Treatment For IBS

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After determining that other conditions are not mimicking irritable bowel syndrome (IBS) symptoms and the elimination of any possible triggers, recommended treatment for IBS includes gut-based strategies and centrally (brain-gut) based strategies. Gut-based strategies target the main digestive symptoms of IBS, such as diarrhea, constipation, bloating, gas, abdominal pain. Centrally based strategies act throughout the entire body, improving pain and well-being.1 Some of the gut-based and centrally based strategies can be made through lifestyle modifications by the patient. However, lifestyle modifications take time and often require a lot of trial and error in terms of figuring out what works for the patient. There is no single diet or lifestyle change that works for every person with IBS, as each patient is different and has unique challenges. In addition, there are a number of alternative and complementary treatment options that are often used by patients with IBS.

Determining Treatment for IBS

The treatment goal for IBS is the management of symptoms, and treatment strategy is determined by assessing two factors: the severity of symptoms and the dominant symptom. The severity of symptoms is determined by:

  • The intensity of the symptoms, how much they bother the patient
  • Whether or how much the patient is utilizing medication to manage the symptoms
  • The rate of absenteeism (missing school or work)
  • The frequency of doctor visits and other health care utilization
  • Any mood disorders the patient may have, such as depression, anxiety or bipolar disorder
  • The quality of life 1

The dominant symptom in IBS is generally in one of two categories: transit time, meaning the speed of which the digestion occurs, and perceptive symptoms, referring to those symptoms the patient reports feeling, such as abdominal pain or bloating. Transit time in IBS is either diarrhea (IBS with predominant diarrhea, IBS-D) or constipation (IBS with predominant constipation, IBS-C), or a patient may have a combination of both diarrhea and constipation (IBS-M for mixed bowel transit times).1

Gut-Based Strategies for Treating IBS

The first step in treating IBS is a combination of gut-based strategies to focus on managing the digestive symptoms. Gut-based strategies include:

  • Dietary modifications, including eliminating trigger foods and adding fiber
  • Laxatives, which work to soften stool and make it easier to pass
  • Antidiarrheal medication
  • Antispasmodic medication, which works to relieve the muscle spasms that may be causing diarrhea
  • Probiotics1

Centrally Based Strategies

Centrally based strategies work on the body as a whole, creating benefits that help with the management of IBS symptoms and improving overall well-being, and they are used in cases of moderate to severe symptoms. Centrally based strategies for IBS are antidepressants, antibiotics and probiotics.1
Both tricyclic and SSRI (selective serotonin reuptake inhibitors) antidepressants have demonstrated benefits in the treatment of IBS. Tricyclic antidepressants have the most studies to show effectiveness in treating IBS even at low doses. There are minor effects on mood at low doses, and the effects of the medications slow bowel transit and relieve spasms, which can be helpful in treating diarrhea. SSRI antidepressants are nearly as effective as tricyclics and produce more of a positive effect on mood and pain.1,2
Antibiotics are commonly used with bacterial overgrowth in the intestines if it is suspected, particularly with gas and bloating. Some studies also support the case for using probiotics, which provide the body with beneficial bacteria through a capsule or fermented food.1,2

Alternative and Complementary Therapies

Patients with IBS frequently seek out alternative and complementary therapies to manage their symptoms. There is research to support the effectiveness of therapies such as hypnotherapy, peppermint oil, and biofeedback. Patients also report symptom relief with the use of acupuncture.1,2

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