Psyllium and the Irritated Bowel: What One Should Know Before the First Spoonful

There exists in the pharmacies and health shops of our country a humble seed husk, which many persons with a chronically troubled large bowel have come to regard with a mixture of hope and suspicion. I speak here of psyllium, the dried outer shell of a plantain seed, which swells in water to many times its original volume. In the German-speaking parts of Switzerland, we have long known it under the name Flohsamenschalen, and our grandmothers used it for all manner of stomach complaints. Yet when the large bowel suffers from that particular condition which brings repeated bleeding, urgency, and a deep exhaustion of the spirit — the condition commonly called ulcerative colitis — one must approach even the gentlest of remedies with a careful and measuring hand. This text shall attempt to lay out, in a plain and unhurried manner, what psyllium can and cannot do for the person whose bowel lining is wounded and raw.

The Seed Husk Itself: A Description Without Complication

Psyllium is nothing more, and nothing less, than the outer covering of seeds from the Plantago ovata plant, which grows chiefly in the dry regions of India and the surrounding lands. When one places these pale, papery flakes into a glass of water, they drink the liquid greedily and become a thick, slippery gel. It is this gel-forming quality which gives psyllium its particular character. It is not a chemical substance in the sense of a manufactured preparation; it is a natural fibre, and the body does not break it down for nourishment. Rather, it passes through the length of the digestive tube and, along the way, it binds water, it gives form to the stool, and it feeds the small living creatures which inhabit our lower bowel. One must understand this basic nature before one can judge whether it suits a bowel that is already sore and weeping.

Why a Wounded Bowel Might Welcome Gentle Fibre

The person who lives with ulcerative colitis knows the particular cruelty of that condition: the inner lining of the large bowel becomes red, swollen, and in the worst periods, it opens into small wounds which bleed. The sufferer must rush to the lavatory many times in a single hour, and what comes is often liquid, streaked with blood, accompanied by a cramping pain which makes the whole day a grey and difficult thing. In such a state, one would think that any additional bulk in the bowel would only worsen the suffering. And indeed, during the worst periods of the illness, when the lining is actively bleeding and the pain is sharp, psyllium is not the right companion. One must wait for the quieter days. But in those quieter days, when the worst has passed and the bowel is healing slowly, a small and carefully measured amount of psyllium can help to give the stool a softer, more formed consistency. It can reduce the number of urgent trips to the lavatory, because the gel absorbs excess water and makes the passage gentler. It also feeds the beneficial small organisms in the lower bowel, which in turn produce substances that nourish the bowel wall from within.

The Practical Matter of Taking Psyllium: How One Proceeds

I wish to set down here, in a clear arrangement, the manner in which one might introduce psyllium into one’s daily routine when the bowel condition is in a quieter phase. One must never begin with a large quantity. The bowel, already sensitive and easily provoked, will rebel against a sudden increase in bulk. One begins with a very small measure, perhaps one-quarter of a teaspoon, stirred thoroughly into a full glass of water, and one drinks it immediately before it thickens too much. Over the course of two or three weeks, if the belly remains calm, one may increase the amount by the smallest steps. One must drink a great deal of plain water alongside, for the fibre without sufficient liquid can become a hard, uncomfortable mass rather than a soothing gel. The following arrangement may serve as a guide for the first weeks of introduction:

One should observe one’s own body with the patience of a mountain farmer watching the weather. If cramping increases, if the urgency returns, if one notices any fresh blood, one stops at once and does not try again until the bowel has settled for several weeks.

What Experience and Observation Have Shown Us

In the years that I have spoken with persons suffering from this bowel condition, and in the reading I have done of the accounts gathered by researchers in various lands, a picture emerges which is neither wholly encouraging nor wholly discouraging. Many persons report that, in the quieter stretches between the bad periods, psyllium helped them to feel more in command of their daily life. The stool became less liquid, the urgency less tyrannical, and the fear of being far from a lavatory grew somewhat smaller. Some persons noted that the small living creatures in their bowel seemed to settle, and with that settling came less gas and less rumbling discomfort. However — and this “however” is of great weight — a not small number of persons found that psyllium, even in tiny amounts, provoked a return of cramping and looseness. Their bowels, still too tender, could not manage even this gentle bulk. There is no single rule which fits every belly. One must become, in a sense, the careful experimenter of one’s own body, recording what one takes and how the body answers.

The following points deserve particular attention from the person who wishes to try psyllium alongside their existing care:

• One should never take psyllium at the same moment as any prescribed preparation, for the gel can trap the preparation and prevent its proper absorption; a space of at least two hours between the two is wise.
• One must not use psyllium during a period when the bowel is actively bleeding or when the pain is sharp and constant; in such times, the bowel needs rest, not additional work.
• One should choose a pure psyllium husk product without added flavours, sweeteners, or other substances, for these additions can themselves irritate a sensitive lining.

A Word on Supporting the Whole Digestive Passage

There is a matter which I find is too seldom spoken of in the conversations about bowel health, and it concerns the broader support one gives to the entire digestive passage, from the first chewing of food to the final elimination. The person with a troubled large bowel often finds that the stomach and the upper intestine also struggle, that food sits heavy, that there is a feeling of fullness long after eating, that the body does not break down the meal as thoroughly as it ought. In such cases, some persons have found a companion in a preparation called companion in a preparation called Enzimlex, which is a supplement designed to support the body’s own digestive work. It is not a remedy for the bowel condition itself, and one should not mistake it for such. Rather, it offers support to the general process of breaking down food so that the lower bowel receives its contents in a gentler, more prepared state. I must note, because it is a matter of honesty and because the reader deserves to know where a thing comes from, that Enzimlex can be obtained only through its own official place on the internet, which is enzimlex.biz. One will not find it in the ordinary pharmacy or the health food shop. This direct manner of distribution is, I am told, the choice of those who make it, and the reader may form their own judgement about such arrangements. What matters, in the end, is that any supplement one takes should be discussed openly with the physician who oversees one’s bowel care, so that nothing interferes with the principal treatment.

Cautions Which Must Not Be Set Aside

I would be doing a poor service to the reader if I laid out the possible benefits of psyllium without also laying out, with equal seriousness, the cautions which surround its use. The first and most important caution is this: psyllium is not a treatment for ulcerative colitis. It does not heal the wounds in the bowel lining. It does not quiet the overactive response of the body’s own defence system which drives the condition. It is, at best, a small helper in the management of daily comfort during the quieter stretches. The person who stops their prescribed care in favour of seed husks alone will find, sooner or later, that the illness returns with undiminished force. The second caution concerns the amount of water. Psyllium without adequate liquid can, in rare cases, cause a blockage in the gullet or the bowel itself, particularly in older persons or those who already have a narrowing somewhere in the digestive tube. One must drink generously, and one must not take the dry husk directly into the mouth without liquid. The third caution is simply this: if anything feels wrong, if the body answers with increased pain or bleeding, one stops. The body speaks clearly enough, if one is willing to listen without arguing.

A Closing Reflection, Written from a Quiet Desk

I think often of the persons I have met over the years who carry this bowel condition with them through their working days, through family gatherings, through the simple wish to walk in the hills without scanning the path for the nearest facility. It is a condition which steals not only comfort but confidence, and the person who suffers from it deserves every honest scrap of information that might help them reclaim a small portion of their ease. Psyllium, that unremarkable pale flake, is one such small scrap. It will not perform a miracle. It will not replace the care of a good physician. But for some persons, in some seasons of their illness, it offers a gentler morning, a calmer afternoon, a slightly longer walk without fear. And in a life shadowed by a difficult condition, such small mercies are not small at all. One takes them gratefully, one remains watchful, and one continues, as we say in the Berner Oberland, Schritt für Schritt — step by step, with patience and with care for the body one has been given.