There are many ways to treat IBS. We prefer more natural remedies such as a nutritional assessment and diet therapy, increasing probiotics, and practicing mindfulness. In fact, we always recommend starting here. However, modern medicine has developed prescription drugs that can help alleviate your IBS symptoms. Read below for more details
Lubiprostone (Amitiza) is prescribed only for patients with IBS with constipation (IBS-C) and has been found to improve symptoms of abdominal pain, stool consistency, straining, and constipation. It’s prescribed only when all other treatments have failed. Side effects may include nausea, diarrhea, and abdominal pain.
Alosetron (LOTRONEX) is intended for use only in women with severe cases of IBS-D who haven’t responded to other treatments. Because of its potentially severe side effects, including severe constipation and ischemic colitis, it can be prescribed only by physicians enrolled in the Prescribing Program for LOTRONEX, which requires them to sign an agreement acknowledging that they understand IBS-D and LOTRONEX’s possible side effects.
Tricyclic antidepressants (TCAs) (eg, amitriptyline [Elavil]) and selective serotonin reuptake inhibitors (SSRIs) (eg, sertraline [Zoloft]) have been shown effective in patients with all subtypes of IBS. It’s thought that TCAs may work best for IBS-D by reducing sensitivity to pain in the GI tract and normalizing GI motility and secretion. SSRIs, on the other hand, may be better suited to patients with IBS-C because of effects on colon transit. Side effects may include drowsiness and constipation.
Antibiotics such as rifaximin (Xifaxan), which stays in the gut without being reabsorbed, may benefit patients with IBS symptoms caused by SIBO. In studies using lactulose or glucose breath testing, SIBO was detected in up to 84% of patients who met the Rome criteria for IBS. Additionally, results from multiple clinical studies have shown that treatment with nonabsorbable antibiotics can reduce or eradicate SIBO and improve IBS symptoms, suggesting that SIBO may indeed play a role in IBS.
Antispasmodic medications such as dicyclomine (Bentyl), which belong to a class of medications called anticholinergics, sometimes are used to treat IBS. Although antispasmodics may be helpful for patients with IBS-D and may help alleviate painful bowel spasms, constipation is one possible side effect, so these drugs should be used only as needed in diarrhea-predominant IBS.
Over-the-Counter Medications and Supplements
Laxatives such as polyethylene glycol 3350 (MiraLAX) sometimes are used to treat IBS but aren’t recommended by the American College of Gastroenterology, as there are other treatments that may provide the same relief from constipation but with fewer potential side effects, such as nausea, abdominal cramping, and gas.
Fiber supplements may be recommended to relieve constipation when increasing dietary fiber is ineffective. Although wheat and corn bran haven’t been shown to be effective in treating IBS, positive results have been seen when adding psyllium, a soluble fiber supplement, to the diet.
Although more research is needed, some studies suggest that probiotic supplements, especially those predominantly containing Bifidobacterium infantis, help alleviate abdominal pain, bloating, and irregular bowel movements. Probiotics are microorganisms that supplement the GI tract’s natural bacteria, helping to balance intestinal flora.
Several mechanisms of probiotics’ beneficial effects on intestinal mucosa have been proposed, including suppression of the growth and binding of pathogenic bacteria, improvement of the epithelium’s barrier function, and alteration of the host’s immune activity.
In a review of 19 randomized controlled trials that included 1,650 patients with IBS, the authors found probiotics to be significantly better than placebo for addressing symptoms, although the magnitude of the benefits and the most effective species and strains were uncertain.
Regarding B infantis, a large-scale, multicenter clinical trial of women with IBS found significant improvement of symptoms, including abdominal pain, bloating, bowel dysfunction, incomplete evacuation, straining, and the passage of gas, with the probiotic vs. placebo.
Studies of patients seeking treatment for IBS have indicated that 50% to 90% of these individuals have a lifetime history or currently have one or more common psychiatric conditions, such as major depressive disorder, generalized anxiety disorder, panic disorder, social phobia, somatization disorder, and posttraumatic stress disorder.
As noted previously, TCAs such as amitriptyline have been shown to be effective for treating IBS, both via reducing sensitivity to pain in the GI tract and normalizing GI motility and secretion, and 13% of patients with IBS have reported using antidepressants. More and more patients, however, are seeking nondrug or mind/body treatments for IBS. Although the evidence is moderate, there are some lifestyle and psychological therapies that may benefit IBS patients. For patients with concurrent IBS and mental health problems, several therapies, such as talk therapy, hypnosis, and mindfulness training, may be beneficial.
One study that compared IBS patients who received various medication(s) alone with those that received medication plus cognitive behavioral therapy (CBT), a type of talk therapy, found that the patients receiving CBT and medication experienced greater resolution of IBS symptoms than did those who received medication alone.
Another study found that IBS patients receiving gut-directed hypnotherapy, a type of therapy that teaches patients hypnotic skills to control gut function, in conjunction with supportive talk therapy, significantly improved physical and psychological well-being vs. those patients who received supportive talk therapy alone.
In addition, patients have been able to successfully reduce IBS symptoms with mindfulness meditation. In one randomized controlled study, 75 women with IBS were randomly assigned to eight weekly and one half-day intensive sessions of either mindfulness training or a support group. training and at three months follow-up, than did those in the support group.