How IBS Is Treated

Irritable bowel syndrome (IBS) treatment does not readily fit into a "one-size-fits-all" plan. Working with your physician, and with a little trial and error, you can find your own path for managing your symptoms. This will likely require a multi-faceted approach, which might include prescription or over-the-counter medication, lifestyle changes, and even psychotherapy.

If you haven't already done so, it is essential that you see a doctor to discuss any ongoing digestive symptoms you may be having—even if you've been diagnosed with IBS and are following a recommended treatment plan to the letter. In the event your condition has changed, your treatment approach must evolve as well.

Diet

The simple act of eating—large or fatty meals, in particular—can stimulate bowel contractions. As such, changing eating habits is one of the most common ways that individuals manage their IBS.

Diet Restriction

A food diary can help you track what you eat and how it makes you feel. If you notice that your symptoms tend to flair after eating a certain food, consider eliminating that food (and similar ones) for a period of about three months to see if this has any effect on your IBS. If not, try eating the food again and repeat the process with the next food on your list.

Common food and drink culprits include:

• Fatty foods
• Gas-producing vegetables
• Carbonated drinks
• Artificial sweeteners
• Caffeine
• Alcohol

Note, however, that what affects your IBS can be somewhat unpredictable. Stress and hormonal changes also contribute to IBS symptoms. Because of this, a food that is poorly tolerated on one occasion may be enjoyed without consequence on another.

In addition to the above changes, you may also consider an elimination diet to rule out lactose intolerance or fructose malabsorption.

The Low-FODMAP Diet

FODMAP stands for fermentable oligo-, di-, monosaccharides, and polyols. These carbohydrates can be particularly problematic for people with IBS because they compound the very issues those with the condition struggle with (i.e., gas, bloating, abdominal pain, diarrhea, and constipation).

Following the low-FODMAP diet can be challenging, but it has some sound research support for its effectiveness. The diet involves eliminating these carbohydrates from your diet for a period of six to eight weeks and then gradually adding them back into your diet to assess for tolerance.

Fiber

Fiber is generally recommended due to its many health benefits and its ability to help soften and firm up stool. However, it is best to add fiber slowly to allow your body time to adjust. There is also some evidence that soluble fiber is better tolerated by people who have IBS.

Meal Size and Timing

To ease the stress on your digestive system, it's recommended that you eat smaller, more frequent meals instead of the traditional three big ones. That said, for constipation, a large breakfast may help encourage intestinal contractions and the urge to have a bowel movement.

Over-the-Counter (OTC) Therapies

There are a wide variety of OTCs used to address digestive symptoms. While you can access these without a prescription, it's best to check with your doctor before using any OTC product for IBS.

A few of the more commonly used OTC drug options include:

• Imodium: Helpful for easing diarrhea, but not necessarily IBS pain
• Laxatives such as Miralax, Metamucil, Benefiber, and Citrucel
• Probiotic supplements: These contain live strains of "friendly bacteria."

Prescriptions

Traditionally, medication options for IBS have been limited. Luckily, that situation is changing rapidly as new medications are being developed. Here are some of the prescription options that are currently available.

Antispasmodics

Antispasmodics are the most frequently prescribed medications for IBS as they help to ease symptoms of abdominal pain and cramping, particularly for people who have diarrhea-predominant IBS (IBS-D).

Examples of antispasmodics that may be prescribed for IBS include:

• Bentyl (dicyclomine)
• Buscopan (hyoscine butylbromide) (It is not available in the U.S.)
• Levsin (hyoscyamine)

Antispasmodics work best if taken 30 to 60 minutes prior to eating and may be better at providing short-term, as opposed to long-term, relief of symptoms.

IBS-Specific Medications

While antispasmodics can be effective, they are used for several conditions, not just IBS. To provide even more targeted relief, pharmaceutical companies have been working to develop medications for treating IBS specifically, with several new options coming onto the market over the past few years.

These medications typically work on receptors within the large intestine to bring about IBS symptom relief.

Options for the treatment of constipation-predominant IBS (IBS-C) include:

• Linzess, Constella (linaclotide)
• Amitiza (lubiprostone)
• Trulance (plecanatide)
• Motegrity (prucalopride)

And for the treatment of IBS-D:

• Viberzi (eluxadoline) (This should not be used in a patient who has had their gallbladder removed.)

Antibiotics

People are often surprised when they hear that antibiotics may be prescribed for IBS, as taking a round of antibiotics can often make IBS symptoms worse.

However, the specific antibiotics used to treat IBS are not absorbed in your stomach. Rather, they target bacteria in your small and large intestine.

Of this class, only Xifaxan (rifaximin)—used for the treatment of non-constipation IBS—has U.S. Food and Drug Administration (FDA) approval.

Antidepressants

Antidepressant medications can affect the functioning of your digestive system. Your doctor may opt for one for several reasons, the most common of which is that these drugs can safely be taken for a long period of time—an advantage for a chronic disorder like IBS.

Doctors are more likely to recommend an antidepressant to you if your symptoms have not been addressed through lifestyle and dietary modifications, and if you also experience depression and/or anxiety alongside your IBS.

Tricyclic antidepressants are used to treat IBS. For patients with IBS in whom depression or anxiety is a co-factor, gastroenterologists work closely with psychiatrists and a selective serotonin reuptake inhibitor (SSRI) may be prescribed. Both classes of medications are thought to have pain-reducing qualities.

Specialist-Driven Therapies

A variety of psychological therapies have been studied for their effectiveness in reducing the frequency, intensity, and duration of IBS symptoms, including cognitive behavioral therapy (CBT), hypnotherapy, stress management approaches, and relaxation exercises.

CBT and gut-directed hypnotherapy have the most solid research support for their effectiveness in reducing IBS symptoms.

CBT is a form of psychotherapy in which you are taught strategies for modifying maladaptive thinking patterns, as well as new behaviors for managing anxiety and handling stressful situations.

Hypnotherapy involves the induction of a relaxing and comfortable state of consciousness in which specific suggestions are offered in order to lead to a permanent change in behavior.

Psychological therapies offer the advantage of helping you to learn long-term strategies for handling your IBS without the risk of possible negative side effects associated with medication.

Complementary Alternative Medicine (CAM)

Studies have shown that enteric-coated peppermint oil has strong antispasmodic qualities and, thus, may be effective in easing IBS pain.

There are a variety of other herbal supplements thought to be good for overall digestive health and the management of digestive symptoms as well.