Irritable bowel syndrome (IBS): Treatment and remedies

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The treatment for IBS depends on the type of this disorder. There are three main types:

• IBS with constipation
• IBS with diarrhea
• IBS with mixed bowel habits, which people may refer to as mixed IBS

Doctors may recommend the following drug treatments for IBS with diarrhea:

• loperamide (Imodium)
• rifaximin (Xifaxan)
• eluxadoline (Viberzi)

People with IBS and constipation may receive the following treatments:

• fiber supplements, in cases where dietary fiber intake is insufficient
• laxatives
• lubiprostone (Amitiza)
• linaclotide (Linzess)
• plecanatide (Trulance)

Other medications are available that may help treat abdominal pain in people with IBS. These include:

• antispasmodics, which relax the smooth muscle in the small and large intestine, thereby reducing abdominal spasms and cramps
• low dose tricyclic antidepressants
• low dose selective serotonin reuptake inhibitors (SSRIs)

Diet and exercise are key factors in the successful management of IBS.

Diet

Certain foods can help alleviate IBS symptoms, while others may trigger IBS episodes. A dietitian can provide tips on which foods to eat and avoid. People will need to try each dietary strategy for at least a few weeks to determine whether it helps.

Below are some strategies that a dietitian or doctor may recommend for managing IBS symptoms.

Keeping a food diary

Some people with IBS may notice their symptoms worsening after they eat particular foods. These individuals may benefit from noting down the foods that they eat throughout the day, along with any IBS symptoms that they experience. Doing this can help them identify the foods that trigger their IBS so that they can exclude them from their diet.

Eating more fiber

Fiber can help relieve IBS-associated constipation. The 2015–2020 Dietary Guidelines for Americans recommend that adults consume between 22.4 and 33.6 grams of fiber each day. The exact amount depends on a person’s age and sex.

Soluble fiber is particularly beneficial for relieving IBS symptoms. This type of fiber mixes with water to form a gel-like substance that aids digestion. Sources of soluble fiber include:

People should add fiber to their diet slowly, as having too much fiber can cause constipation. Dietitians recommend gradually adding a little extra fiber each day until the person reaches the recommended amount. Possible side effects of increased dietary fiber include gas and bloating.

Avoiding gluten

Some people may notice that their symptoms worsen after they eat foods that contain gluten. Gluten is a protein that is present in wheat, barley, and rye. Limiting or avoiding the following gluten-rich foods may help alleviate IBS symptoms in some people:

• cereals
• grains
• pasta
• bread
• most processed foods, particularly those containing thickening agents, flavorings, or colorings

Following the low FODMAP diet

Some people also have difficulty digesting foods that contain carbohydrates called fermentable oligo-, di-, mono-saccharides and polyols, or FODMAPs. The low FODMAP diet eliminates or limits foods that contain these difficult-to-digest carbohydrates.

Examples of such foods include:

• certain fruits, such as apples, cherries, and pears
• certain vegetables, including artichokes, beans, and cabbage
• dairy products
• wheat and rye products
• honey and high fructose corn syrup
• candy and gum

Exercise

The authors of a 2014 review of IBS treatments note that exercise helps reduce stress and maintain the function of the digestive tract. Exercise should, therefore, help alleviate some symptoms of IBS.

According to the review, cycling and yoga may be particularly beneficial. One study found that practicing pranayama yoga twice a day for 2 months provided the same level of IBS relief as 2–6 milligrams of loperamide a day.

Many people try natural remedies to relieve their IBS symptoms. These remedies include those below.

Probiotics

The following three probiotics are the focus of clinical studies on the treatment of IBS:

• Lactobacilli
• Saccharomyces boulardii
• Bifidobacteria

According to a 2014 review of IBS treatments, studies of Lactobacillus have so far yielded conflicting or inconsistent results. Saccharomyces boulardii and Bifidobacteria have shown some benefits in the treatment of IBS. However, further research is necessary to establish their effects.

According to the review, a type of Bifidobacteria called Bifido bacterium infantis 35624 shows the strongest effects against IBS. Studies show that it may reduce IBS pain and bloating when a person takes it once daily. Some people also report that this strain of probiotic helps them pass stool and normalizes their stool habits.

No other probiotics have demonstrated IBS symptom improvement in appropriately designed studies. Further studies are necessary to confirm the effectiveness and safety of probiotics for treating IBS symptoms.

When choosing a probiotic, people must select the exact product that researchers used in the clinical study. All probiotic products differ in their composition and dosage, meaning that some may prove less effective than others.

People should also consult a doctor before taking probiotics to ensure that the product is safe.

Peppermint oil

Some people who have IBS take antispasmodic medications. These help relax the smooth muscles in the small and large intestines, which can alleviate painful abdominal spasms.

According to a 2014 review, the American College of Gastroenterology Task Force on IBS recommend peppermint oil as an alternative to antispasmodic medications. The review notes that three separate placebo-controlled trials showed that peppermint oil decreased stomach discomfort, pain, and bloating in people with IBS.

However, there have been no trials looking at the safety and efficacy of peppermint oil for the long-term treatment of IBS.

Researchers have identified an association between psychological distress, daily stress, and the worsening of gastrointestinal symptoms.

Some doctors may, therefore, recommend the following mind-body therapies as a complementary treatment for IBS:

As the authors of a 2012 review note, most studies that have looked into the efficacy of the above therapies for IBS have been flawed. These inadequacies prevent researchers from drawing firm conclusions about the effectiveness of the different therapies. Nonetheless, each of the therapies shows the potential to be more effective than standard IBS treatments.

According to other research, relaxation therapy may be particularly beneficial for people with IBS. This therapy appears to be at least as effective as standard pharmacological IBS treatments.

Drugs currently exist to target mechanisms that contribute to IBS. These mechanisms include:

• inflammation
• smooth muscle movements in the large intestine
• changes in gut bacteria

Researchers continue to investigate the effect of IBS medications that act on the digestive tract. Newer research is also evaluating IBS drugs that target the central nervous system.

In 2014, 16 potential IBS drugs were in phase II or III clinical trials. Such trials represent the intermediate and advanced stages of drug testing.

Today, doctors can use a range of different strategies to treat and manage IBS. Medications, diet, and lifestyle are important factors to consider as part of this treatment plan.

Some medications help alleviate abdominal spasms, while others relieve constipation and diarrhea or target the central nervous system. Researchers continue to develop newer medications, some of which researchers are investigating in phase II or III clinical trials.

Some people try natural remedies such as probiotics and peppermint oil to relieve their IBS symptoms. Some may also find therapies to relieve stress and promote relaxation beneficial. However, further well-controlled clinical trials are necessary to establish the extent to which these treatments are effective.