Irritable Bowel Syndrome

Treatment of Irritable Bowel Syndrome

Treatment Options for IBS

Irritable bowel syndrome (IBS) treatment does not readily fit into a "one size fits all" type plan. Working with your physician, and with a little trial and error, you will find your own pathway for managing your IBS. This pathway may require a multi-faceted approach, but as you will see in this overview, there are plenty of treatment options for you to pursue.

Your First Step

If you haven't already done so, it is essential that you see a doctor to discuss any ongoing digestive symptoms you may be having.

Although the symptoms of IBS include abdominal pain along with chronic bouts of constipation, diarrhea, or both, such symptoms can also be the result of other more serious health conditions. Once your doctor has confirmed a diagnosis of IBS, you can then work with them to set up an optimal treatment plan for addressing your symptoms.

Medications for IBS

Traditionally, medication options for IBS have been limited.

Luckily, that situation is changing rapidly as new medications are being developed. Here are some of the prescription options that are currently available:

Antispasmodics: Antispasmodics are the most frequently prescribed medications for IBS as they help to ease symptoms of abdominal pain and cramping, particularly for people who have diarrhea-predominant IBS (IBS-D). Antispasmodics work best if taken 30 to 60 minutes prior to eating and may be better at providing short-term, as opposed to long-term, relief of symptoms.

IBS-Specific Medications: Pharmaceutical companies have been hard at work developing medications for treating IBS, with several new options coming onto the market over the past few years.

These medications typically work on receptors within the large intestine to bring about IBS symptom relief. Options for the treatment of constipation-predominant IBS (IBS-C) include:

And for the treatment of IBS-D:

Antibiotics: People are often surprised when they hear that antibiotics may be prescribed for IBS, as often taking a round of antibiotics can make IBS symptoms worse. However, antibiotics used to treat IBS are of a very specific type—antibiotics that are not absorbed in your stomach, but rather will target bacteria in your small and large intestine. Of this class, only Xifaxan has FDA approval and is for the treatment of non-constipation IBS.

Antidepressants: Your doctor may choose to prescribe an antidepressant medication due to their effects on the working of your digestive system and because they can be safely taken over a long period of time—an advantage for a chronic disorder like IBS. Doctors are more likely to recommend an antidepressant to you if your symptoms have not been addressed through lifestyle and dietary modifications and if you also experience depression and/or anxiety alongside your IBS.

Antidepressants used to treat IBS include both the SSRIs and the older tricyclic antidepressants. Both classes of medications are thought to have pain-reducing qualities. Your doctor may choose which type of antidepressant based on your predominant bowel problem, e.g. constipation or diarrhea, as different antidepressants have different effects on stool formation and bowel movement frequency.

Over-the-Counter Remedies for IBS (OTCs)

There are a wide variety of OTCs used to address digestive symptoms. These products are available without a prescription and rarely is there much research as to their true effectiveness in easing IBS symptoms. Remember that it is always important to check with your doctor before using any OTC product. Here are a few of the more commonly used OTCs for IBS:

  • Imodium: Helpful for easing diarrhea, but not necessarily IBS pain.
  • Laxatives such as Miralax, Metamucil, Benefiber, and Citrucel.
  • Probiotic supplements: These contain live strains of "friendly bacteria."
  • Peppermint oil: Studies have shown that enteric-coated peppermint oil has strong antispasmodic qualities and thus is effective in easing IBS pain.
  • Herbal supplements: There are a variety of herbal supplements thought to be good for overall digestive health and to treat individual digestive symptoms.

Eating Changes

One of the most common ways that individuals try to cope with IBS is through dietary restriction. Faced with such traumatic symptoms, it is easy to point to food as a culprit. An important fact to keep in mind is that the simple act of eating, in particular eating large or fatty meals, can stimulate bowel contractions. Stress and hormonal changes also contribute to IBS symptoms, so that a food that is poorly tolerated on one occasion may be enjoyed without consequence on another.

Keeping all of that in mind, there are some helpful things that you can do in relation to eating that might be of help in easing your symptoms (or at least, not making them worse!). Here are some options:

1. Keep a food diary. Food diaries are simply an ongoing account of what you eat and how you feel. It is recommended that if you have identified a particular food as being a possible culprit, that you eliminate that food for a period of about three months to see if this has any effect on your symptoms.

If not, try eating the food again and repeat the process with the next food on your list. Common offenders are fatty foods, gas-producing vegetables, carbonated drinks, artificial sweeteners, caffeine and alcohol. You may also consider an elimination diet to rule out lactose intolerance or fructose malabsorption.

2. Eat smaller, more frequent meals. An exception to this is that for constipation a large breakfast may help to encourage intestinal contractions and the urge to have a bowel movement.

3. Increase fiber. Fiber is generally recommended due to its many health benefits and its ability to help to both soften and firm up stool. However, it is best to add fiber slowly to allow your body time to adjust. There is also some evidence that soluble fiber is better tolerated by people who have IBS.

4. Look into the low-FODMAP diet. Although the low-FODMAP diet can be challenging, it has some sound research support for its effectiveness. The diet involves eliminating certain carbohydrates from your diet for a period of six to eight weeks and then gradually adding them back into your diet to assess for tolerance.

Psychotherapy for IBS

A variety of psychological therapies have been studied for their effectiveness in reducing the frequency, intensity and duration of IBS symptoms, including cognitive behavioral therapy (CBT), hypnotherapy, stress management approaches and relaxation exercises, with generally positive results.

CBT and gut-directed hypnotherapy have the most solid research support for their effectiveness in reducing IBS symptoms. CBT is a form of psychotherapy in which you will be taught strategies for modifying maladaptive thinking patterns as well as new behaviors for managing anxiety and handling stressful situations. Hypnotherapy involves the induction of a relaxing and comfortable state of consciousness in which specific suggestions are offered in order to lead to a permanent change in behavior.

Psychological therapies offer the advantage of helping you to learn long-term strategies for handling your IBS without the risk of possible negative side effects associated with medication.

Making the Decision That’s Right for You

Research has shown that with IBS, the more informed you are as a patient, the better your treatment outcome will be. Research has also shown that your treatment outcome is enhanced if you have a good working relationship with your doctor. You will find so much information here on Verywell about your treatment options. Spend some time learning as much as you can and then work with your doctor to come up with a symptom management plan that is best for your unique body.

Sources:

Foxx-Orenstein, AE. New and emerging therapies for the treatment of irritable bowel syndrome: an update for gastroenterologists. Therapeutic Advances in Gastroenterology. 2016;9:354–375.

Tack J, Vanuytsel T, Corsetti M. Modern Management of Irritable Bowel Syndrome: More Than MotilityDigestive Diseases. 2016;34:566-573.

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