Irritable bowel syndrome (IBS) treatment is generally not a 'one size fits all' plan. A multi-faceted approach is often called for, including having a good working relationship with your physician, the possible use of prescription medicine (for diarrhea or constipation) and over-the-counter (OTC) remedies, nutritional and lifestyle changes, and in some cases, psychotherapy. Working with your physician, and with a little trial and error, you can find your own pathway for treating your IBS. As you try to find your way, be reassured that although IBS can be detrimental to your quality of life, it is not detrimental to your overall health or life expectancy.
Can medicine help IBS? Yes and no. There is no one drug cure for IBS, but a variety of medications are available that address specific symptoms. The problem is that IBS can be a chronic condition, and patients are often cautioned against taking a medication over a long period of time. Thus, for an ongoing condition like IBS, it is a good idea to explore non-drug treatment alternatives instead of, or in addition to, medication.
For the treatment of severe symptoms, your physician does have a variety of prescription options.
- Antispasmodics: These medications may be prescribed for the treatment of abdominal pain and cramping and are best taken on an as-needed basis.
- Antidepressants: Medications in this class can be taken over a longer period of time and may be chosen for their pain-reducing capability or to treat a co-existing depression or anxiety disorder.
- Medications that target the neurotransmitters (chemicals that pass information in the nerves of the brain and gut) that affect the speed of muscle contraction, secretion of mucus, and the absorption of fluids in the intestines are available for the treatment of diarrhea and constipation, but with strict guidelines as to who they can safely be prescribed for. The major medications in this class are Lotronex for diarrhea, and Zelnorm for constipation.
- Antibiotics: A newer, but still controversial, option for IBS is the use of specific antibiotics to target a possible overgrowth of bacteria in the small intestine.
These products are available without a prescription and may be helpful in reducing certain abdominal symptoms. Remember that it is always important to check with your doctor before using any OTC product. Here are a few of the more commonly used OTCs for IBS:
- Imodium (Loperamide): Used to control the symptoms of diarrhea.
- Laxatives: (Benefiber, Citrucel, Metamucil) Supplements to increase dietary fiber.
- Probiotics: Dietary supplements that contain bacteria that may help to balance the intestinal tract.
- Herbal Supplements: Herbs have long been used for digestive health and to treat individual digestive symptoms.
One of the most common ways that individuals try to cope with IBS is through dietary restriction. Faced with such traumatic symptoms, it is easy to point to food as a culprit. An important fact to keep in mind is that the simple act of eating, in particular eating large or fatty meals, can stimulate bowel contractions. Stress and hormonal changes also contribute to IBS symptoms, so that a food that is poorly tolerated on one occasion may be enjoyed without consequence on another.
- Keep a food diary. A helpful way to determine the role of food in relation to your symptoms is to keep a food diary, an ongoing account of what you eat and how you feel. It is recommended that if you have identified a particular food as being a possible culprit, to eliminate that food for a period of about three months to see if this has any effect on your symptoms. If not, try eating the food again and repeat the process with the next food on your list. Common offenders are gas-producing vegetables, artificial sweeteners, caffeine and alcohol.
- Eat smaller, more frequent meals.
- For constipation, try to eat a large breakfast, as this may be the best time to encourage intestinal contractions and the urge to defecate.
- Increase fiber, but use caution. Fiber is generally recommended due to its many health benefits. However, research is somewhat mixed as to the effectiveness of the two types of fiber, soluble fiber and insoluble fiber for relieving IBS symptoms, and some types of fiber might actually exacerbate symptoms. So, add fiber slowly and evaluate the effects on your symptoms. A starting guide may be to increase soluble fiber, particularly in the form of psyllium, for diarrhea-predominant IBS, and insoluble fiber for the treatment of constipation.
- Look into the low FODMAPs diet as it has some sound research support for its effectiveness: "The Low FODMAPs Diet for IBS".
Two forms of psychotherapy have been shown to be clinically effective in reducing the frequency, intensity and duration of IBS symptoms: Cognitive Behavioral Therapy (CBT) and Hypnotherapy. CBT is a form of therapy in which the individual is 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. In either form, psychotherapy offers 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.
Essential Reading from Dr. Bolen, Your IBS Guide:
Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome (2004). Bijkerk, C.J., et.al. Alimentary Pharmacology & Therapeutics19:245-51.
Dietary Aspects of Irritable Bowel Syndrome (IBS) (2007) Whorwell, P.J. DigestiveHealth Matters, 16:6-7.
Small Intestine Bacterial Overgrowth: A Framework for Understanding Irritable Bowel Syndrome (2004) Lin, H. Journal of the American Medical Association 292:773.
Use of Diet and Probiotic Therapy in the Irritable Bowel Syndrome: Analysis of the Literature. (2005) Floch, M. Journal of Clinical Gastroenterology 39: S243-246.
DISCLAIMER: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.