil, ointment liniment extract, tincture, leaves
dried herb, and capsules (Kligler et al., 2007; Cappello et
al., 2007).
Reported uses
Peppermint is used to treat nausea, irritable bowel
syndrome (IBS), colitis, colic, ileitis, Crohn’s disease and
other spasmodic conditions of the bowel. It’s also used in
liver and gallbladder complaints, cramps of the upper GI
tract and bile ducts, menstrual cramps, colds and flu,
inflammation of the oral and pharyngeal mucosa, loss of
appetite, dyspepsia, flatulence, and gastritis (Mearin et
al., 2005). Peppermint is used to treat the nausea and
vomiting related to pregnancy and motion sickness. It’s
used externally formyalgia, itching, and skin irritation, and
the oil is applied to the forehead to relive tension and
migraine headaches (Nash et al., 1986)
PHARMACOLOGY
The active ingredients are volatile oils such as menthol,
menthone and methyl acetate. Its current use is mainly
for colic and irritable bowel syndrome. Enteric, coated
capsules of a standardized oil have been shown to be
effective against irritable bowel syndrome in placebo
controlled trials (Hdley et al., 1998; Thomson et al.,
2002), relieving or improving all symptoms of the disorder
(Hdley et al., 1998). The topical use of peppermint oil for
postherpetic neuralgia was found to be beneficial in one
report (Davies, 2002).
Hazards
Adverse effects associated with peppermint include:
headache, flushing spasm of tongue, eye irritation,
gastroesophageal reflux, respiratory arrest, contact
dermatitis, irritation, and allergic reactions. Calcium
channel blockers, such as amlodipine, bepridil, diltiazem,
felodipine, isradipine nicardipine, nimodipine,
nitrendipine, and verapamil, may have decreased effects
if used with peppermint and if patients are monitored
closely. Patients with gallstones, obstructed bile ducts,
gallbladder inflammation and severe liver damage should
not use peppermint. The oil should not be applied to the
face or nasal of infants or children because of the risk of
tongue spasms or respiratory arrest (Huang, 1990; Liu et
al., 1997).
Peppermint oil and irritable bowel syndrome
An oil extract of the peppermint plant (Mentha piperita
Linnaeus) has been used to treat stomach upset for
thousands of years. It appears to relax intestinal smooth
muscle cells by interfering with calcium channels. Short-
term trials suggest that daily use of 3 to 6 enteric-coated
capsules containing 0.2 to 0.4 ml of peppermint oil each
improves IBS symptoms. These observations are
supported by 2 meta-analyses. The first was based on 5
trials that suggested efficacy, but heterogeneous
diagnostic criteria and symptom scores weakened the
findings. Another review of 4 small trials found overall
symptom improvement with peppermint oil (odds ratio
2.7, 95% CI 1.6 to 4.8).
These results are strengthened by a recent trial of 110
patients who were screened for celiac disease, lactose
intolerance. After patients took 4 capsules daily for 4
weeks, symptoms improved in 75% of those taking
peppermint oil compared with 38% of those taking
placebo (P < 0.01). The strict inclusion criteria limit the
generalizability of the results, but peppermint oil could be
considered for all patients with IBS symptoms.
Peppermint oil appears to alleviate IBS symptoms,
including abdominal pain. Patients should be reminded
not to chew the capsules, which are enteric coated to
prevent gastroesophageal reflux from lower esophageal
sphincter relaxation. Perianal burning and nausea are
occasionally reported side effects. The safety of
peppermint oil during pregnancy has not been
demonstrated (Rees et al., 1979).
Probiotics
Probiotics are nutritional supplements that contain good
bacteria (Drossman, 1999). That is, bacteria that normally
live in the gastrointestinal tract and seem to be beneficial.
Taking probiotics may increase the good bacteria in the
GIT which may help to ward off bad bacteria that may
have some effect on causing irritable bowel syndrome
symptoms.
There is some evidence that taking probiotics may help
ease symptoms in some people with IBS. At present,
there are various bacteria that are used in probiotic
products. Further research is needed to clarify the role of
probiotics and which one or ones are most helpful (Dew
et al., 1984). Prebiotics are the substances, which reach
to colon in intact form, that is, without getting depleted by
the gastric pH and digestive acids. These prebiotics also
selectively promote the growth of colonic probiotic
bacteria, hence they act as fertilizers for these symbiotic
bacteria. For example, insulin which is a polyfructose
obtained from raw chicory (roots of Cichorium intybus) or

Jeruslem artichoke. Chicory is rich in fibrous
polysaccharide inulin, which is soluble dietary fibre and
resistant to digestive enzymes, thus reaches to large
intestine or colon essentially intact, where it is fermented
by resident bacteria, Lactobacilli and Bifidobacteria digest
inulin and feed themselves on it. The dairy products like
sour milk and A/B culture yoghurt contain these
prebiotics.
Antispasmodic medicines
Antispasmodic medicines are usually used for relaxation
of muscle in the gastrointestinal tract. Mebeverine and
peppermint oil are prescribed as antispasmodic
medicines. Antispasmodic drugs have few or no side
effects. Antispasmodic drugs are not given to pregnant
women (Dew et al., 1984).
Modification of diet
A diet history might reveal patterns of symptoms related
to dairy or gas-producing foods. Exclusion of foods that
increase flatulence (for example, beans, onions, celery,
carrots, raisins, apricots, prunes, brussels sprouts, wheat
germ, pretzels, bagels) should be considered in patients
with symptoms of bloating or gas (Spiller et al., 2007).
Underlying visceral hyperalgesia in irritable bowel
syndrome may explain the exaggerated discomfort
experienced with the consumption of gas-producing
foods. An increase in the intake of fiber is generally
recommended, through diet or the use of commercial
bulking supplements. Although, the efficacy of fiber
supplements has not been proved, some improvement
has been demonstrated in patients with IBS whose
primary complaints are abdominal pain and constipation.
Many types of fiber supplements are available; some are
synthetic, such as polycarbophil or methylcellulose, and
others are from natural sources, such as bran or psyllium
compounds. All types of fiber can cause increased
bloating and gaseousness because of the colonic
metabolism of nondigestible fiber. Because of its safety, a
trial of fiber supplementation is advised for patients with
IBS, especially those with constipation-predominant
symptoms. The amount should be titrated to symptoms
(Lawson et al., 1988).
CONCLUSION
Herbal medicines are affective in the treatment of irritable
bowel syndrome. The efficacy and safety of herbal
medicine have been proved. People all over the world are
using herbal medicine in the treatment of irritable bowel
syndrome. It is concluded that herbal medicine have
therapeutic efficacy.
Akram et al. 6937
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