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Case Study

Irritable Bowel Syndrome and Ulcerative Colitis
Dr P V Venkataraman

A study of a commonly indicated remedy in irritable Bowel syndrome and Ulcerative Colitis.

Both these have become common problems, thanks to stresses of modern living. Though there is a lot of difference between these two diseases, I prefer to keep them together for clinical purposes. In most patients these two conditions alternate frequently. In some one condition gets transformed into another.
Most cases present with some typical symptoms: Viz.

  1. Frequent urge to stool. Constant unfinished feeling.
  2. Can't come out of toilet due to Rectal dissatisfaction.
  3. Stool difficult to pass or unable to control.
  4. Lack of confidence in sphincter ani.
  5. Frequent small stools with mucus.
  6. Blood in stool on and off (never in IBS).
  7. Pain during or after stool.
  8. Associated anxiety or depression in life. Some constant worry - even the worry of this disease as the problem can become chronic.

The following cases show how the patients present.
The following cases show Some typical presentations:

Case 1: Mr M 36 yrs, a teacher; diagnosed as "Idiopathic Procto Colitis" suffering for 10 yr. Histopathology report: moderate to severe chronic sub acute colitis with focal ulceration.

Symptoms: bloody stools with frequent urge, 8 to 10 times a day. Unable to control the urge. Unfinished feeling. His wife lives separately due to some misunderstanding.

Case 2: Mr KMS 47 yrs, has a printing office. Frequent urge to defecate. Difficult to control. Stool pasty, semisolid and offensive. Occ bloody stool with mucus. Fear of going out; fear of eating out as that would initiate urge to defecate, difficult to control. His son is 14 yrs old with mild mental retardation.

Case 3: RG aged 27 years. Stool 5-6 times a day. Pasty, sticky, semisolid stool, must sit for a long time to clear. Constant, unfinished feeling. Washing also initiates the urge. He is under weight. No known worry other than this health problem.

Case 4: Mrs. U 58y. Severe burning in abdomen with painful stool. Either constipation or loose stool but never a normal stool for years. Underwent Hysterectomy, cholecystectomy, Appendicectomy and omentectomy and was diagnosed as ulcerative colitis. She has Hypertension and had P/H of peptic ulcer. She is in severe depression without apparent cause. Has to take sleeping pills daily.

In all the above cases anxiety, worry and depression were present along with rectal complaints. All were diagnosed either ulcerative colitis or irritable bowel syndrome.

All these patients received Aloes, Arg-nit, Merc-cor, Nit-ac, Puls and Sulphur on various occasions and are now almost all right, except for an occasional symptoms, which recover on its own.

When I studied all these cases, prescriptions and the response along with the Materia Medica, I found one remedy indicated more often, which I would like to share with you. Not to say it is a specific remedy, but has the highest marks in the group of remedies, which come up for this condition. The final prescription is of course on the totality of presenting symptoms.

Nitric Acid
The full Rectal and stool totality:

  1. Difficult and irregular evacuations
  2. Before stool: colic, cutting, constant pressing in rectum, constant but fruitless desire.
  3. During stool: nausea, tenesmus, anal spasm, cutting in anus and rectum, acute pain in abdomen, sensation as if feces remained and could not be expelled, splinter-like pains in rectum (with ineffectual urging), burning, tearing, palpitation of heart.
  4. After stool: continued urging, exhaustion, irritation, anxiety, general uneasiness in anus--sore, raw, cutting, straining, shooting in rectum, continuing for hours, prolapse with sensation of constriction in anus: stitching pains, Hemorrhage, discharge of prostatic fluid.
  5. Constipation. Inability to evacuate feces.
  6. Constant ineffectual desire, not better by defecation.
  7. Feces hard and dry.
  8. Constipation with fissure: symptoms - bleeding, pain, distending stool.
  9. Evacuations too frequent.
  10. Urgent desire to evacuate.
  11. Loose evacuations, sometimes mucous, or of putrid smell.
  12. Offensive and undigested evacuations.
  13. Much discharge of blood after stools.
  14. Sanguineous, dysenteric evacuations, with tenesmus.
  15. Black, offensive blood, mucous pseudo-membrane, with straining and burning in rectum.
  16. Colic before stools.
  17. After stools: excitability and dejection.
  18. Burning pain and itching in anus and rectum, with prolapse.
  19. Sticking in rectum, and spasmodic contraction in anus during stool, fissures.
  20. Oozing excoriation at anus.
  21. Hemorrhoids, protruding, painless or burning.
  22. Pain as if rectum would be torn as under during a stool
  23. Swelling of hemorrhoidal tumours in anus, which bleed at every evacuation - Moisture on anus.

It also covers the stress and tension, most often be associated with IBS and Ulcerative Colitis.

Mental symptoms are:

  1. Excessive melancholy and fits of anguish, especially in evening, or at night.
  2. Uneasiness respecting health, with fear of death.
  3. Excessive, nervousness, great excitability, especially after the abuse of Mercury. Easily startled and frightened.
  4. Unfit for labor.
  5. Concentration in self - Taciturn, disinclined to communicate anything.
  6. Vexed at trifles.
  7. Attacks of rage, despair, with cursing
  8. Irritability and obstinacy
  9. Passion.


Nitric-acid also covers the syphilitic Miasm. However, the evolving picture will have to be closely observed for the emerging next remedy - constitutional or intercurrent. Without which a lasting cure may not be feasible.