Irritable bowel syndrome treatment
The first priority in the treatment of irritable bowel syndrome should be to make lifestyle and diet modifications, including stress management and exercise. Avoiding fatty foods and caffeine may also help. However, pharmacies sell some over-the-counter treatments for more troublesome symptoms. Symptom-specific treatment includes products to alleviate diarrhoea, constipation and pain.
Diarrhoea-predominant symptoms
Anti-diarrhoeal drugs such as loperamide (e.g. Imodium) and atropine plus diphenoxylate (e.g. Lomotil) are effective when taken ‘as-needed’. Stool bulking with fibre (dietary or supplemental) may also be worthwhile. However, fibre should be introduced gradually to minimise the side effects of abdominal gas and bloating.
Constipation-predominant symptoms
The first step in the treatment of constipation-predominant symptoms should be through dietary changes, including daily consumption of a high-fibre cereal, high-fibre breads and plenty of fresh fruits and vegetables. You should also increase your fluid intake and take regular exercise. If up to 30 grams of dietary fibre per day is not effective, you should try supplemental fibre, such as psyllium.
If constipation is severe, increased fibre may be ineffective and may worsen abdominal pain and bloating. In this case you should take osmotic laxatives or, in more resistant cases, a stool-softener such as docusate, with or without enemas. Stimulant laxatives such as senna should generally be avoided, as should prolonged use of any laxative.
Tegaserod (Zelmac) is a prescription medication that became available in Australia in January 2002 for the treatment of constipation in irritable bowel syndrome in women. It stimulates the bowel to help move faeces along. In April 2007, however, Zelmac was withdrawn from use due to clinical trial data that showed a higher incidence of cardiovascular ischaemic events (such as heart attack, angina and stroke) in patients taking Zelmac compared with those taking placebo (dummy drug). Patients taking Zelmac should see their doctor to discuss alternative treatment.
Psyllium (e.g. Metamucil), frangula with sterculia (Normacol Plus), lactulose (e.g. Actilax), sorbitol (Sorbilax) and docusate (e.g. Coloxyl) are some of the over-the-counter products available to relieve constipation. However, people with irritable bowel syndrome tend to find the side effects of lactulose and sorbitol difficult to manage.
Pain-predominant symptoms
Medications that relieve abdominal cramping should be used ‘as-needed’, rather than on a regular basis. These medications 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 (e.g. Mintec), hyoscine butylbromide (e.g. Buscopan), hyoscyamine (Donnatab) and mebeverine (e.g. Colofac).
Antidepressants
Some antidepressant medications, including low doses of tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), may be beneficial in people with IBS-associated anxiety or depression. Successful treatment of depression and anxiety may lead to resolution of abdominal symptoms.
Last Reviewed: 05 April 2007
