Can Antispasmodics Treat IBS?

How antispasmodic drugs target smooth muscle to alleviate symptoms

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Antispasmodics are medications used to treat irritable bowel syndrome (IBS), a functional gastrointestinal disorder that causes abdominal pain and changes in bowel habits. These drugs stop painful spasms by targeting smooth muscles in the digestive tract.

This article looks at types of antispasmodics used for IBS, their benefits and side effects, and other ways to treat IBS.

Woman with stomach issues

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Why Antispasmodics Are Used for IBS

Studies suggest about 5% of Americans have IBS symptoms. Researchers have yet to identify the cause of IBS, so treatment is primarily aimed at relieving the symptoms, which can include:

  • Abdominal pain
  • Cramping
  • Bloating
  • Diarrhea
  • Constipation

Particularly among people with the diarrhea-predominant subtype (IBS-D), some antispasmodics (also referred to as spasmolytics) have proven moderately effective in alleviating symptoms by targeting and relaxing the smooth muscles of the digestive tract, preventing spasms.

Because symptoms of IBS tend to be worst after eating, taking these medications 30 to 60 minutes before a meal may help prevent symptoms.

A few types of antispasmodics for IBS include:

  • Anticholinergics
  • Direct smooth muscle relaxants
  • Peppermint oil

Types of Antispasmodics for IBS

There are two types of antispasmodic medications used for IBS: anticholinergics and direct smooth muscle relaxants. Peppermint oil also has antispasmodic properties and is sometimes used.

Anticholinergics

Anticholinergics are a type of antispasmodic designed to block the neurotransmitter acetylcholine. This is a chemical produced by the body that acts on the autonomic nervous system, the part of the nervous system associated with involuntary functions.

By blocking acetylcholine receptors in the digestive tract, anticholinergics can slow digestion, decrease the severity of muscle spasms, and reduce the overproduction of mucus.

Examples of commonly prescribed anticholinergics include:

However, in their 2021 Clinical Guideline for Management of Irritable Bowel Syndrome, the American College of Gastroenterology (ACG) recommends against using any of the medications above, citing a lack of good evidence that they actually work.

Direct Smooth Muscle Relaxants

A class of drugs called direct smooth muscle relaxants, which are synthetic anticholinergics, appear to be more effective at treating IBS than regular anticholinergics. These drugs also have fewer problems with side effects.

However, these antispasmodics aren't currently FDA-approved for any use in the United States. Medications available in other countries include:

  • Cimetropium
  • Mebeverine
  • Otilonium
  • Pinaverium bromide
  • Trimebutine

These drugs work by altering the transportation of sodium and calcium.

Peppermint Oil

Peppermint oil is an over-the-counter (OTC) natural antispasmodic. It contains menthol, a substance that scientists believe relaxes smooth muscle by operating on calcium channels in smooth muscle cells in the gut.

Some prescription calcium channel blockers are used similarly to treat high blood pressure (hypertension) and other cardiovascular disorders, because they relax smooth muscles in the blood vessels.

The American College of Gastroenterology recommends peppermint oil for its antispasmodic properties. They also suspect that peppermint exerts direct antimicrobial effects and anti-inflammatory effects, and may help with feelings of distress caused by IBS.

A 2014 review of studies by the University of California, San Diego concluded that persons with IBS symptoms were nearly three times more likely to achieve relief with peppermint oil than with a placebo.

Benefits of Antispasmodics

Antispasmodics' main job is to reduce the muscle spasms that cause IBS symptoms.

Anticholinergics stop cell signals that contract muscles in the digestive tract, heart, lungs, and urinary tract. In addition to IBS, they're used for:

  • Biliary colic
  • Pancreatitis
  • Preventing motion sickness
  • Stomach ulcers
  • Asthma
  • Urinary incontinence
  • Overactive bladder
  • Chronic obstructive pulmonary disorder (COPD)
  • Some types of poisoning
  • Involuntary muscle movements in Parkinson's disease and similar illnesses

Direct smooth muscle relaxants affect the smooth muscle of the digestive tract only. They're only used for IBS and intestinal cramping.

Peppermint oil is used for IBS, other digestive problems, and:

  • The common cold
  • Sinus infections
  • Headaches
  • Topically (on the skin) for muscle and joint pain, itching
  • As aromatherapy for coughs, colds, pain, improved mental function, stress reduction

Most of the research into the medicinal uses of peppermint oil has been related to IBS.

Antispasmodic Side Effects

Antispasmodic drugs can cause unwanted side effects. These vary by type and specific medication.

Anticholinergics

Anticholinergics can affect organ systems beyond the digestive tract, triggering side effects such as:

  • Blurred or double vision
  • Constipation
  • Decreased urination
  • Dizziness
  • Gastric reflux
  • Dry mouth
  • Sore throat
  • Lack of sweating, which can lead to heat exhaustion
  • High body temperature
  • Increased heart rate
  • Poor coordination
  • Confusion, concentration, and memory problems

Due to the risk of constipation, these antispasmodics are best used in cases of diarrhea-predominant IBS (IBS-D) rather than constipation-predominant IBS (IBS-C).

Who Shouldn't Take Them?

You shouldn't take anticholinergics if you're older than 65, pregnant or breastfeeding, or if you have:

  • Myasthenia gravis
  • Hyperthyroidism
  • Glaucoma
  • Enlarged prostate
  • High blood pressure
  • Urinary tract blockage
  • Severe ulcerative colitis
  • Stenosing peptic ulcer
  • Paralytic ileus
  • Intestinal obstruction
  • Toxic megacolon
  • Prostatic hypertrophy
  • Heart disease
  • Liver or kidney disease

Direct Smooth Muscle Relaxants

Direct smooth muscle relaxants very rarely have reports of side effects. When they are reported, common ones appear to be:

  • Dry mouth
  • Nausea
  • Dizziness
  • Indigestion
  • Heartburn
  • Constipation
  • Insomnia
  • Anorexia
  • Headache
  • Fatigue
  • Unusual muscle movements
  • Rash or itchy skin

You shouldn't take this type of antispasmodic if you have paralytic ileus. It should be used with caution in:

  • Young children
  • People with angioedema
  • People with thrombocytopenia

Peppermint Oil

While considered safe for short-term use, peppermint oil is known to cause heartburn in some people. To avoid this side effect, you can use enteric-coated capsules. Their coating doesn't dissolve until it's farther along in the digestive system, which prevents irritation.

This natural antispasmodic should be used with caution if you have:

  • Heartburn
  • Hiatal hernia
  • Severe liver damage
  • Gallbladder inflammation
  • Bile duct obstruction

Be sure to consult your healthcare provider before taking peppermint oil or any other OTC supplement.

Other Ways to Treat IBS

In addition to antispasmodic medications, dietary changes can also significantly improve IBS symptoms. Depending on the symptoms you're experiencing, you may want to:

  • Increase dietary fiber or use a fiber supplement to relieve IBS constipation or diarrhea.
  • Increase water intake if constipated.
  • Avoid caffeine (peppermint tea is an excellent substitute).
  • Avoid legumes to decrease bloating.
  • Limit foods containing lactose, fructose, or FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols).

Frequently Asked Questions

  • Do antispasmodics always work for IBS?

    No, but they can be helpful. They can be useful for diarrhea prominent IBS (IBS-D). But since constipation is a side effect, these drugs should not be used for people with constipation-predominant IBS. 

  • Is there an over-the-counter antispasmodic?

    Peppermint oil is the only OTC antispasmodic available in the U.S.

  • What are spasmolytics?

    Spasmolytics are better known as antispasmodics. These are medications that target smooth muscle tissue to prevent spasms. Spasmolytics are part of a class of drugs known as anticholinergics, which block the neurotransmitter acetylcholine. This decreases the severity of muscle spasms.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Barbara Bolen, PhD
Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.