4 IBS Treatment Plans for Uncomfortable Symptoms

IBS treatment: Finger hitting irritable bowel syndrome key

Irritable bowel syndrome (IBS) affects nearly 10% to 15% of North Americans — many of whom are under the age of 50 [1]. This chronic condition can have a severe impact on patients’ quality of life, including frequent trips to the bathroom and excruciating stomach pain.

IBS has no cure, but it can be managed. In this article, we’ll take a look at various IBS treatments, from diet and probiotics to medications and behavioral therapy. 

What Is IBS?

IBS is a gastrointestinal disorder that primarily affects the large intestine. 

There is no singular cause of IBS, and root causes vary among patients. However, IBS has been linked to small intestinal bacterial overgrowth (SIBO) and other gut issues [2]. One meta-analysis suggests that SIBO is prevalent in 38% of IBS patients [3]. 

Irritable bowel syndrome symptoms include:

  • Abdominal pain
  • Bloating
  • Cramping
  • Gas and flatulence
  • Constipation and/or diarrhea

There are three types of IBS diagnoses: constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), and a mix of constipation and diarrhea (IBS-M).

Non-digestive symptoms of irritable bowel syndrome may include:

  • Fatigue, brain fog, and other cognitive issues [4, 5]
  • Joint or body pain [6, 7, 8]
  • Dry eyes [9, 10]

Common triggers of irritable bowel syndrome episodes include:

  • Diet [11, 12]
  • Stress and anxiety [13, 14]
  • Hormonal fluctuations during menstruation [15, 16, 17]

IBS is sometimes confused with inflammatory bowel disease (IBD), as both conditions share symptoms. However, IBS is a functional GI disorder that isn’t life-threatening. But IBD — which encompasses ulcerative colitis, Crohn’s disease, and celiac disease — can be life-threatening without proper treatment.

IBS Treatment Options

IBS is a chronic condition for which there is no cure. However, there are several lifestyle changes you can make to curb IBS symptoms. 

Before starting any IBS treatment plan, speak with your doctor about the best options for you.

IBS Treatment with a Low FODMAP Diet

Table full of low FODMAP foods

One of the first (and easiest) things you can do to limit the symptoms of IBS is to change your eating habits. 

A low FODMAP diet has been shown  to be one of the most beneficial diets for IBS patients to follow [18].

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are types of fermentable starches and sugars. These short-chain carbohydrates and sugar alcohols can’t be easily absorbed by the small intestine, leading to digestive problems.

High FODMAP foods can trigger IBS symptoms like constipation, diarrhea, bloating, and abdominal pain. A low FODMAP diet removes food triggers that can contribute to IBS flare-ups. 

Examples of low FODMAP foods include:

  • Leafy greens such as lettuce, kale, and bok choy
  • Vegetables such as bell peppers, zucchini, and Brussels sprouts
  • Fruits such as blueberries, cantaloupe, and grapes
  • Grains such as white rice, quinoa, and millet
  • Lactose-free milk such as almond milk, soy milk, and rice milk 
  • Aged cheese such as brie and cheddar

High FODMAP foods consist of the following:

  • Vegetables such as cauliflower, artichokes, and cabbage
  • Fruits such as avocados, apricots, blackberries, and watermelon
  • Dairy products such as ice cream and yogurt
  • Legumes such as lentils, chickpeas, and soybeans
  • Nuts such as cashews and pistachios
  • Artificial sweeteners such as high fructose corn syrup (HFCS), sorbitol, and xylitol

There is scientific research that suggests a low FODMAP diet can manage the symptoms of irritable bowel syndrome:

  • A couple of meta-analyses conclude that a low FODMAP diet reduces abdominal pain and other digestive symptoms while improving IBS patients’ overall quality of life [19, 20].
  • A low FODMAP diet can normalize bowel movements by positively impacting gut endocrine cells [21, 22, 23]. 
  • Two randomized controlled trials show the efficacy of a low FODMAP diet for IBS-D patients [24, 25].

Alternatively, some studies show that a gluten-free diet may also help a subset of IBS patients who have non-celiac gluten sensitivity (NCGS) [26, 27], which could contribute to IBS symptoms.

Elimination diets like the low FODMAP diet are meant to be a short-term solution. You can start to reintroduce other foods once your symptoms subside. Practicing mindful eating and keeping a food diary can help you identify foods that might contribute to IBS symptom flare-ups, especially upon reintroduction of eliminated foods.

IBS patients must also be careful to not over- or under-restrict their diet, a balance that can be attained with direction from a gastroenterologist, dietitian, or health coach [28].

IBS Treatment With Probiotics

Diet alone won’t cure your IBS symptoms. You’ll also want to consider taking high-quality probiotic supplements. Probiotic bacteria are live microorganisms that maintain your gut environment. 

For best results, incorporate a combination of the three main categories of probiotics:

  • Lactobacillus and Bifidobacteria blends
  • Saccharomyces boulardii (a beneficial yeast)
  • Soil-based probiotics (usually Bacillus species)

Recent studies show that probiotics are an effective way to limit the symptoms of irritable bowel syndrome and improve patients’ overall quality of life:

  • Meta-analyses of clinical trials show that composite probiotics containing Bifidobacterium infantis and Lactobacillus are effective at reducing IBS symptoms [29, 30].
  • Further, probiotics have been proven to be effective in relieving:
    • Diarrhea [31, 32]
    • Constipation [33, 34]
    • Bloating and abdominal pain [35, 36]
  • Probiotics are also effective against SIBO, which is prevalent in many IBS patients [37, 38, 39, 40].

Daily probiotic supplements are generally safe for long-term use and have very few, if any, side effects. Best of all, there is plenty of research showing that probiotics can improve IBS symptoms.

Remember that every patient has a unique gut microbiome. Talk with your doctor to find the best combination of probiotics to suit your needs.

IBS Treatment With Medication 

IBS treatment: Pills spilling out of a bottle

Depending on the severity and scope of your symptoms, your doctor may recommend over-the-counter drugs or prescription medications you can take for IBS. 

The following over-the-counter drugs may be used to treat mild to moderate cases of irritable bowel syndrome:

  • Bismuth subsalicylate is an anti-diarrheal that reduces stomach inflammation and kills bad bacteria [41].
  • Loperamide decreases bowel movements and makes stools more solid.
  • Bulk-forming laxatives such as psyllium and methylcellulose increase the amount of water in the stool.
  • Emollient laxatives such as docusate sodium and docusate calcium act as stool softeners.
  • Hyperosmotic and saline laxatives such as glycerin and magnesium draw water to your intestines for easier stool movement.

For more severe cases of IBS, your doctor may put you on one of the following prescription drugs:

  • Rifaximin (brand name Xifaxan) is an antibiotic derived from rifamycin that stops the overgrowth of clostridium difficile and e.coli bacteria, which makes it a popular treatment for traveler’s diarrhea and SIBO.
  • Lubiprostone (brand name Amitiza) treats chronic idiopathic constipation for women with IBS-C.
  • Alosetron (brand name Lotronex) is specifically for women with diarrhea-predominant IBS.
  • Eluxadoline (brand name Viberzi) reduces diarrhea and abdominal pain in IBS-D patients.

Your doctor may also prescribe antispasmodics such as Bentyl (anticholinergic dicyclomine) and Levsin (hyoscyamine) to relax the gut muscles and alleviate pain:

  • Antispasmodics are effective when used in conjunction with simethicone, an OTC drug that relieves gas [42, 43]. 
  • Peppermint oil is a natural antispasmodic that has effectively treated stomach pain with minimal side effects [44, 45].

Low-dose antidepressants can block pain signals in the GI tract from reaching the brain: 

  • Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to patients with IBS-D [46, 47].
  • A meta-analysis and systematic review have found TCAs more effective than SSRIs at managing IBS pain [48, 49]. 
  • Antidepressants can be given to IBS patients without depression, but one study shows that 27% of people seeking treatment for depression also meet the criteria for IBS [50].

Unlike probiotics, medications often have side effects. Prolonged use of these drugs has the potential to create other problems in your digestive tract or contribute to liver disease.

Common side effects for most of the above medications include nausea, vomiting, loss of appetite, headache, tiredness, diarrhea, and constipation. 

More adverse effects may also occur and will require immediate medical attention. 

For example, Xifaxan side effects include peripheral edema (fluid buildup in your limbs), muscle spasms, and chest pain. Meanwhile, Alosetron has been linked to a decrease in blood flow to the bowels (ischemic colitis).

Speak with your primary health care provider or gastroenterologist regarding potential drug interactions, allergic reactions, or hypersensitivity reactions before starting any OTC or prescription drug for IBS. Also, read any included drug information carefully upon starting a new medication.

IBS Treatment with Cognitive-Behavioral Therapy

IBS itself is a functional disorder that is likely to be aggravated by stress, anxiety, and mood disorders [51, 52]. 

Thus, cognitive-behavioral therapy (CBT) may be recommended in addition to other treatments for irritable bowel syndrome.

A randomized controlled trial concluded that CBT was more effective in 12 months of follow-up than standard IBS treatment [53].

While this type of specialized therapy is not accessible for everyone, this is gradually changing as telemedicine becomes more available due to COVID-19 [54, 55]. 

Talk To Your Doctor About IBS Treatment Plans

This guide is not meant to replace any medical advice from a qualified healthcare professional. However, it should give you a starting point for your treatment of irritable bowel syndrome.

There is no cure for IBS, but it can be successfully managed with a strong patient-physician relationship [56]. Allow our dedicated team of doctors and a nutritionist to work with you to create a customized IBS treatment plan that will help you overcome your symptoms and feel better.

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