Coping with persistent irritable bowel syndrome (IBS)—cramping, abdominal pain, discomfort, bloating, diarrhea or constipation—can leave you feeling embarrassed and frustrated. However, understanding what IBS is and how to treat and manage IBS symptoms can help you feel more in control of your situation and feel better. Let’s take a closer look at what irritable bowel syndrome is and the treatment options available.
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome is a gastrointestinal disorder of the large intestine that affects up to 20% of Americans, or more than 15 million according to the FDA. IBS impacts the large intestine, otherwise known as the colon, and can cause a wide range of IBS symptoms including chronic diarrhea, bloating, abdominal pain, gas, cramping, or constipation.
The underlying cause of IBS remains a mystery to doctors. It is diagnosed based on the patient’s symptoms. There is no cure for irritable bowel syndrome and the condition is chronic, which means it can linger for months or even years and require long term treatment and monitoring.
Though doctors have still not determined the underlying cause of irritable bowel syndrome, new research is getting closer to understanding what some of the triggers for the digestive disease might be. About two thirds of IBS sufferers are women under 45. There are signs that may link at least some cases of IBS to depression, stress, or anxiety. IBS is also associated with diet and can be triggered by carbohydrates, coffee, high or low fiber foods, and so on.
How is IBS diagnosed?
If you are suffering from GI tract symptoms you suspect might be caused by irritable bowel syndrome, you’ll want to schedule an appointment with your primary caregiver for an initial exam. Your healthcare provider will refer you to a gastroenterologist. Since the underlying causes of irritable bowel syndrome remain unknown, there are no definitive tests that your doctor can use to conclusively diagnosis you.
Your doctor provider will first begin by taking your medical history, family history, performing a physical exam, and further testing meant to rule out other conditions such as celiac disease and inflammatory bowel diseases (IBD) e.g., Crohn’s disease and ulcerative colitis. They will also look for signs or symptoms that could indicate a condition other than IBS such as weight loss, anemia, fever, vomiting, and so on.
Your doctor will also likely ask you a series of questions to help with the diagnosis. These could include:
Are you experiencing pain, discomfort, or a change in frequency or consistency of your bowel movements? What are you noticing about your bowel habits that are different?
Have you noticed mucus in your stool?
Do you have pain associated with incomplete bowel movements or pain and discomfort that’s relieved by defecation?
How often are you experiencing symptoms and for what duration?
Have you noticed symptoms worsen when you’ve eaten certain foods?
Have you been experiencing stress or depression?
If your doctor suspects that you are suffering from IBS, they will ask questions that help diagnosis your specific type of IBS: diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or a mix of both. This will help ensure that you get the treatment(s) that are most effective for your condition type.
Before making a definitive diagnosis of irritable bowel syndrome, your doctor may also recommend additional testing to further rule out the chance of underlying infections, malabsorption, lactose intolerance, a breath test to check for an overgrowth of bacteria, and so on. These include a colonoscopy, CT scan or X-rays, a flexible sigmoidoscopy of the digestive tract (small intestine, large intestine, and stomach), endoscopy, or stool examination.
IBS treatment options
There are no known cures for IBS, though there are many clinical tests and trials in progress. Treatment of irritable bowel syndrome can be accomplished by addressing symptoms during flare-ups through prescription medicines, over-the-counter medications, lifestyle changes, and natural remedies such as changes to your diet. Many IBS sufferers also find relief of symptoms through psychological therapies such as cognitive behavioral therapy or hypnotherapy.
Most medications utilized in the treatment of IBS work to alleviate symptoms. These include both prescription and over-the-counter antidiarrheal and laxatives to regulate bowel movements and antispasmodic drugs that reduce gas in the intestines that causes bloating, pain, or discomfort.
IBS medications
IBS medications fall into two classifications: over-the-counter and prescription. Over-the-counter medications include antidiarrheals such as Kaopectate or Pepto Bismol, gas relief medications such as Mylicone or Gas-X, and laxatives such as Dulcolax or Miralax.
For cases of IBS that don’t respond to OTC medications, your gastroenterologist or healthcare provider may prescribe a prescription-strength anti-diarrheal, antispasmodic, antidepressant, anticholinergic, pain medication for bloating and pain, or laxative depending on symptoms and your health history.
Over-the-counter antidiarrheals
Antidiarrheal medications such as Kaopectate or Pepto Bismol can help manage diarrhea by balancing the way your intestines move fluids and slowing down the digestive process. By coating the stomach, they can also help stunt the growth of bacteria and viruses in the gut that cause diarrhea. Side effects might include constipation, ringing in the ears, and blackening of tongue or stools.
Prescription antidiarrheals
Prescription antidiarrheals are designed to work by reducing muscle contractions and fluid secretions inside the intestines, help relax the colon and slow movement of stool through the bowels and increase rectal muscle tone. These include Lotronex (alosetron), Viberzi and loperamide. Side effects can include abdominal pain, nausea, or constipation.
Over-the-counter gas relief
OTC gas relief products such as Imodium work by slowing down digestive processes and allowing your body more time to absorb fluids and fully form stools. They can also have a positive effect on reducing diarrhea and controlling pain from bloating or gas. Some possible side effects of gas relief medications include nausea, dizziness, and constipation.
Prescription antibiotics
Some cases of IBS could be caused by a bacterial overgrowth inside of the gut that may cause diarrhea. A prescription antibiotic such as Xifaxan (rifaximin) may help regulate bacterial growth and rebalance the dietary tract. Side effects of prescription antibiotics could include nausea, bloating, constipation, or vomiting.
Prescription antidepressants
An effective strategy for combating the symptoms of IBS such as pain and diarrhea could be managing underlying depression and/or stress. The two options most commonly prescribed include:
Selective serotonin reuptake inhibitors (SSRIs): SSRIs are antidepressants such as Prozac (fluoxetine) or Paxil(paroxetine) that regulate depression and help with constipation or pain symptoms. All SSRIs come with a warning to watch for suicidal thoughts.
Tricyclic antidepressants: These antidepressants have been shown to inhibit the overactivity of neurons that affect the intestines and also help manage depression, pain or diarrhea symptoms. If pain and diarrhea are present without depression, your doctor may prescribe a tricyclic antidepressant such as imipramine or Norpramin (desipramine) at a lower dosage. Side effects can include drowsiness, dizziness, dry mouth, or blurred vision.
Over-the-counter laxatives
OTC laxatives such as Miralax and Dulcolax work differently in the body. They can soften stool either by adding fluids or helping your stool absorb more liquids, by lubricating the intestines to help ease bowel movements or by stimulating the bowel into having contractions to help pass stool.
OTC laxatives are a short-term solution for constipation caused by IBS and should be taken in low doses and in consultation with your doctor or pharmacist. Side effects can include cramping, diarrhea, nausea, or bloating and gas.
Prescription laxatives
Prescription laxatives such as Linzess (linaclotide) and Amitiza (lubiprostone) work by increasing fluid secretions inside of the small intestine and help stimulate bowel movements.
Prescription anticholinergic medications
Anticholinergic medications include Bentyl (dicyclomine) which can help relieve symptoms associated with pain from overactive bowel spasms caused by diarrhea.
Prescription pain medications
On occasion, your doctor may recommend a prescription pain medication that specifically targets pain or bloating caused by IBS. These include Lyrica (pregabalin) or Neurontin (gabapentin). Side effects could include nausea, constipation, or dizziness.
What is the best medication for IBS?
The best IBS medication for you depends on the severity of your case, medical history, type of IBS (IBS-D, IBS-C, or both) and interactions with other prescription medications. Consult your doctor or pharmacist for medication recommendations.
Dosage is determined by your doctor based on your medical condition, response to treatment, other medications, age, and weight. Other possible side effects exist. This is not a complete list.
What are common side effects of IBS medications?
Antidiarrheal medications and antispasmodics can cause belly pain or bloating, nausea, diarrhea, constipation, or gas. These medications can, but very rarely, result in fast heartbeat, severe constipation, fainting, or severe dizziness. Some side effects may be present at the beginning of treatment but then subside as use continues. As with all side effects, you should contact your gastroenterologist, doctor or pharmacist should they continue or get worse.
Antidepressants can cause dizziness, dry mouth, nausea, vomiting, trouble sleeping, sexual side effects, cramping, or pain. Very rarely they may cause severe changes in mood, irregular heart rhythm, anxiety, and rapid changes in blood pressure among other effects. If any of these occur, contact your medical professional immediately. This list is not exhaustive, so talk to a healthcare professional about possible side effects for your specific prescription.
What are the best natural remedies for IBS?
Many doctors recommend making lifestyle changes such as shifts in your diet and reducing stress in order to cope with the symptoms of irritable bowel syndrome and prevent or delay new episodes from recurring. Since IBS symptoms can vary widely from patient to patient, it’s important to experiment with what works best for you and always check with your doctor or healthcare provider for guidance.
Popular recommendations for changes in lifestyle and home remedies to help control and reduce symptoms of IBS include:
Incorporating more fiber into the diet
Whether you’re experiencing IBS-D, IBS-C, or some combination of the two, adding more fiber in your diet can help clear out the digestive tract or slow things down. Foods that are particularly high in fiber include fresh fruits and vegetables, whole grains, beans and nuts like almonds.
Reducing stress
Reducing stress can have a high impact on gut health and help reduce IBS symptoms. Practicing self-care, low-impact exercise, meditation, massage, and mindfulness are all great ways to help alleviate stress and help rebalance the symbiotic relationship between mind and body.
Low-FODMAP diet
Making substantial changes to one’s diet can be challenging, but it is often the first line of defense recommended by doctors. To that end, your doctor may suggest you follow a low-FODMAP diet. Low-FODMAP stands for low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are all sugar alcohols and short-chain carbohydrates that are difficult for your GI tract to process and absorb, which could be the cause of abdominal pain and bloating.
Alternative therapies
Peppermint oil:Some research has found positive results in incorporating peppermint oil, a natural antispasmodic, into a healthy diet to help control IBS symptoms. When taken in capsule form, peppermint oil supplements can be a short-term strategy for helping regulate pain and bloating symptoms for some IBS sufferers.
Acupuncture: Many IBS sufferers have been able to find relief from pain symptoms associated with IBS as well as stress by utilizing a regimen of acupuncture.
Cognitive behavioral therapy (CBT): A newer form of treatment that has gained popularity as a treatment for IBS is cognitive behavioral therapy or CBT. CBT is the practice of “rewiring” the brain to process information in new ways and it has been found to help reduce stress and alleviate depression in some IBS sufferers, which regulate symptoms and minimize pain.
Probiotics: Some researchers suspect some incidents of IBS are due to an overgrowth of bad bacteria in the gut, and taking probiotics may help restore balance to the GI tract and ward off gastrointestinal disorders.
Hypnosis: Though researchers are still working on determining the exact cause of IBS, one thing is clear about the digestive disease: it can often be triggered by psychological factors such as stress and depression. Some studies have found hypnotherapy quite effective in clearing up symptoms for a large number of sufferers. In fact, a 2012 study found that hypnotherapy not only can reduce symptoms and outbreaks, it can also help keep patients IBS-free for up to a year.
Frequently asked questions about IBS
Can IBS be cured?
Unfortunately, IBS is a chronic disorder without a known cure. The good news is that symptoms of irritable bowel syndrome can be managed by focusing on lowering stress and making changes to your diet. Anti-diarrheal medications or laxatives for diarrhea and constipation respectively can also help alleviate symptoms and get you feeling more regular again.
How long does it take for IBS to go away?
IBS is a chronic condition, so it can take months or years to resolve or it can be a lifelong condition. The symptoms of irritable bowel syndrome can last for 2-5 days during a flare-up before improving or clearing up.
Fiber-rich foods such as lentils, beans, peas, quinoa, and nuts
Cooked vegetables like carrots, avocados, beets, artichokes, etc. (You may want to avoid vegetables that can cause gas such as broccoli, cabbage, or cauliflower)
Fruits with peels and skins removed such as pears and apples
Foods that are low in fat
Dairy products are fine unless you are lactose intolerant
Foods that aren’t overly spicy
Meats prepared without adding fats (i.e., by steaming, grilling, baking, or broiling instead of sautéing or frying)
Low fat, high-protein or high-fiber snacks such as pretzels, yogurt, rice cakes, etc.
Can IBS make you tired?
Fatigue is a common symptom of IBS. Though researchers aren’t sure why the two conditions are linked, some speculate that it is due to lost nutrition to the body from chronic diarrhea. IBS is also commonly linked with other diseases such as chronic fatigue syndrome or mistaken for more serious conditions such as Crohn’s Disease, so if fatigue persists, it’s important to consult with your gastroenterologist or doctor.
Dr. Anis Rehman is an American Board of Internal Medicine (ABIM) certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism who practices in Illinois. He completed his residency at Cleveland Clinic Akron General and fellowship training at University of Cincinnati in Ohio. Dr. Rehman has several dozen research publications in reputable journals and conferences. He also enjoys traveling and landscape photography. Dr. Rehman frequently writes medical blogs for District Endocrine (districtendocrine.com) and hosts an endocrine YouTube channel, District Endocrine.
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