IBS Global Treatments
Global treatments affect more than one symptom. Their goal in irritable bowel syndrome (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.
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. Linactlotide (Linzess) is a newer medication for IBS with constipation and for chronic constipation. In studies, patients taking Linaclotide experienced improvement in multiple symptoms including pain or discomfort, bloating, and bowel function.
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. A 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. Elobixibat is a first-in-class compound under investigation for treatment of chronic idiopathic constipation (CIC), and for irritable bowel syndrome with constipation (IBS-C). It works by reducing bile acid absorption in the small intestine. This stimulates bowel movements by increasing fluid secretions and motility in the colon.
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.