Medication Management: The Four Pillars of Gut Health

In keeping with my promise from my last post, we’re going to discuss the second pillar of gut health: medication management!

I like to say that, with every medication there is a reaction in the body - some that we want, and others not so enjoyable. Some medications can cause unwanted IBS-like symptoms (cramping, diarrhea, constipation, etc.), so it’s important to discuss with your doctor any side effects you’re experiencing and whether these effects will resolve over time. It may also be helpful to talk to a gastroenterologist to make a plan to manage your medications alongside your IBS symptoms.

The ultimate goal in treating IBS is alleviating your symptoms and giving you a better quality of life. To do this, medications can be a helpful ally in helping to manage your symptoms. Some general medications or supplements can help with IBS symptoms, while other medications are specifically used to treat IBS. It’s important to recognize that most medications used to reduce IBS symptoms are a band-aid solution, and determining the root cause of your symptoms should be the ultimate end goal for treatment.

As a registered dietitian working in conjunction with gastroenterologists, I believe that a ‘food first’ approach should be taken to symptom management, with strategic use of medications to optimize symptom management, where required – however – each case is individual. Talking with your health care team can help to determine an approach that is best for you.

General Medications/Supplements

• Bulking Agents: Fiber supplements may help with constipation by softening the stool, or with diarrhea by absorbing excess water in the colon. A well-known example is Metamucil (i.e. psyllium fiber).
• Stool Softeners: Increases the amount of water in the stool, making them softer and easier to pass.
• Laxatives: If fiber supplements do not alleviate symptoms, there are other types of laxatives that may help to regulate bowel movements; however, use should be discussed with your doctor. Talk to your doctor about which laxative is best for you.
  • Stimulant Laxatives: Help to eliminate stool by triggering the rhythmic contractions of the intestines (e.g. Senokot, Dulcolax).
  • Osmotic Laxatives: Draw water into the colon to allow easier passage of stool (e.g. lactulose, PEG).
  • Saline Laxatives: Used to relieve occasional constipation and administered rectally. For usual constipation, a milder product (e.g. stool softener, bulking agent) is often advised.
  • Rectal Suppositories: Trigger rhythmic contractions of intestinal muscles and soften the stool (often are glycerin-based).
• Motility agents: Also called prokinetic agents, these medications enhance the muscle activity in the digestive system by increasing the contractions of the small intestine. Common motility agents include maxeran, prucalopride, domperidone (motilium), and linaclotide. These medications typically require a prescription from a physician and are not without side effects. Use should be carefully discussed with your physician.
• Anti-diarrheal medication: Over-the-counter medications (such as Imodium) can help control diarrhea.
• Selective Serotonin Reuptake Inhibitors (SSRI): Low serotonin may cause visceral hypersensitivity, which is the experience of pain within the inner organs at a level that is more intense than normal. This is a hallmark sign of IBS. Taking an SSRI will increase reuptake of serotonin, which can improve symptoms of IBS.
• Anticholinergics/Antispasmodics: Inhibit intestinal smooth-muscle stimulation, which helps to relieve the symptoms of intestinal spasms and abdominal pain. Examples include Buscopan (hycosine) and Dicetel (pinaverium).

Medications Specific to IBS

• Peppermint oil: Enteric-coated (to allow the medicine to be delivered right to the intestines) peppermint oil capsules relax smooth muscles in the intestines. This helps to manage the symptoms of IBS and, if taken 30 minutes before a meal, can aid in the digestion of food.
• Constella (linaclotide): For individuals with constipation-predominant IBS (IBS-C), this medication increases the fluid pulled into the intestines, which helps to relieve constipation. It also decreases the activity of pain-sensing nerves in the intestine, which can help to alleviate abdominal pain associated with IBS.
• Resotran (prucalopride): A once-daily medication that stimulates intestinal muscle movement to relieve constipation. Initially, Resotran stimulates a bowel movement within 2-3 hours of ingestion; 4-5 days after starting regular treatment, spontaneous complete bowel movements typically begin to occur.
• Iberogast: An evidence based herbal supplement that can reduce many IBS symptoms including relief of intestinal spasms, pain relief in the digestive tract, improvement of digestive secretions, reduction of gas, and reduction of digestive inflammation.

This is not meant to be a comprehensive list of all medications and supplements that are used to manage IBS symptoms. For best results, talk to your doctor, gastroenterologist and dietitian to see what will work best for you and your symptoms.