Irritable bowel syndrome treatment
The main treatment for irritable bowel syndrome (IBS) is making dietary and lifestyle modifications, including stress management, getting enough sleep and exercise.
Irritable bowel syndrome (IBS) is a common condition that causes abdominal pain, cramping or discomfort, diarrhoea, constipation and bloating. Irritable bowel syndrome is a chronic (ongoing) condition and there is no cure, but there are treatments available that can relieve the symptoms of IBS and you can try to avoid your personal triggers. Symptom-specific treatment for IBS includes products to alleviate diarrhoea, constipation and pain.
Diet for IBS
Developing a routine eating pattern that involves regular small meals is a good place to start. Make sure you eat a good variety of foods, and avoid excessive amounts of coffee or alcohol.
Avoiding any foods that you know aggravate your IBS symptoms is also a good idea. Some common foods that can cause problems for people with IBS include: beans, broccoli, cabbage, cauliflower, fats, spices, alcohol, caffeine and carbonated drinks.
If you are not sure which foods seem to trigger your symptoms, record what you eat and your symptoms for a week or 2, and discuss the results with your doctor. Don’t eliminate any major food groups from your diet without first discussing your dietary needs with your doctor or a dietitian.
Foods that are high in FODMAPs often cause problems for people with IBS. FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are a collection of types of carbohydrate, specifically sugars and sweeteners, that can be difficult to digest. Examples of these foods include:
- fruits such as apples, apricots, watermelon, mangoes and pears;
- vegetables such as garlic, lentils, mushrooms, onions, beans and cabbage;
- some dairy products (e.g. milk, yoghurt, ice cream);
- foods containing wheat or rye;
- foods containing high-fructose corn syrup; and
- certain artificial sweeteners.
Many people find that some of these foods aggravate their symptoms but not others. Your doctor may recommend seeing a dietitian to help determine whether a low-FODMAP diet may be of benefit.
Stool bulking with fibre (dietary or supplemental) may help relieve symptoms of constipation. However, fibre should be introduced gradually to minimise the side effects of abdominal gas and bloating.
Dietary changes that increase your fibre intake include eating wholemeal or wholegrain breads and cereals, and plenty of fresh fruits and vegetables.
If up to 30 grams of dietary fibre per day is not effective for relieving constipation, supplemental fibre, such as psyllium may be an option.
You should also increase your fluid intake and take regular exercise.
Foods (such as yoghurt) and supplements that contain probiotics – so-called ‘good’ bacteria that are normally found in your bowel – may help with some symptoms of IBS, including diarrhoea, pain and bloating.
Medicines for IBS
Medicines are available to treat the different symptoms of IBS, so your doctor will recommend treatment based on whether you have diarrhoea-predominant IBS (IBS-D) or constipation-predominant IBS (IBS-C).
Medicines for diarrhoea
Anti-diarrhoeal medicines are effective when taken ‘as-needed’ on an intermittent basis.
Anti-diarrhoeal medicines include:
- loperamide (brand names include Imodium, Gastro-Stop, Stop-It); and
- atropine plus diphenoxylate (e.g. Lomotil, Lofenoxal).
Side effects will depend on the type of medicine you take.
Medicines and supplements for constipation
If constipation is severe, increased fibre may be ineffective and may worsen abdominal pain and bloating. In this case your doctor may recommend laxatives.
Stimulant laxatives such as senna should generally be avoided, as should prolonged use of any laxative.
Some of the over-the-counter products available to relieve constipation include:
- psyllium (e.g. Metamucil);
- macrogol 3350 (e.g. Movicol, OsmoLax);
- frangula plus sterculia (Normacol Plus);
- lactulose (e.g. Actilax, Dulose, Duphalac);
- sorbitol (e.g. Sorbilax, Sorbisol);
- paraffin liquid (e.g. Agarol, Parachoc); and
- docusate (e.g. Coloxyl).
Some laxatives are not suitable for certain people. People with irritable bowel syndrome tend to find the side effects of lactulose and sorbitol (such as wind, bloating, cramping, diarrhoea) difficult to manage. Check with your doctor about the most appropriate type of laxative for you.
Medicines for pain and bloating
Medicines that relieve abdominal cramping should be used ‘as-needed’, rather than on a regular basis. These medicines may also be used preventively when pain is predicted, such as after large meals.
Prescription and over-the-counter products that help alleviate the pain associated with IBS include:
- peppermint oil (brand name Mintec);
- hyoscine butylbromide (e.g. Buscopan, Setacol);
- hyoscyamine plus hyoscine hydrobromide plus atropine (brand name Donnatab); and
- mebeverine (e.g. Colofac, Colese).
Some antidepressant medicines including tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), when taken in low doses, may be beneficial in reducing pain in people with IBS. In these situations the antidepressant medicines are being used for their pain-relieving properties rather than for their effect on mood.
Side effects will depend on the type of medicine you take.
Stress, anxiety and depression can trigger symptoms of IBS, so managing these problems can help.
There are several psychological therapies that can be used in the treatment of irritable bowel syndrome.
- Cognitive behavioural therapy (CBT) is a type of therapy that involves identifying and challenging negative thinking patterns and developing alternative ways of thinking and acting.
- Hypnotherapy is a technique where a therapist guides you to enter a relaxed state and to relax your abdominal muscles to help relieve pain and bloating.
- Relaxation therapy or meditation can help relieve stress.
- Counselling may be an important part of treatment for stress, depression or anxiety and related symptoms.
Getting regular physical activity can also help relieve stress and depression, and help restore normal contractions in your bowel.
2. MayoClinic. Irritable bowel syndrome (updated 31 Jul 2014). http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/con-20024578 (accessed Feb 2016).
3. Gastroenterological Society of Australia (GESA); Digestive Health Foundation (DHF). Information about irritable bowel syndrome (IBS); Third edition 2010. http://www.gesa.org.au/consumer.asp?id=16 (accessed Feb 2016).
4. Irritable bowel syndrome (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Nov. http://online.tg.org.au/complete/ (accessed Feb 2016).