Treatment for IBS
There is no cure for irritable bowel syndrome, but the condition usually can be managed with lifestyle modifications and medication. Patience is key and in many cases, it takes 6 months or longer before symptoms improve. All treatment plans should be supervised by a health care provider.
Lifestyle Modifications & IBS
Changing eating habits may help to reduce symptoms of IBS. In some cases, eating smaller, frequent meals throughout the day can be helpful. Patients should avoid foods that are known triggers (e.g., fatty foods, chocolate) and increase low fat/high carbohydrate foods (e.g., rice, whole grain breads, pasta). Reducing the intake of gas-inducing foods, like raw fruits and vegetables, also may help. A nutritionist can advise on the best ways to replace missing nutrients after a certain food type has been removed from the diet.
Staying hydrated by drinking 6 to 8 glasses of water daily is also recommended. Eating high fiber foods or taking a fiber supplement (often in pill form or as a powder that can be sprinkled on food or dissolved in a beverage) can help the intestines work more smoothly. Drinking more water also can help fiber do its job.
Fiber comes in two types. Soluble fiber is found in foods like citrus fruits, apples, and beans. Supplements (e.g., Fiberall, Metamucil) contain psyllium, which is a natural vegetable soluble fiber. Insoluble fiber adds more substance to the stool and can be found in wheat bran and whole grain breads. Fiber should be increased gradually to give the body a chance to get used to it. Increasing fiber too quickly can worsen bloating and gas symptoms.
Because swallowing air can cause gas and worsen IBS symptoms, it may be helpful to avoid drinking from a straw and chewing gum. Some patients benefit from counseling, relaxation, and stress management techniques. Getting plenty of sleep and exercise also can be helpful.
Medications to Treat IBS
Patients who suffer from IBS may need to try several medications, or different combinations of medications, before symptoms improve. Medications may include antispasmodics, such as hyoscyamine and dicyclomine, which can help ease the contractions of the colon. Loperamide (found in Imodium) can help reduce diarrhea.
Medications for anxiety and depression (e.g., antidepressants) may help relieve some of the discomfort caused by stress. In some cases, other medications are needed to counteract constipation, which is a common side effect of antispasmodics and antidepressants.
Alosetron hydrochloride (Lotronex) can be used in women to treat severe diarrhea that has not responded to other treatments. This medication can interfere with blood flow to the colon, causing severe constipation, and must be used under careful medical supervision. The Food and Drug Administration (FDA) has not approved this drug for use in men.
In May 2015, the FDA approved eluxadoline (Viberzi) and rifaximin (Xifaxan) to treat IBS with diarrhea in adults. Eluxadoline is taken twice a day with food and contains a new ingredient that activates receptors in the nervous system that reduce bowel contractions. Rifaximin (an antibiotic also approved to treat certain types of traveler's diarrhea) can be taken 3 times a day for 14 days. If symptoms recur, an additional 14-day course can be taken after 10 weeks. Xifaxan is thought to change the bacterial content of the GI tract.
Common side effects of eluxadoline include constipation, nausea, and abdominal pain. This medication should not be used in people with a history of liver impairment, pancreatitis, severe constipation, or bile duct obstruction, or in people who drink more than 3 alcoholic drinks a day.
Common side effects of rifaximin include nausea and increased blood levels of the liver enzyme alanine aminotransferase. It should be used with caution in people with liver impairment and those who take other medications. If IBS symptoms do not improve, a type of infectious diarrhea called C. difficile enterocolitis may be suspected.
Other IBS Treatments
Acupuncture can help ease muscle spasms and improve bowel function. A probiotic diet replenishes the "good" bacteria that are naturally present in the intestines. Increasing these bacteria, either through foods like yogurt or through dietary supplements, may help to alleviate IBS symptoms.
Herbs, particularly peppermint, can relieve spasms in the digestive tract, but patients should consult a qualified health care provider or a pharmacist before taking herbs to make sure they will not interact negatively with current medications. Enteric-coated capsules are recommended. Heartburn is a common side effect of herbal supplements.