A key to achieving relief for irritable bowel syndrome (IBS) is the understanding that IBS is a complex motility (motor) and sensory disorder. It may have physical and stress-related dimensions.
A strong partnership between a knowledgeable patient and an empathetic, knowledgeable health care provider can produce significant improvement and control over symptoms for individuals with IBS.
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.
The term "lifestyle" refers to things in your life you have control over. For example, evaluate any dietary or stress-related factors that may be related to symptoms and discuss these with a health care provider. If certain foods set off or worsen symptoms, reduce or avoid them. If the abdominal discomfort or pain occurs after eating, it may be helpful to eat smaller and more frequent meals.
Increased stress may result in the onset or worsening of IBS symptoms and associated non-bowel symptoms such as fatigue or low energy. Proper rest and exercise can help reduce stress levels and positively influence IBS.
Remember that having IBS is also a stress and learning more about the disorder, communicating effectively with your health care provider, and taking more of a role in your self-care can reduce that stress.
If lifestyle changes do not completely relieve IBS symptoms, a number of medications may be helpful:
- Antispasmodics [e.g., dicyclomine (Bentyl), hyoscyamine (Levsin)] have limited benefit for treating IBS but may relieve abdominal pain or discomfort in some persons, particularly if the symptoms occur soon after eating.
- Anti-diarrheal agents [e.g., loperamide (Imodium), diphenoxylate (Lomotil)] can be effective in preventing and relieving symptoms of diarrhea but may not be as helpful for the pain.
- Laxatives can help treat symptoms of constipation but not necessarily the pain and should be used under the supervision of a physician.
- Anti-anxiety medications can be helpful for some people with IBS, particularly those with psychological distress.
Some individuals with more mild-moderate symptoms will only require medications now and then. For example, an anti-diarrheal or antispasmodic may be taken by a person with diarrhea-predominant IBS before leaving home or eating a meal. Individuals with constipation may benefit from bulking agents (provided they relieve and don’t worsen symptoms) or laxatives on occasion.
There are also effective medications available that relieve the pain and improve the changes in bowel habit. These may need to be taken on a more long-term basis, such as low-dose antidepressant agents or the relatively newer medications.
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, are aware of alternatives, understand the risks as well as benefits, and know what to do if side effects occur or symptoms return.
Individuals who have not responded to lifestyle changes and careful use of medications should consider being evaluated by a physician who specializes in functional GI and motility or stress-related GI disorders. More complex medication regimens and specialized screening can reveal specific conditions which may respond to treatment.
Probiotics and Antibiotics
The digestive tract contains trillions of bacteria. Research is currently showing that the composition of these bacteria may affect various aspects of health and disease. There is some evidence that certain probiotics may help improve IBS symptoms. Learn more about probiotics for IBS.
There is also a potential role for some “bad” bacteria residing in the gut to be associated with IBS symptoms in some people. Recent clinical trials have shown that antibiotics, which reduce or alter the bacteria in the gut, may relieve the symptoms of IBS. Learn more about antibiotics for IBS.
Psychological and behavioral therapies may be indicated and effective in certain individuals. Examples include:
- Cognitive behavioral therapy (CBT), 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
- Interpersonal psychotherapy to address stressful responses to interactions with others.
Behavioral therapy or skilled counseling may help with selfunderstanding and with identifying personal traits or problems that can be dealt with. Talking to a 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 mutually develop a program for change.
Complementary and Alternative Medicines (CAM)
The effectiveness of CAM 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.
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Adapted from IFFGD Publication #101 revised and updated by Douglas A. Drossman, MD, Drossman Gastroenterology PLLC, Chapel Hill, NC.