Since IBS can cause a wide variety of symptoms, many different classes of drugs are used. Guidelines for irritable bowel syndrome medications are based on the severity of the disease, the type of IBS, tolerance of side effects, the age of the person with IBS, and any other health conditions they have or medications they use.
For people with mild or occasional IBS symptoms, changes to diet and lifestyle are sometimes effective in treating IBS. Lifestyle changes may include diet, exercise, and reducing stress.
Although irritable bowel syndrome (IBS) is not caused by the food you eat, your symptoms may be worse when you eat certain foods. Modifying your diet for your specific needs may help reduce IBS symptoms. There is no one set of dietary recommendations that will provide the best results for every person with IBS.
One of the best ways to pinpoint which foods are well tolerated and which produce the worst symptoms for you is to keep a food diary. Over several weeks, take note of what you eat and how you feel throughout the day. It will likely become apparent which foods are problematic and which are safe.
Foods that trigger IBS symptoms differ from person to person. However, some of the most common triggers include caffeinated and alcoholic beverages, high-fat foods, milk products, artificial sweeteners, and gassy foods such as cabbage and beans. Some people with IBS obtain positive results with a diet low in a type of carbohydrates known as FODMAPs, short for “fermentable oligo-, di-, mono-saccharides and polyols.” Foods containing FODMAPS include wheat, some dairy, some fruits, and vegetables such as onions, broccoli, sprouts, and beets. However, the low-FODMAP diet can cause nutritional deficiencies and additional bowel problems if it is followed too stringently for too long. Read more about diet recommendations for IBS.
The results of several scientific studies have indicated that probiotics may benefit some people with IBS. Probiotics are sold as supplements in the form of pills, capsules and powders. Many fermented foods naturally contain live probiotic cultures, including yogurt, sauerkraut, miso, soft cheeses, sourdough bread, and tempeh. Drinks such as kefir, acidophilus milk, and kombucha also contain live cultures. It is not yet known which strains of probiotic bacteria are beneficial in which conditions. It is likely that each person has a unique optimal balance of each strain of bacteria, and probiotics that benefit one person may prove useless in another.
The results of a small clinical trial indicate that moderate, regular exercise can improve quality of life and some symptoms in those with IBS. Regular exercise does not necessarily mean going to the gym or playing sports. Nearly any physical activity that increases your heart rate and makes you breathe more deeply can provide significant benefits to those with IBS.
Reducing stress and improving mood
Irritable bowel syndrome (IBS) is frequently associated with psychological factors such as stress, anxiety, and depression. Emotional distress can cause worsening of symptoms in many people with IBS.
Psychotherapy, also known simply as therapy, can be valuable in treating psychological factors in IBS. There are many forms of psychotherapy. Cognitive behavioral therapy (CBT) focuses on identifying and correcting ways of thinking that lead to depression. Interpersonal therapy (IPT) focuses on improving communication and behavior with family and friends. Some therapists specialize in one type of therapy, while others utilize a combination of psychotherapeutic approaches.
Natural and alternative treatments are popular with many people who have IBS. Complementary treatments for IBS may include acupuncture, herbal or nutritional supplements, hypnotherapy, and mind-body practices such as meditation. Some people with IBS report that they feel better after using one natural treatment or another. Some alternative treatments are accepted by doctors as potentially benefiting some people with IBS, but most have not been studied in rigorous clinical trials to establish their safety and effectiveness. Since some natural or complementary treatments can interfere with IBS medications or cause their own side effects, it is important to talk to your doctor before trying any alternative treatments.
Medications for IBS
People with moderate to severe IBS symptoms that impact their daily life may be recommended to take one or more types of medication.
Over-the-counter (OTC) medications
Diarrhea is one of the most common symptoms of IBS. Diarrhea can be treated with over-the-counter (OTC) medications such as Imodium (Loperamide) or Pepto-Bismol (bismuth subsalicylate). Bile salt binders such as Cholestyramine (sold under brand names such as Questran and Questran Light) may be prescribed for chronic diarrhea.
Safe OTC bulking agents such as Citrucel (Methylcellulose) and Metamucil (Psyllium powder) treat constipation by adding water-soluble fiber to the stool, making it softer and easier to pass. Other OTC options for constipation include glycerin suppositories, stool softeners such as Colace (Docusate), osmotic laxatives like Miralax (Polyethylene glycol), Milk of Magnesia (Magnesium hydroxide solution), and stimulant laxatives such as Dulcolax (Bisacodyl) and Senekot (Senna glycoside).
Prescription medications for diarrhea and constipation
If OTC products are ineffective in treating IBS symptoms, your doctor may prescribe medications.
The prescription laxative Amitiza (Lubiprostone) is believed to work by increasing secretions in the gastrointestinal tract. A rare side effect of Amitiza is labored breathing.
Linzess (Linaclotide) is another prescription laxative. Linzess is a guanylate cyclase-C agonist. It is believed that Linzess works by calming pain-sensing nerves in the bowel and by promoting motility. Rarely, Linzess can cause severe diarrhea.
Bentyl (Dicyclomine) and Levsin (Hyoscyamine) are anticholinergic drugs and antispasmodics prescribed for IBS symptoms. It is believed that these drugs work by blocking the neurotransmitter acetylcholine in the nervous system and preventing the movement of smooth muscle in the gastrointestinal tract. Rarely, drugs in this class can cause heat-related illness, psychosis, and worsening of heart problems.
Lomotil is a combination of the drugs Diphenoxylate and Atropine. Diphenoxylate is an opioid medication. Diphenoxylate is believed to work by slowing the transit of food through the digestive system. Atropine is an anticholinergic and antimuscarinic medication. Atropine is believed to work in cases of diarrhea by inhibiting the secretion of mucus.
Viberzi (Eluxadoline) is a prescription antidiarrheal medication believed to work by modulating the nerves in the intestines, making them less sensitive and slowing the movement of food through the gut.
For severe diarrhea in women with IBS, Lotronex (Alosetron) may be prescribed when other treatments have failed. Lotronex is an antidiarrheal medication. Lotronex is believed to work by reducing gastrointestinal secretions, slowing the transit of food through the intestines, and inhibiting nerves from signaling pain and discomfort. Rarely, Lotronex has caused severe constipation and ischemic colitis, a condition resulting from inadequate blood supply to the large intestine.
People with IBS who mainly have diarrhea may be prescribed a course of Xifaxan (Rifaximin) or another antibiotic. The main side effect of antibiotics is the alteration of the balance of beneficial bacteria that normally colonize the digestive tract.
Antidepressants and anxiolytics
Some people with IBS that is affected by depression, anxiety, or stress may be prescribed an antidepressant or anxiolytic (anti-anxiety medication). Some antidepressants have also shown effectiveness at decreasing certain types of pain, especially neuropathic pain.
Anxiolytics may include Valium (Diazepam) and Ativan (Lorazepam).