Treatments for IBS

Irritable bowel syndrome (IBS), a gastrointestinal disorder, can have a huge impact on quality of life. IBS causes abdominal pain and changes in bowel movement patterns. Depending on the type of IBS you have, you might experience diarrhea, constipation, or a combination of these symptoms.¹

Although doctors aren't exactly sure what causes IBS, it's believed to involve signals between the gut and the brain. Treatments, which include lifestyle and dietary changes, medication, and mental health therapy, are designed to help with symptoms.^{2, 3}

Here's what research says about treatments for reducing and controlling IBS symptoms.

IBS Treatments

Treatments for IBS focus on improving health in the gut—specifically the large intestine, also known as the colon. They also help address mental health conditions. People with IBS often experience depression and anxiety, which may affect the severity of their IBS symptoms.^{2, 4}

No treatment for IBS works for everyone with the disorder.⁵ Your healthcare provider will help you identify the treatments that might work best for you based on your symptoms.

Here's what might be part of your comprehensive treatment plan.

Dietary changes

As a first step, your healthcare provider may recommend making changes to what you eat. These may include:^6,7

• Eating more fiber-rich fruits and vegetables to increase fiber intake
• Avoiding gluten, a protein found in wheat, rye, and barley (including some bread, cereal, and pasta)
• Trying a low-FODMAP diet. FODMAPs, or fermentable oligosaccharides, disaccharides, monosaccharides and polyols, are sugars that are difficult to digest. On a low-FODMAP diet, you avoid dairy, wheat, beans, and certain fruits and vegetables. Instead, you prioritize low-FODMAP foods, including meat, eggs, rice, oats, potatoes, and berries.

Lifestyle changes

If you have IBS, consider keeping a food journal. That will help you identify what foods seem to trigger your symptoms. Then you and your doctor or dietitian can work to replace them with foods that ease your symptoms.⁸

Getting enough sleep each day (most adults need 7 to 9 hours of shuteye, on average), minimizing stress in your life, and increasing your level of physical activity can also be beneficial. One small study found the people who increased their physical activity experienced symptoms improvement.^1,9

Mental Health Interventions

IBS and mental health conditions, including anxiety and depression, often occur together. Research also suggests a link between stress and IBS. Although the exact relationship between each psychological factor and IBS isn't clear, interaction between the gut and the brain is believed to play a role.^{2, 3} Many of the chemical messengers in the brain are also found in the gut.¹⁰

Mental health treatments that might help with IBS include:^3,6

• Cognitive behavioral therapy (CBT). This therapy focuses on changing thoughts and behaviors around IBS symptoms.
• Gut-directed psychotherapy or hypnotherapy. These therapies focus on relaxing deeply and changing the way that you relate to your gut functions.
• Mindfulness. In many people, stress triggers IBS symptoms. Learning a mindfulness practice like meditation may help manage symptoms
• Antidepressants. These medications, including tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), have been shown to reduce IBS-related pain.

Medications

Healthcare providers often encourage people with IBS to adopt dietary and lifestyle changes as a first step before recommending medication. However, there are several medicines considered first-line treatments for controlling IBS symptoms. It means that someone with diarrhea will have a different medication than someone with constipation or pain. You should talk to your doctor about what medications are right for you

Here are some of the different types of medications used to treat IBS:⁶

Medicines that treat diarrhea:

• Loperamide, an antidiarrheal agent available by prescription or over the counter¹¹
• Rifaximin, a prescription antibiotic¹²
• Eluxadoline, a prescription medicine (known as amu-opioid receptor agonist) that decreases bowel activity¹³
• Alsosetron, a prescription drug (known as a5-HT2 receptor antagonist) that slows stool movement.¹⁴ It is approved severe IBS in women with diarrhea.²

Medicines that treat constipation:

• Over-the-counter fiber supplements
• Over-the-counter laxatives
• Prescription laxatives including Lubiprostone
• Linaclotide, a prescription drug (a guanylate cyclase-C agonist) that speeds the movement of food waste through the gut¹⁵
• Plecanatide, another prescription guanylate cyclase-C agonist¹⁶

Medicines that help with abdominal pain and cramping:

• Antidepressants, including SSRIs
• Peppermint oil, taken as a supplement
• Antispasmodics, drugs that reduce muscle spasms, for short-term relief.⁹ (The American College of Gastroenterology does not recommend these drugs for IBS due to a lack of data to support their efficacy.)²

Probiotics

Probiotics are live organisms (usually bacteria) thought to benefit the gut. They're naturally found in fermented foods, including yogurt and kefir, and available as nutritional supplements.⁶

Researchers have been studying whether probiotics may be helpful in treating IBS. Some doctors suggest using probiotics to ease GI symptoms. But the lack of large, rigorous trials makes it difficult to assess the value of probiotic treatment. Questions remain about which types (species and strains) of probiotics are most beneficial and the size of that benefit. Based on current evidence, the American College of Gastroenterology recommends against probiotic use for IBS symptoms.^2,9

Summary

Navigating treatments for IBS can be challenging, since there are so many different pieces to the puzzle. Dietary changes, lifestyle changes, mental health therapies, and medications can be part of a treatment plan for IBS.

Treatments that work for one person may not work for someone else. If you have IBS, find a trusted general practitioner or gastroenterologist who will work with you on tailoring a plan for managing your IBS.

Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases. Irritable bowel syndrome (IBS).
2. Lacy BE, Pimentel M, Brenner DM, et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036
3. Black CJ, Ford AC. Best management of irritable bowel syndrome. Frontline Gastroenterol. 2020;12(4):303-315. Published 2020 May 28. doi:10.1136/flgastro-2019-101298
4. Hu Z, Li M, Yao L, et al. The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis. BMC Gastroenterol. 2021;21(1):23. Published 2021 Jan 7. doi:10.1186/s12876-020-01593-5
5. Food and Drug Administration. Irritable bowel syndrome treatments aren't one size fits all.
6. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Irritable bowel syndrome.
7. Monash University. High and low FODMAP foods.
8. Academy of Nutrition and Dietetics. Irritable bowel syndrome.
9. UpToDate from Wolters Kluwer. Treatment of irritable bowel syndrome in adults.
10. Gros M, Gros B, Mesonero JE, Latorre E. Neurotransmitter Dysfunction in Irritable Bowel Syndrome: Emerging Approaches for Management. J Clin Med. 2021;10(15):3429. Published 2021 Jul 31. doi:10.3390/jcm10153429
11. MedlinePlus. Loperamide.
12. MedlinePlus. Rifaximin (Xifaxan).
13. MedlinePlus. Eluxadoline (Viberzi)
14. MedlinePlus. Alosetron (Lotronex)
15. MedlinePlus. Linaclotide (Linzess)
16. MedlinePlus. Plecanatide (Trulance)
17. Hungin APS, Mitchell CR, Whorwell P, et al. Systematic review: probiotics in the management of lower gastrointestinal symptoms - an updated evidence-based international consensus. Aliment Pharmacol Ther. 2018;47(8):1054-1070. doi:10.1111/apt.14539