Today, people with irritable bowel syndrome (IBS) have more medication choices than ever before, and doctors know more about how to treat the condition.
Because IBS symptoms vary from person to person, there isn’t one remedy that’s best for everyone. “It really has to be tailored to the patient,” says Braden Kuo, MD, director of the Gastrointestinal Motility Laboratory at Massachusetts General Hospital. A person who has IBS with constipation (IBS-C) will likely need a different approach than someone with IBS with diarrhea (IBS-D).
Your best course of action may include a special diet, medicines, stress relief, or alternative therapies — or, most likely, a combination of these.
Your eating habits affect your digestion and can make IBS symptoms — like pain, bloating, diarrhea, or constipation — worse. Try making some changes to your meals and snacks to get relief.
Get more fiber, but do it gradually: When you add fiber-rich foods to your diet — like whole grains, beans, fruits, and vegetables — you add bulk to your stool, which can help with both diarrhea and constipation. Don’t do it all at once, though. Start with just 2 to 3 grams a day to avoid gas and bloating, and eventually aim for 22 to 34 grams a day.
Think about a supplement: A daily pill that has fiber, such as psyllium husk (Metamucil) or wheat dextrin (Benefiber), may also help. Sometimes, though, too much of it can make constipation and bloating worse. “I’m more cautious recommending fiber to constipation patients,” Kuo says. “They can have bloating initially, but if they can get past the first 2 to 3 weeks it often goes away.”
Avoid problem foods: High-fat foods, dairy products, alcohol, caffeine, and artificial sweeteners can trigger stomach pain and digestive problems. It also helps to skip foods that cause gas, like beans and cabbage, or to eat smaller meals more often.
How can you tell which foods cause you trouble? Start a food diary that covers what you eat and how you feel. After a while, you can pinpoint the foods that seem to make your IBS flare up.
Try probiotics: “Good” germs like bifidobacterium may relieve pain and bloating. They’re inexpensive, safe, and you can buy them over-the-counter as pills and in some yogurts. But be careful: Because supplements aren’t regulated by the FDA in the same way as medicine, there’s no guarantee a product actually has the ingredients it claims.
Until recently, there were no medications that treated IBS specifically. Instead, doctors prescribed drugs to ease the symptoms like pain, depression, and general stomach issues. But that’s changing as new IBS-specific drugs have hit the market, says Sidney Cohen, MD, co-director of the Gastrointestinal Motility Program at Thomas Jefferson University Hospital. “We’re finally able to treat the condition and not just the symptoms,” he says.
This gives people more options, but it can still take a lot of trial and error to find the best treatment for you.
IBS-specific drugs: These prescription medicines treat either IBS-D or IBS-C. Studies have shown that they work pretty well: Most did about 20% better than a placebo drug, Kuo says.
“That’s still great, and they will certainly help a lot of people, but it’s not like any one of these drugs is curing IBS,” he says.
Drugs approved to treat IBS-D include:
Drugs approved to treat IBS-C include:
Drugs for muscle spasms may relieve stomach pain by calming your colon. But they don’t treat other IBS symptoms. Examples include cimetropium, hyoscine, and pinaverium. Cohen says doctors don’t prescribe these as often as in the past.
Antidiarrhea drugs can help people with IBS-D by making waste more solid. But they don’t help with pain or bloating, and they can cause constipation. Examples include diphenoxylate (Lomotil, Lonox) and loperamide (Imodium, Maalox Anti-Diarrheal, Pepto Diarrhea Control).
Laxatives: People with IBS-C may get some relief from these over-the-counter medicines that make bowel movements easier. You can take them as pills or as tablets that go in your bottom, called suppositories.
Laxatives can help if you use them once in a while, but if people take them too long, they can get used to them and end up needing them every day, Cohen says. “Many times if you take them off the laxatives and just give them a fiber product, they actually do better.”
Antidepressants: Even though symptoms happen in the digestive tract, pain signals that the brain sends also play a big role in IBS. That’s one reason antidepressants can help.
Doctors use very low doses of a certain type of the drug, called tricyclic antidepressants, to treat IBS. “Sometimes patients get upset about being prescribed antidepressants,” Kuo says, “but actually these low doses are not used for depression, they’re used for chronic pain.”
They can cause constipation, though, so they’re best for people with IBS-D. “We don’t want to make one symptom better by making another symptom worse,” Kuo says. “Instead, we try to use drugs’ side effects to our advantage.”
Another type of antidepressant, selective serotonin reuptake inhibitors (SSRIs), can cause diarrhea, so these are best for people with IBS-C. Not only do they treat pain, but they may also relieve the anxiety that can come with bad cases of IBS.
Stress can trigger IBS symptoms or make them worse. And since IBS itself can make you anxious and frustrated, the cycle can go on and on. Kuo’s research shows that relaxation, through practices like mindful meditation and deep breathing, can relieve symptoms.
Talk therapy can teach you tools to handle IBS stress and help you find a more positive attitude about your health — which may, in turn, help you feel better.
Hypnosis by a licensed hypnotherapist may also ease your anxiety about IBS. The procedure works for many people with few side effects. But it doesn’t help everyone, and insurance doesn’t always cover it.
Some people try acupuncture for IBS, too. Kuo says there’s no good evidence that it works. But it’s generally safe, he says, and some people find it helpful.
“If patients believe a treatment — any treatment — is going to help them, that can really make a difference,” Kuo says. “Many people are so frustrated and pessimistic, thinking they’ve tried everything. But in reality, they just haven’t tried a more individual, carefully thought-out approach.”
