Due to the cause of IBS being largely unknown, treatment focuses on relieving the symptoms in order to improve your lifestyle and ensure that your daily life can still be functional. In the majority of cases, the symptoms can be controlled through coping with stress and making the right changes in your lifestyle and diet. It is advised that you avoid the foods that tend to trigger symptoms of IBS, stick to a healthy exercise regime, drink the recommend amount of water (about two litres / half a gallon) a day and getting enough sleep (seven to eight hours a night).
Depending on the severity of your symptoms, treatment may need to include more than lifestyle changes, you may also be given certain medications.
The treatment for IBS can be explained as follows:
- Anti-diarrheal – There are a number of over-the-counter medication that can be used to treat diarrhoea. These include Loperamide (marketed as Imodium) – a well-known treatment for diarrhoea. Other medications that can be beneficial are known as bile acid binders, these include Prevalite, Colestid and Welchol. Please note that these often lead to being bloated – which can be very uncomfortable for most people.
- Fibre supplements – Psyllium or methylcellulose is a great fibre supplement which aids in the relief of constipation. When fibre is obtained through food, this may result in bloating whereas when it is obtained through supplements, it often results in far less bloating. If fibre supplements are not a strong enough treatment to improve bowel movements, you may be prescribed osmotic laxatives. These include polyethylene glycol or milk of magnesia.
- Antidepressants – If you are experiencing severe amounts of pain which can lead to depression (amongst other things), your doctor is likely to prescribe a SSRI (selective serotonin reuptake inhibitor) or a tricyclic antidepressant. These are known to aid in relieving the symptoms of depression and also inhibit the neuron activity that has control over the intestines.
- If you experience abdominal pain and diarrhoea and do not develop depression, your doctor might recommend a lower dosage of tricyclic antidepressants. These include Pamelor (nortriptyline), Elaval or Trepiline (amitriptyline) or Tofranil (imipramine). However, the side effects can include constipation and drowsiness, amongst others. Prozac or Sarafem (SSRIs) are often helpful if you experience depression as well as constipation and pain.
- Antispasmodic and anticholinergic medications – Levsin (hyoscyamine) and Bentyl (dicyclomine) are medications that aid in relieving the symptoms of bowel spasms that are painful. They can also be used for those with flare-ups of diarrhoea, however, they are known to worsen symptoms of constipation and often lead to a number of other symptoms, such as experiencing a difficulty when urinating. If you have glaucoma, these medications should be administered with caution.
- Counselling – This may be beneficial if you are stressed or depressed, which are known to make your symptoms worse.
- Antibiotics – The overgrowth of bacteria is often treated with antibiotics. Your doctor may suggest that you supplement these with probiotics to help preserve the ‘good’ intestinal flora.
IBS specific medication
There are two medications that have been approved for IBS specifically:
- Lubiprostone (Amitiza) – This works through increasing your secretion of fluid in the small intestine in order to aid in the passing of stools. This has been approved for women over the age of 18 that are suffering from IBS -C (IBS and constipation). The effectiveness and result in men has not yet been proven. The common side effects of this drug include diarrhoea, nausea and abdominal pain. It is normally prescribed to women who have severe constipation with IBS when other treatments have had no effect.
- Alosetron (Lotronex) – This was created to aid in relaxing the colon in order to slow down the lower bowel movement of waste. This can only be prescribed for those with severe diarrhoea. Like Lubiprostone, it is only approved for use in women and should only be prescribed when all other options have been exhausted.
There are also a number of dietary changes that can be made over and above medications. These include the following:
- Cutting out gluten – If you experience symptoms of diarrhoea with IBS, by stopping eating rye, wheat and barley (gluten foods), research has shown that symptoms can significantly improve.
- Cutting out fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) – This may sound made up, however, these are foods that invoke a reaction or sensitivity to certain types of carbohydrates such as lactose, fructans, and fructose – these are what are known as FODMAPs. These are typically found in certain vegetables, grains, dairy products and fruits. People do not normally react to every kind of FODMAP food. But symptom relief is often found through lowering your intake of these foods and then slowing reintroducing them.
- Cutting out foods with high-gas content – If you find that you are often bloated and seem to pass a large amount of gas, then your doctor may recommend that you eliminate fizzy drinks, and some vegetables such as cauliflower, cabbage and broccoli, as well as raw fruits.
Home remedies for IBS
In the majority of IBS cases, lifestyle and dietary changes are known to provide significant relief. These improvements are not always immediate but are often long-term solutions, whereas medication can often be temporary.
These changes include:
- Fibre experimentation – If you have IBS, fibre is known to be a blessing that is often mixed. It can help in the relief of constipation, however, it often makes bloating, cramping and gas worse. It is advised that slowly increasing your fibre intake over a certain number of weeks can help your body to react in a more comfortable way. Bean, vegetables, fruit and whole grains are known as high-fibre foods. It may be best to speak to a dietician for guidance in doing this in a healthy manner.
If you take fibre supplements, try to drink plenty of water in order to reduce constipation, bloating and gas.
- Avoid trigger foods – If you know of certain foods that tend to worsen your symptoms of IBS, it is best to avoid them completely. These are known to include:
- Fizzy drinks
- Non-nutritive sweeteners
If gas is one of your symptoms, try to avoid foods that make this worse. We mentioned them above, but for the sake of easy reading, these are:
It is also good to note that chewing gum and drinking liquids through a straw can result in swallowing air, which leads to bloating.
- Stick to regular eating times – Do not skip any meals and try to eat at the same time each day as this helps in regulating the function of your bowels. When experiencing diarrhoea, frequent and small meals may help. However, in the case of constipation, eating high-fibre foods and having meals in larger amounts helps in moving the food through the intestines with ease.
- Avoid or limit dairy products - In some more severe cases, dairy products may need to be cut out completely. If this is the case, then you may need to take vitamin B, calcium and protein supplements. However, in less severe cases, it can help to substitute milk or cream for yoghurt, eating dairy with other foods at the same time or taking an enzyme supplement to aid in the digestion and breakdown of lactose.
- Drink enough fluid – Water is the best fluid for your body. Avoid caffeinated beverages and alcohol as these stimulate the intestines and often make diarrhoea even worse. Fizzy drinks also create more gas.
- Adopt a healthy exercise regime – If you are experiencing stress or depression, exercise aids in stimulating the contraction of the intestines and through the release of endorphins, helping you to feel better. If you have any medical issues, it is best to consult with your doctor and a personal trainer or biokineticist beforehand.
- Be cautious when taking laxatives and anti-diarrheal medication – Try to use the lowest recommended dosage when taking over-the-counter medication or sticking to the prescribed dose when taking prescription medication. If you have any questions about these, it is best to speak to your doctor or pharmacist.