Treating IBS

Getting Started

The first line of treatment for IBS includes general measures such as:

• establishing an effective patient-physician relationship,
• obtaining education about IBS, and
• implementing lifestyle changes which may be associated with symptoms.

Lifestyle Changes

Are there any dietary or stress-related factors that may be related to your symptoms? Discuss these with a health care provider.

If certain foods set off or worsen symptoms, reduce or avoid them. A diet high in fiber can help some people with mainly constipation. Adding bulk to the diet, such as psyllium or methylcellulose preparation, may help regulate the bowel dysfunction.

Psyllium, in particular, has been shown to be beneficial in relieving the constipation associated with IBS. But a diet too high in fiber may itself cause diarrhea and gas. This especially applies if you have diarrhea-predominant IBS.

Increased stress may result in the onset or worsening of IBS symptoms. It can also cause fatigue or low energy. Proper rest and exercise can help reduce stress levels and positively influence IBS.

Next Steps

A thorough evaluation by a physician is an important step toward selecting the treatment that is most appropriate for your individual circumstances. Regardless of the treatment therapy, always discuss it thoroughly with your doctor so you are:

• familiar with the therapy or method,
• aware of alternatives,
• understand the risks as well as benefits, and
• know what to do if side effects occur or symptoms return.

Medications

If lifestyle changes do not relieve IBS symptoms, a number of medications may be helpful. Some people with more mild-moderate symptoms will only need medications now and then.

Antispasmodics – have limited benefit for treating IBS. In some persons they relieve abdominal pain or discomfort, usually if the symptoms occur soon after eating. Examples include dicyclomine (Bentyl), and hyoscyamine (Levsin). Read More

Anti-diarrheal agents – can be effective in preventing and relieving symptoms of diarrhea. Examples include Loperamide (Imodium), and diphenoxylate and atropine (Lomotil) Read More

Laxatives – can help treat symptoms of constipation. Laxatives should be used under the supervision of a physician. Read More

Bulking agents­ – provided they relieve and don’t worsen symptoms, can ease stool passage Examples include bran or psyllium.

Anti-anxiety medications – can be helpful for some people with IBS, mainly those with emotional distress.

There are also effective medications available that relieve the pain and improve the changes in bowel habit. They may need to be taken on a more long-term basis. These include low dose antidepressant agents or the relatively newer medications.

Antidepressants –The use of the antidepressant drug class in low doses for treatment of IBS symptoms is not linked to depression, but rather likely to effects on the brain and the gut. Antidepressant medications can reduce the intensity of pain signals going from gut to brain. Read More

Newer Medications Available – There are other medications that are either under study or have been shown to be effective in treating IBS in multi-center, high quality clinical trials. These are prescription medications intended for specific use under a doctor’s supervision. Read More

Psychological and Behavioral Therapies

Behavioral therapies may be indicated and effective in certain individuals. Examples include:

• cognitive behavioral therapy, which allows the individual to regain personal skills as well as mental techniques to better manage the symptoms;
• hypnosis, to reduce painful discomfort;
• relaxation training, for general body relaxation; and
• interpersonal psychotherapy, to address stressful responses to interactions with others.

Behavioral therapy or skilled counseling may help with self understanding, and with identifying personal traits or problems that can be dealt with. Talking to an objective professional allows discussions of personal matters without fear of recrimination or blame (which is what can happen when talking to family, friends, or colleagues), and often helps to devise a program for change. Read more about Psychological Treatments

Complementary and Alternative Medicine (CAM)

CAM therapies for IBS are currently being studied. There is some evidence that certain probiotics may help improve IBS symptoms. Probiotics are living bacteria which provide health benefits. These bacteria are different from the bacteria that are known to cause illness. Probiotics can regulate bowel function including motility, sensation, and immune function. They come in many different forms, such as liquid or pills, and can be single or in combination.

Most of the studies which have examined the benefit in IBS are small and of poorer quality. The probiotic that has been studied in high quality studies and has been shown to improve the symptoms in IBS is Bifidobacterium infantis. Recent reviews of all of the probiotic studies have concluded that Bifidobacteria appear to have a beneficial effect in IBS. The symptoms that have shown more consistent improvement with probiotics are gas and bloating.

The effectiveness of other alternative therapies such as Chinese herbal therapy, acupuncture, acupressure, mindfulness meditation, and yoga are being evaluated in IBS patients. Acupuncture studies have demonstrated that a positive provider-patient interaction during acupuncture treatment sessions is associated with a beneficial effect in IBS. Read more about Complementary Therapies

Putting it All Together

The key to achieving relief for IBS is to embrace the understanding that IBS is a complex motility (motor) and sensory disorder. It may have physical and stress-related dimensions. Understanding the condition and having a strong partnership with an empathetic, knowledgeable health care provider can help produce significant improvement and control over symptoms of IBS. Read more about Working with your Physician

 

 

Adapted from IFFGD publication #101 revised and updated by: Lin Chang, MD, UCLA School of Medicine, Los Angeles, CA, and Douglas A. Drossman, MD, University of North Carolina, Chapel Hill, NC