Treatment Options for Irritable Bowel Syndrome
There’s no one-size-fits-all treatment for IBS. Most people with IBS try different treatments before they find one or more that work.
Dietary Changes
Your doctor may suggest dietary changes before other types of treatment for IBS. These may include increasing your fiber intake through food or supplements and staying away from foods that may be triggers.
Figuring out which foods cause IBS symptoms can be tricky, however. Consider keeping a food diary to help you identify foods that may be triggers.
A low-FODMAP diet can also help ease symptoms for some people. FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols,” which are poorly digested carbohydrates that can cause gas, bloating, and diarrhea. Reducing these requires cutting down on dairy, fruit, some vegetables, beans, and sugar-free sweeteners. This is meant to be temporary to identify food triggers. Working with a dietician is key to reintroduce foods; there are also modified versions of the low-FODMAP diet that may be less restrictive.
Other diets that cut carbohydrates in favor of proteins and fats have reduced symptoms for a majority of people with IBS.
Talk to your doctor or a registered dietician before making any dietary changes. Some diets are restrictive and may leave you without necessary nutrients, while others may not be appropriate for your situation.
Medications
Medications for IBS with diarrhea include:
- Loperamide (Imodium) “Even though loperamide hasn’t been well-studied in relation to IBS, it works well for diarrhea,” says Anthony Lembo, MD, of Cleveland Clinic’s Digestive Disease and Surgery Institute in Ohio.
- Eluxadoline (Viberzi) This reduces muscle contractions and fluid in the intestine and can slow down an overactive bowel. Possible side effects include stomach pain, allergic reactions, and constipation.
- Rifaximin (Xifaxan) A gut-selective antibiotic, this reduces diarrhea, abdominal pain, and bloating. The drug is given as a two-week course and may need to be repeated.
- Alosetron (Lotronex) This blocks the action of serotonin on the intestine, which helps reduce cramping, abdominal pain and discomfort, diarrhea, and the sudden need for a bowel movement. One of the more common side effects is constipation. This is only prescribed for women with severe IBS-D.
- Bile Acid Binder Your doctor may recommend cholestyramine (Prevalite), colestipol (Colestid), or colesevelam (Welchol) if excess bile is irritating your colon. This medication may cause bloating.
If you have IBS with constipation, medications may include:
- Laxatives These hold more water in your bowel to soften stool, making it easier to have a bowel movement.
- Lubiprostone (Amitiza), plecanatide (Trulance), and linaclotide (Linzess) These medications increase fluid secretion in your small intestine to help you pass stool. Side effects may include nausea and dizziness. Some may be prescribed only to women with severe IBS-C.
- Tenapanor (Isbrela) This increases water retention, which can lead to more frequent and softer bowel movements. It may be prescribed after another first-line treatment has failed. Side effects include diarrhea, flatulence, and dizziness.
Your doctor also may prescribe low doses of tricyclic antidepressants (TCAs) and antispasmodics if you are having pain with IBS. Some also may suggest antidepressants known as selective serotonin reuptake inhibitors for IBS, especially if you can’t tolerate TCAs and experience depression.
Complementary and Integrative Therapies
If you are consuming too little fiber, your doctor may recommend soluble fiber supplements. Fiber can make bulky stool easier to pass, decreasing your chance of constipation, but it can also solidify stool, providing relief from diarrhea. Still, be aware that consuming too much fiber is a real problem that can bring on bouts of bloating, gas, and other IBS symptoms.
Other potential options for easing IBS symptoms may include:
- Peppermint Oil Peppermint contains L-menthol, which can help reduce painful spasms in the digestive tract.
- Probiotics Evidence is mixed on their efficacy, however.
- Cognitive Behavioral Therapy (CBT) This form of psychotherapy focuses on symptom-related worry. CBT targets the brain-gut connection, a key contributor to IBS symptoms.
- Gut-Directed Hypnotherapy This therapy aims to alter your body’s responses to IBS symptoms by making your gut react less to emotional upheaval and stress and changing how the brain interprets signals from the gut.