An Expert's Guide to Treating Irritable Bowel Syndrome

By

Brian E. Lacy, PhD, MD

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Once thought to be an uncommon disorder, health care providers now understand that irritable bowel syndrome (IBS) is a prevalent condition needing specific treatment options. This condition is a chronic bowel disorder associated with periodic symptoms of constipation, bloating, diarrhea, gas and abdominal pain. And while it can present serious quality of life issues for patients, we now have a variety of good therapeutic methods for treating and managing IBS. Gastroenterologist Brian Lacy, PhD, MD, shares the advice he gives his patients about living with IBS.

1. Q: Can IBS be cured?

A: At this point, we can’t cure IBS. However, we now have a much greater array of therapeutic options compared to 10 years ago. We are able to improve patients’ symptoms and their quality of life. One important point worth stressing is that there is no data showing that IBS ever evolves into something more serious, nor does it increase the risk of the patient developing other severe diseases. We know IBS can be frustrating, discouraging, and even debilitating, but the condition is not inherently dangerous and thankfully there are multiple ways to control it.

2. Q: What are the medication options for treating IBS with diarrhea-predominant symptoms?

A: There are a different set of medications used to treat IBS with diarrhea (IBS-D) than for IBS with constipation (IBS-C). Treatments for IBS-D include certain antibiotics, probiotics and oral drugs. Loperamide (Imodium) treats the symptoms of diarrhea by slowing down bowel movement; it also makes stool less watery. Probiotic supplements, which are capsules filled with live bacteria essential for your digestive system, can be hit or miss with patients, but we often add these to help the bowel function healthily and alleviate IBS symptoms. I often recommend an antibiotic called rifaximin (Xifaxin), an oral drug used to treat diarrhea by stopping diarrhea-causing bacteria from growing. A new medication for treating IBS-D is eluxadoline (Viberzi), which also treats abdominal pain. All of these medications are prescribed on a case-by-case basis depending on the severity and frequency of symptoms. You and your doctor should work together to find the right combination of medication for your IBS.

Other medications that may help abdominal pain in either IBS-C or IBS-D patients include smooth muscle anti-spasmodics, which relax the smooth muscle wall of the gut and are best used on an as-needed basis; we also may recommend peppermint oil or medications for neuropathic pain, like gabapentin (Neurontin, Horizant). Additionally, there are several kinds of antidepressants that, when given in low dosages, can ease abdominal pain. It is important to note that these agents are not approved specifically for IBS, but they are commonly and safely used for this purpose when prescribed by a physician.

3. Q: Is there a specific diet for easing IBS symptoms?

A: There are a number of diets suggested for the treatment of IBS, but there isn’t one specific diet that works for every patient. The most commonly recommended diet is called the low FODMAP diet. By minimizing foods that contain FODMAPs, the name for certain carbohydrate compounds linked to IBS symptoms, patients experience less distension in the intestine, less irregular bowel stimulation, and less fermentation in the gut. Patients with diarrhea should see improvement in their gas, bloating and in some cases abdominal pain. Foods high in FODMAPs include asparagus, onions, legumes, apples, pears, mangos, wheat, and dairy products. Foods low in FODMAPs include carrots, cucumbers, lettuce, tomatoes, bananas, oranges, grapes, and many gluten-free items. Although researchers and physicians are still studying this diet, we know that it is safe, reasonably easy to adopt (although best managed with a dietitian) and effective. However, it is not designed for long-term use; rather, this diet is designed to get you feeling better and in control of your IBS. Once symptoms improve, then foods that were eliminated from the diet can be slowly reintroduced. Talk to your doctor about how to begin this diet before starting.

4. Q: Is a gluten free diet effective for treating IBS?

A: Another diet commonly recommended is the low-gluten diet. Gluten is a sticky protein found in wheat, barley, rye, and sometimes oats. When following a low-gluten or gluten-free diet, patients will either avoid or completely eliminate products containing gluten, like bread, crackers, pasta, and cookies. Several well-designed studies have shown that this diet can improve IBS symptoms, especially for patients that experience frequent diarrhea. While not eveyrone responds well to a gluten-free diet, I’ve had many patients see their abdominal pain and bloating improve after cutting out gluten products. Even if you don’t have celiac disease, a disease characterized by extreme reactions to gluten, this diet can be effective in treating IBS patients that struggle with diarrhea.

5. Q: What lifestyle changes can help treat IBS?

A: There are several healthy lifestyle habits that can help lessen and ease IBS symptoms. IBS is often linked to stress, so finding ways to reduce stress certainly helps regulate bowel function. Exercise also improves symptoms to some degree. Getting enough sleep is another good way to keep your bowel functioning smoothly. Poor sleep can change your digestive system’s response to activity and patients may feel more of their gastrointestinal symptoms when sleep deprived. These three lifestyle changes, in combination with smart eating habits, should be an integral part of your treatment for IBS symptoms.



THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.


Dr. Brian Lacy

Brian E. Lacy, PhD, MD

Brian E. Lacy, PhD, MD, is a Professor of Medicine and Chief of the Section of Gastroenterology and Hepatology at the Dartmouth-Hitchcock Medical Center in Dartmouth, NH. He also authored a book called Making Sense of IBS. View his Healthgrades profile >

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