IBS Medication: How To Relieve Symptoms and Heal the Gut

If you have irritable bowel syndrome (IBS), you’ve probably tried several treatment approaches. IBS symptoms vary drastically from person to person. Some IBS patients can manage their symptoms with simple dietary and lifestyle improvements. Others may need to consider IBS medication options. 

IBS doesn’t need to be a life sentence of unpredictable symptoms and poor quality of life. Every IBS patient needs to find the right combination of treatment approaches to help resolve symptoms.

In this article, we’ll discuss the types of over-the-counter, prescription, and natural medications that have proven effective for patients with irritable bowel syndrome (IBS). A few of these medications can help to treat the root causes of IBS, while others simply offer symptom relief. We’ll also discuss dietary and lifestyle interventions that support IBS gut health.

What Is Irritable Bowel Syndrome (IBS)?

Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders, affecting approximately 10-15% of Americans [1]. 

IBS usually presents as a collection of digestive, immune system, and nervous system symptoms [2]. However two symptoms must be present for an IBS diagnosis: abdominal pain and a change in bowel habits (diarrhea, constipation, or both). 

Common digestive symptoms of irritable bowel syndrome include:

  • Abdominal pain [3]
  • Altered bowel habits [3]
  • Bloating [4]
  • Cramping [5]
  • Indigestion [6]
  • Heartburn [6]
  • Reflux [6]
  • Flatulence (gas) [5]

Non-digestive symptoms of IBS include:

  • Fatigue (including chronic fatigue syndrome) [7, 8, 9]
  • Depression and anxiety [10, 11, 12, 13, 14, 15]
  • Migraine headaches [16, 17]
  • Respiratory symptoms [18, 19]
  • Fibromyalgia (widespread body pain) [9]
  • Temporomandibular joint disorder (lockjaw) [9]
  • Chronic pelvic pain [20, 21]

Irritable Bowel Syndrome (IBS) is a cluster of symptoms rather than a single disease process. Research suggests there are many possible reasons why IBS develops. These include:

  • Small intestine bacterial overgrowth (SIBO) and other bacterial imbalances of the gut
  • Long-term effects of food poisoning [22]
  • Leaky gut [23, 24] or immune system imbalance [25]
  • A serotonin imbalance that affects bowel function [2]

Research supports an individualized approach to managing irritable bowel syndrome (IBS), including dietary changes, lifestyle modifications, stress reduction, and medical interventions [2].

IBS Medication for Root Causes

Several medications can be used to treat the root causes of IBS. These should be used along with diet and lifestyle changes (which we’ll discuss later). We recommend a step-by step approach, starting with probiotics. For many patients, probiotics, along with dietary and lifestyle modifications, are adequate treatments for restoring gut health.

Step 1: Probiotics

Since imbalances between good and bad gut bacteria are a common cause of IBS, probiotics are an important starting point for treatment. Five different meta-analyses (highest quality science) show probiotics improve common IBS symptoms — mainly bloating and abdominal pain [26, 27, 28, 29, 30].

Non-digestive symptoms of IBS, which include joint pain [31, 32, 33], brain fog [34, 35], and headaches [16, 17], have also shown improvement with the use of probiotics.

Research indicates that multi-strain probiotics (which contain more than one species of bacteria) are more effective than single-strain probiotics [36, 30]. In a meta-analysis of studies treating constipation, multi-strain probiotics produced more significant symptom relief [37].

At the clinic, we have found IBS patient’s who regularly use a multi-strain probiotic protocol have experienced IBS symptom improvement. 

Step 2: Digestive Enzymes

Digestive enzymes may be helpful for some IBS patients. They provide relief for IBS symptoms that come from an inability to digest certain types of foods. Most digestive enzymes fall into one of three categories: 

  • Amylase breaks down carbohydrates
  • Protease breaks proteins down into amino acids
  • Lipase breaks dietary fats down into fatty acids

In a study of 43 patients with inflammatory bowel disease with IBS symptoms, those given a digestive enzyme showed reduced bloating, flatulence, and abdominal pain compared to those receiving conventional treatment [38].

Step 3: Betaine HCI

The digestive process requires adequate stomach acid (HCI) to maintain a balance of good and bad bacteria. Stomach acid should kill much of the bacteria that enters the stomach [39]. However, some patients don’t produce enough stomach acid to do this.

Betaine HCI is a supplemental form of acid for those with low stomach acid. It can improve digestive function and nutrient absorption for patients with low stomach acid [40].

Consider a trial of Betaine HCI if you suspect you have low stomach acid. We do not recommend the common practice of increasing Betaine HCI dosage until your stomach burns, as this can lead to very high doses that damage the stomach lining. 

Simply follow the recommended dosage for 2-3 weeks and monitor for symptom improvement. If you experience any burning sensation at the recommended dosage, discontinue your trial. It’s likely you already have adequate stomach acid.

Step 4: Antimicrobials

If you’re still experiencing symptoms after dietary changes, lifestyle modifications, probiotics, and digestive supports like enzymes and Betaine HCI, antimicrobials offer another treatment option. 

Herbal Antimicrobials

Herbal antimicrobials offer a natural option to clearing stubborn bacterial and fungal overgrowths.  

Herbal antimicrobials work in the same way as Rifaximin (a prescription antibiotic) and are more commonly used in functional medicine. There are fewer studies for herbal antimicrobials, but they have been shown effective in IBS and SIBO [41, 42].

Herbal antimicrobials generally act against bacteria, fungi, and protozoa, while antibiotics mostly work against bacteria.

Rifaximin

The FDA considers prescription antibiotics as an option for IBS, to be considered only if lifestyle changes don’t help [43]. The FDA has approved Rifaximin (Xifaxan), an prescription antibiotics as a treatment for IBS [44, 45].

Rifaximin is used as a standard SIBO treatment to reduce bacterial overgrowths in both the small and large intestine.

Research shows that this approach eliminates SIBO for 67% of patients [46].

If you are interested in pursuing antimicrobial treatment for IBS, we recommend working with a knowledgeable healthcare practitioner.

Step 6: Serum Bovine Immunoglobulins

A new supplement, serum bovine immunoglobulins, may be a helpful treatment option for patients who didn’t respond to other therapies. 

Rather than resolving bacterial imbalances, immunoglobulins bind to harmful bacteria and toxins in the gut. This helps to calm the immune system and reduce gut inflammation.

Multiple clinical trials have shown that serum bovine immunoglobulins improve IBS symptoms [47, 48, 49, 50, 51, 52, 53]. In one promising study, serum bovine immunoglobulins (SBIs) improved symptoms by 75% for patients with IBS, SIBO, or a combination of the two who didn’t respond to other treatments [49].

IBS Medication for Symptom Management

While we encourage patients to treat the root cause of their IBS, we recognize that IBS medications for symptom management can be beneficial. Whether you use them while working to establish better gut health or to manage an occasional flare-up, here are treatment options that may be effective for managing IBS symptoms.

IBS Medication To Manage Bloating

Bloating is one of the most common symptoms of IBS. Medications that may help with bloating include:

  • Bentyl (dicyclomine) and Levsin (hyoscyamine) are prescription antispasmodics typically prescribed by a gastroenterologist. 
  • Peppermint oil is a natural alternative with an antispasmodic effect on the digestive tract.

IBS Medication to Manage Diarrhea

Watery stool and frequent bowel movements are common symptoms of IBS-D. Diarrhea occurs when food travels too rapidly through the digestive tract.

The medications below can be used for symptom management by reducing bowel movement frequency and slowing the rate at which food moves through the digestive tract.

Over-the-Counter Medications

  • Imodium (loperamide) is an over-the-counter medication that slows gut motility by relaxing the digestive system’s muscles.

Prescription Medications

  • Viberzi (eluxadoline) is a prescription medication for IBS with diarrhea.
  • Lotronex (alosetron) is a prescription medication for women with IBS-D and trouble controlling their bowel movements.

Bile Acid Binders

Chronic diarrhea may occur when your body produces too much bile acid, as this acid builds up in the small intestine. If your doctor finds bile acid malabsorption (BAM) is the cause of your diarrhea, it can be treated through the use of bile acid binders such as:

  • Cholestyramine (Locolest)
  • Colestipol (Colestipol)
  • Welchol (colesevelam)

IBS Medication to Manage Constipation

Keeping your bowels moving is critical for reducing bacterial overgrowth and IBS symptoms. Constipation is defined by having fewer than three bowel movements per week. The following medications can be used to speed up gut motility, soften your stool, and reduce relapse of IBS-C.  

Over-the-Counter Medications

Laxatives: Glycolax, Miralax, and magnesium citrate help keep bowel movements regular. Regular bowel movements reduce the likelihood of small intestinal bacterial overgrowth (SIBO) [54].

Prescription Medications

Calcium channel activators: Prescription medications like Trulance (plecanatide) and Amitiza (lubiprostone) activate the calcium channel and increase fluid in the intestines. They act as a laxative by improving stool texture and relieving constipation. 

Motility Agents and Medications

Maintaining healthy gut motility (speed that food moves through your digestive tract) is vital to maintaining symptom remission. The following medications support healthy gut motility, which may reduce the likelihood of bacterial overgrowth.

Over-the-Counter Motility Agents

MotilPro and Iberogast are two over-the-counter herbal supplements that have shown promising results in constipation-dominant IBS. The ginger and herbal formulas provide gut signaling to increase motility. They offer an excellent alternative for individuals who prefer natural support to prescription medications.

Prescription Motility Medications

Medications with the most promise and the fewest side effects include:

  • Prucalopride (brand names: Motegrity, Resolor): Prucalopride was recently approved by the FDA for use in the United States.
  • Low Dose Naltrexone (LDN)
  • Linzess (linaclotide)

Serotonin enhancement: For some patients, problems metabolizing serotonin in the digestive tract tissue may cause constipation [54]. Some healthcare providers prescribe selective serotonin reuptake inhibitors (SSRIs) or low-dose tricyclic antidepressants for constipation [55]. But these medications carry risks of uncomfortable side effects [55].

Fiber Supplements

Several studies show promising results for treating irritable bowel syndrome with constipation (IBS-C) by using fiber supplements [56].

Metamucil and psyllium are two commonly recommended soluble fiber supplements. A meta-analysis concluded that soluble fiber improved overall IBS symptoms [57]. Several individual studies support this conclusion [58, 59].

Fiber may trigger abdominal pain, bloating, and flatulence for some IBS patients [56]. Start with a low dose and slowly increase if you have adverse side effects, do not continue.

Creating a Comprehensive Treatment Plan

Natural and prescription IBS medication can be very helpful in an overall IBS treatment plan. However, never overlook the value of dietary and lifestyle changes for supporting healing and long-term symptoms remission. 

Dietary Changes

A diet high in processed foods, sugars, alcohol, and poor quality fats can aggravate IBS symptoms [60]. 

The most important basics for an IBS diet are to remove inflammatory foods such as sugar, refined carbohydrates, trans fats, and excessive alcohol. Choose fresh, whole, unprocessed foods, including lots of vegetables and moderate amounts of fruit. 

The Paleo diet is an anti-inflammatory diet template we often recommend to patients. This can be a good starting point for restoring gut health.

Low FODMAP Diet

If you’ve implemented a Paleo diet for at least 30 days and haven’t had symptom improvement, consider trying the low FODMAP diet. 

The low FODMAP diet is one of the most scientifically validated diets for treating IBS [61, 62].

The low FODMAP elimination diet is a short-term diet that temporarily restricts the consumption of fermentable carbohydrates. This approach can lead to reduced inflammation and fewer IBS symptoms. 

Two systematic reviews and meta-analyses showed that the low FODMAP diet reduced digestive symptoms and abdominal cramping and increased quality of life in IBS patients [61, 62].

Lifestyle Modifications

Stress is a common trigger for IBS symptoms. Lifestyle modifications and stress reduction can significantly improve IBS treatment.

Here are a few simple changes to start with:

  • Prioritize getting 7-9 hours of good sleep every night
  • Get outside and spend time in nature
  •  Moderate exercise 
  • Spend time with friends, family, and pets
  • Do a hobby or activity you enjoy

Preliminary research suggests that stress reduction techniques such as cognitive-behavioral therapy [63, 64], hypnotherapy [65, 66], yoga [67], and meditation [68] can be helpful for IBS patients.

The Bottom Line

A personalized approach to healing your gut is fundamental for restoring gut health. Over-the-counter and prescription medications do play a role in an effective IBS treatment plan. However, it’s equally if not more important to focus on dietary and lifestyle changes that will support your gut health.

Contact our team at Austin Center for Functional Medicine if you need help creating a plan for treatment of irritable bowel syndrome.

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