IBS Treatment Options

A short bout of abdominal pain and diarrhea or constipation now and then is not unusual.  But long-term or recurring symptoms are not normal. They may signal irritable bowel syndrome (IBS) – and are generally treatable.

IBS Treatments Depend on Symptom Severity

Mild symptoms occur infrequently. They sometimes interfere with normal daily functioning.

Moderate symptoms occur more intensely and frequently. They more often interfere with daily activities.

Severe symptoms are frequent and intense. They chronically interfere with daily functioning.

Whether mild, moderate, or severe all IBS treatment should begin with education about the nature of the disorder...

• IBS is a long-term condition
• Symptoms flare over and over again  
• Symptoms can change over time
• The symptoms themselves are not life threatening
• IBS is not a risk for another more serious disease

For moderate symptoms consider...

• Use of a diary, such as IFFGD’s Personal Daily Diary, to help find factors that worsen or bring on symptoms
• Stress management, gut-directed hypnosis, biofeedback, relaxation, or pain management techniques
• Consulting with your physician about the use of drug therapy. This often depends on your dominant bowel symptom

If symptoms are severe, also consider...

• The use and benefits offered by cognitive-behavioral therapy
• Consulting with your doctor about the use of drug therapy for treatment of pain. This may involve a low-dose antidepressant, which acts as a pain reliever.
• Seeking referral to a pain treatment center. These specialty centers are usually connected with universities.

Start right

IBS treatment starts with getting your facts straight. Learn all you can about IBS. Here are some things you need to know.

What it's not:

What it is:

• Is a long-term condition
• Symptoms tend to come and go over time
• Symptoms often change over time
• Symptoms can usually be managed so that you feel better

Investigate

Are there certain things that seem to worsen your IBS? If so, sorting these out can be helpful. This is not always clear-cut. Using a diary for 2-3 weeks can help identify factors that seem to worsen or trigger symptoms. Discuss your findings with your doctor.

Lifestyle factors

Lifestyle habits do not cause IBS. But minimizing excesses may help reduce or avoid symptom flare-ups. Things like lack of sleep and exercise, prolonged stress, or irregular eating habits can worsen symptoms.

Dietary factors

Meals may seem to trigger symptoms. It may be the process of eating and not a certain food that sets off your symptoms. Eating stimulates the digestive tract, which can over-respond because of IBS.

• Try eating smaller meals, more often, spread throughout your day. Instead of 3 meals, try 5 or 6 regularly scheduled small meals.
• Slow down; don't rush through meals.
• Avoid meals that over-stimulate everyone's gut, like large meals or high fat foods.

If you think a certain food is a problem, try cutting it out of your diet for about 12 weeks. (If you suspect more than one, cut out one at a time so you know which one causes you problems.) If there's no change, go back to eating it.

The foods most likely to cause problems are:

• Insoluble (cereal) fiber
• Coffee/caffeine
• Chocolate
• Nuts

Be sure to eat a healthy diet. If food is a major problem for you, talk to your doctor or a registered dietician to work out a meal plan that's best for you. Here are some more general tips that may help you feel better.

Targeted Treatments

IBS is a group of symptoms. Most medicines are aimed at only one symptom. If your IBS is interfering with your daily life, your doctor may suggest or prescribe a medicine based on your most troubling symptom. Effects will vary widely from person to person.

All medicines have possible side effects. Ask your doctor or pharmacist about these including what to watch out for and what to do if side effects do occur.

Here are some examples of treatments that target certain symptoms:

Pain

Antispasmodics and some peppermint oils, taken before meals, may provide short-term reduction of abdominal pain after eating. However, the evidence for their effectiveness is weak.

Probiotics based on bifidobacteria and some combinations of probiotics may help reduce pain and bloating. Probiotics are live microorganisms that may be of benefit, but they must be taken in adequate amounts.

Constipation

A soluble fiber supplement, such as psyllium may help with simple constipation. If fiber doesn't help, talk to your doctor about a laxative. Neither helps with pain.

Diarrhea

Loperamide may help with simple diarrhea, as well as leakage or soiling. It does not help with pain.

Global Treatments

Global treatments affect more than one symptom. Their goal in IBS treatment is to reduce overall symptoms.

Relaxation therapy can be helpful to promote well-being. Hypnosis or cognitive behavioral therapy (CBT), delivered by trained therapists knowledgeable about IBS, has been shown to reduce pain and other IBS symptoms in some people.

Prescription Medicines

Drugs used to treat overall symptoms of IBS, including pain, are prescribed based on the dominant bowel symptom being experienced.

When constipation is the dominant bowel symptom, lubiprostone (Amitiza) may reduce overall IBS symptoms including pain, especially in women.

When diarrhea is the dominant bowel symptom, alosetron (Lotronex) may reduce overall IBS symptoms. This drug is currently available to women only through a special Prescribing Program because of potential side effects.

New Drugs in Development – Other drugs that show promise for IBS treatment have not yet been reviewed by the U.S. Food and Drug Administration (FDA) as to their safety and effectiveness. FDA approval is needed before a drug can be marketed in the U.S. Linaclotide is a newer medication being looked at for IBS with constipation and for chronic constipation. It boosts intestinal fluid secretion in the bowel. In studies, patients taking Linaclotide experienced improvement in multiple symptoms including pain or discomfort, bloating, and bowel function. Another newer medication for non-constipated IBS is Rifaximin, which is a broad-spectrum antibiotic that targets bacterial overgrowth in the small intestine. In studies, improvement was reported in overall IBS symptoms and IBS specific symptoms of bloating, stool consistency and abdominal pain and discomfort.  

Antidepressants

When symptoms are severe or have not responded to other IBS treatments, your doctor may suggest a low-dose antidepressant. These drugs are useful in IBS, not to treat depression, but to reduce pain and also overall symptoms. Doses are much lower than what is used to treat depression.

In general, when constipation is the dominant bowel symptom, a low dose selective serotonin receptor inhibitor (SSRI) may reduce pain and overall symptoms of IBS.

In general, when diarrhea is the dominant bowel symptom, a low dose tricyclic agent may reduce pain and overall symptoms of IBS.

However, either a tricyclic agent or SSRI may be tried regardless of the dominant bowel symptom.

Over-the-counter or prescription medicines

Remember, all medicines have potential side effects. What's a medicine? Anything you take for a therapeutic effect. It can be readily available over-the-counter, in a pharmacy or grocery store, or limited by prescription only. It might be a drug or a supplement; manufactured or "natural." It might come in a pill, a liquid, or a food product. When you take something for a long-term therapeutic effect, tell your doctor about it. He or she can help you monitor quality, effectiveness, possible interactions with other medicines you may be taking, or possible side effects.

Working with your doctor

IBS persists or recurs over time. A long-term relationship with a knowledgeable and empathetic doctor or therapist can be very important. Ideally, your doctor should:

• know your entire medical history,
• recognize the importance of your symptoms,
• empathize with your discomfort, and
• be prepared to spend the necessary time explaining their meaning.

Whether you see a family physician, internist, or other specialist for your IBS, your primary care doctor should help educate you about IBS and work with you, over the long term, to achieve the best possible results.

Putting it All Together

For persons with IBS, effective diagnosis and treatment starts with an understanding of IBS. Work together with your doctor or therapist. Develop your own IBS treatment plan and outcome goals. Working in partnership with a health professional can help achieve the best possible results. 

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