Irritable Bowel Syndrome Management

The first step in treating IBS is usually to monitor your symptoms, daily bowel habits, and any other factors that may affect your bowels. This can help to identify things that worsen symptoms in some people with IBS, such as lactose, other food intolerances, or stress. Keep track of what you ate, what you did, and how you felt each day.

It is reasonable to try avoiding or limiting foods that may aggravate IBS, although it’s best to talk to your doctor before you make significant changes to your diet. Eliminating foods without assistance can potentially worsen symptoms or cause new problems if you aren’t getting the nutrients you need.

Many clinicians recommend temporarily eliminating milk products, since lactose intolerance is common and can aggravate IBS or cause symptoms similar to IBS. The greatest concentration of lactose is found in milk and ice cream, although it is present in smaller quantities in yogurt, cottage and other cheeses, and any prepared foods that contain these ingredients

If your doctor suggests eliminating lactose, you should avoid all lactose-containing products for two weeks. If IBS symptoms improve, it is reasonable to continue avoiding lactose. If symptoms do not improve, you may resume eating lactose-containing foods. 

Many foods are only partially digested in the small intestines. When they reach the large intestine (colon), further digestion takes place, which may cause gas and cramps. Eliminating certain foods temporarily is reasonable if gas or bloating is bothersome.

The most common gas-producing foods are legumes (such as beans) and cruciferous vegetables (such as cabbage, Brussels sprouts, cauliflower, and broccoli). In addition, some people have trouble with onions, celery, carrots, raisins, bananas, apricots, prunes, sprouts, and wheat.

Increasing dietary soluble fibre (either by adding certain foods to the diet or using fibre supplements) may relieve symptoms of IBS, particularly if you have constipation . By reading the product information panel on the side of the package, you can determine the number of grams of fibre per serving. Fibre may also be helpful in some people with diarrhea-predominant symptoms since it can improve the consistency of stools.

A fibre supplement may also be recommended to increase fibre intake since it is difficult to consume enough fibre through diet alone. Fibre supplements should be started at a low dose and increased slowly over several weeks to reduce the symptoms of excessive intestinal gas, which can occur in some people when they first start taking supplements.

Fibre can make some people with IBS more bloated and uncomfortable. If this happens, it is best to decrease fibre intake and consider other laxative treatments for constipation.

Stress and anxiety can worsen IBS in some people. The best approach for reducing stress and anxiety depends upon your situation and the severity of your symptoms. Have an open discussion with your healthcare provider about the possible role that stress and anxiety could be having on your symptoms, and together decide upon the best course of action.

• Some people benefit from formal counseling, with or without antidepressant or antianxiety medications. Other treatments, such as cognitive behavioural therapy, may also be helpful. Cognitive behavioural therapy helps you to focus on a particular problem in a limited time period. You learn how your thoughts contribute to anxiety or stress and learn how to change these thoughts.
• Participation in a support group can also be valuable.
• Many people find that physical activity is helpful in maintaining a sense of well-being. Regular exercise can also have favorable effects on the bowels.

IBS is a chronic, life-long condition. Although medications cannot cure IBS, they can help relieve symptoms. The choice among these medications depends in part upon whether your primary symptom is diarrhea, constipation, or pain. 

In general, medications are recommended for people whose symptoms have not adequately responded to more conservative measures such as changes in diet and fibre supplements. If you do need medication, your health care provider will work with you to figure out the right approach for your situation.

These medications block the nervous system’s stimulation of the gastrointestinal tract, helping to reduce severe cramping and irregular contractions of the colon. These medications may be particularly helpful when taken preventively (before you have symptoms) and thus are most helpful if you know what triggers your symptoms and predict when they are most likely to happen. Common side effects include dry mouth and eyes and blurred vision.

While primarily used to treat depression, many medications called “tricyclic agents” (TCAs) have a pain-relieving effect in people with IBS. The dose of TCAs is typically much lower than that used for treating depression. It is believed that these medications reduce pain perception when used in low doses, although the exact mechanism of their benefit is unknown.

TCAs commonly used for pain management include Amitriptyline, imipramine, and Nortriptyline. It is common to experience fatigue when starting a TCA; this is not always an undesirable side effect, since it can help improve sleep when TCAs are taken in the evening. TCAs are generally started in low doses and increased gradually. Their full effect may not be seen for three to four weeks.

TCAs also slow movement of contents through the gastrointestinal tract and may be most helpful in people with diarrhea-predominant IBS.

Another class of antidepressants, called “selective serotonin reuptake inhibitors” (SSRIs), may be recommended if you have both IBS and depression. Common SSRIs include Fluoxetine, Sertraline, Paroxetine, Citalopram  and  Escitalopram.

Other antidepressant medications that may be recommended include Mirtazapine, Venlafaxine and Duloxetine.

 A number of herbal and natural therapies have been advertised (especially on the internet) for the treatment of IBS. Unfortunately, there is no evidence supporting their benefit. Although small studies may support some of these therapies, the studies are either too small or have major flaws that make definitive conclusions impossible.

Below are some of the herbal remedies you may have heard about for treating IBS:

Unproven – There is increasing interest in the possible beneficial effects of “healthy” bacteria (probiotics such as acidophilus) in a variety of intestinal diseases, including IBS. Whether supplements containing these bacteria are of any benefit is unproven.

Chamomile tea is of unproven benefit in treating IBS. Furthermore, chamomile can aggravate allergies in people who tend to be allergic to grasses.

Evening primrose oil (a supplement containing gamma linolenic acid) and fennel seeds are also of unproven benefit.

Potentially unsafe – Wormwood is of unproven benefit and may be unsafe; wormwood oil can cause damage to the nervous system. Comfrey is also of unproven benefit and can cause serious liver problems. Iberogast is an herbal product containing nine extracts from medicinal plants . Although thought to be effective in some cases of IBS, cases of acute liver failure have been reported.