How is irritable bowel syndrome (IBS) treated?

Irritable bowel syndrome (IBS) is treated with diet and behavior modifications, followed by medications.

IBS treatment involves changing diet and lifestyle habits, as well as specific medications.

IBS treatment is generally directed at the specific symptoms that the patient is experiencing. Most find that dietary changes can be helpful, especially eating smaller, more regular meals, having at least eight cups of noncaffeinated fluids daily, increasing soluble fibers such as psyllium (Metamucil), and reducing wheat products and fat intake to less than 40-50 grams daily. Treatments for constipation include laxatives such as Miralax. Imodium is used to treat diarrhea, with Lotronex reserved for more severe diarrheal cases. Pain is usually treated with antispasmodics, and peppermint oil has also been found to be effective in some cases. Some people may also respond to probiotics, and psychological treatments such as cognitive behavioral therapy and relaxation techniques may be helpful in some cases.

What's necessary to understand about the diagnosis of irritable bowel syndrome (IBS) is that it is actually a diagnosis of exclusion. That means when everything else has been ruled out as a source of chronic abdominal pain or bloating or alteration in bowel habits and doctors can't find the source, then it's diagnosed as IBS.

Because it's not clear what causes irritable bowel syndrome (IBS), treatment focuses on the relief of symptoms so that you can live as normally as possible. In many cases, you can learn to manage stress and make changes in your diet and lifestyle to successfully control mild signs and symptoms of irritable bowel syndrome. If your problems are more severe, you may need more than lifestyle changes. You may want to try:

  • Eliminating high-gas foods: If you have bothersome bloating or are passing considerable amounts of gas, your doctor may suggest that you cut out such items as carbonated beverages, salads, raw fruits and vegetables, especially cabbage, broccoli and cauliflower.
  • Anticholinergic medications: Some people need medications that affect certain activities of the autonomic nervous system (anticholinergics) to relieve painful bowel spasms. These may be helpful for people who have bouts of diarrhea but can worsen constipation.
  • Medications for constipation: There are two drugs, Zelnorm and Amitiza, used to treat IBS with constipation as their main bowel problem. These two drugs are used to calm the stomach down in the same way that Prozac is used to treat depression and other conditions within the brain.
  • Antidepressant medications: If your symptoms include pain or depression, your doctor may recommend a tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI). These medications help relieve depression as well as inhibit the activity of neurons that control the intestines.
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Irritable bowel syndrome (IBS) is treated by avoiding triggers and preventing flares, therefore, treatment is different for each person. Avoiding trigger symptoms is key. Common triggers include coffee, alcohol, ingestion of fatty foods, dairy products, fruit, artificial sweeteners, beans, cabbage and uncooked broccoli or cauliflower. Increasing fiber and water intake in the diet can help with constipation. Regular exercise can help reduce bloating and keep the bowels regular. Some medications are found to be helpful, such as anticholinergics for cramping, medications for diarrhea or constipation, antidepressants or antianxiety medications are also found to be of benefit.

Patsy Catsos
Nutrition & Dietetics Specialist

Therapy for irritable bowel syndrome (IBS) depends on which symptoms predominate, and how severe they are. For all types, stress management, exercise and use of various medications (ranging from anti-spasmodics to anti-diarrheals to anti-depressants) may help. Use of probiotics, or stocking the gut with beneficial bacteria, is often recommended for those with IBS.

Individuals with constipation-predominant IBS are often counseled to increase fiber intake from foods such as whole grains, fruits and vegetables. Many people use fiber supplements such as Benefiber (wheat dextrin), Metamucil (psyllium) or Citrucel (cellulose). Regular exercise and drinking plenty of fluids can also be helpful in the treatment of constipation. These measures help many people manage constipation, and should be tried first.

Those with diarrhea-predominant IBS often are advised to avoid milk products, caffeine, "gassy" foods and non-nutritive fats, such as those in fat-free potato chips. Ice cold and steaming hot beverages may be avoided. "Safe" foods for diarrhea-predominant IBS have traditionally included pasta, white bread, applesauce and yogurt. Dietary fiber and fiber supplements are often recommended for diarrhea, not just constipation. To prevent watery stools, soluble fiber is sometimes able to "gel" the intestinal contents. If these measures help, good for you. If not, read on.

The FODMAPS elimination diet is based on limiting "FODMAPS" in the diet. FODMAPS stands for Fermentable Oligo-, Di- and Mono-saccharides And Polyols. Specifically, some of the dietary carbohydrates described by the term FODMAPS are lactose, fructose, fructans, polyols and galactans. These are sugars, starches and fibers in food that some people cannot fully digest and absorb.

The FODMAPS Elimination Diet is meant for people who have tried standard therapies for IBS but have failed to find relief from their symptoms. Many IBS sufferers stick with conventional therapies for years without noticeable results, and become resigned to their symptoms.

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Treatment should combine pharmacological therapy to treat symptoms of altered bowel habits, dietary interventions to address food intolerances and integrate evaluation and treatment of stress and psychological factors contributing to IBS. Constipation is treated with increased dietary fiber intake (fruits, vegetables), fiber supplements (psyllium, methylcellulose, isapghula and bran), stool softeners (docussate sodium) and laxatives (milk of magnesia, polyethylene glycol, lactulose, sorbitol). Prescription medications include lubiprostone and tegaserod (only available for emergency use). Anti-diarrheal agents include loperamide, diphenoxylate/atropine and opioids. Alosetron is available via a restricted management program. Abdominal pain, bloating and cramping are treated with antispasmodics such as dicyclomine and hyoscyamine. Tricyclic antidepressants (TCA) may be used to treat the pain. Simethicone and activated charcoal are used as anti-gas agents. Antibiotics (rifaximin) and/ or probiotics may be used to alleviate bloating symptoms. Dietary interventions which may be helpful in alleviating symptoms: exclude spicy foods, caffeine, dairy products if known to be lactose intolerant, greasy/fatty foods and a FODMAPs diet (excludes certain carbohydrates). Complementary and alternative treatment approaches include hypnotherapy, meditation, relaxation breathing, acupuncture, cognitive behavioral therapy. Patients should be educated regarding the disease chronicity and IBS pathophysiology involving the brain- gut axis to help them effectively manage their symptoms.

The treatment for irritable bowel syndrome (IBS) depends on the predominant symptom, diarrhea or constipation. For diarrhea, anti-diarrhea agents (Imodium, Lomotil, Questran) are prescribed; for constipation, Miralax or Amitiza are prescribed; and for abdominal cramping anti-spasmotics (Bentyl, hyoscyamine, Librax) are prescribed. Antibiotics and/or probiotics can be used to alter the bacteria in the intestine.

Irritable bowel syndrome treatments vary from patient to patient. Treatments can include changes in diet, exercise and nutrition, among others. There are no medications that cure IBS, but your doctor may also ask you to make some lifestyle changes such as adding fiber supplements to your diet and eliminating foods such as carbonated beverages, salads and vegetables such as cabbage which cause gas and bloating. Over-the-counter medications for diarrhea may be recommended or your doctor may prescribe an anti-diarrhea medication. If you suffer from pain and depression, he may also prescribe an antidepressant and refer you to counseling.

Treating Irritable Bowel Syndrome (IBS) usually involves medicine, dietary changes, stress management and exercise.

Medication: Laxatives may be prescribed to treat constipation, anti-diarrheals to treat diarrhea, antispasmodics to help control colonic spasms and pain, and low doses of certain antidepressants can help reduce the pain, diarrhea and constipation seen often in patients with IBS. A new drug, alosetron, can help women with severe IBS whose major symptom is diarrhea.

Diet: Addressing diet is important. Your physician may ask you to keep a food diary to track symptoms and food eaten to determine what foods may exacerbate symptoms. Foods that worsen IBS should be avoided, including fatty foods, milk products, alcohol, chocolate, carbonated drinks and caffeine. Adding foods with fiber to your diet gradually can also help, as can eating smaller meals. Drinking 6-8 glasses of water a day is also important.

Stress Management: Stress management—yoga, exercise, and counseling—can also reduce symptoms, and exercise can help the bowel function better as well as reduce stress.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.