How is IBS treated?
Treatment of IBS varies from person to person and from case to case. Treatments include—where appropriate—changes in lifestyle, exercise, and eating regular meals. Changes in diet may be helpful, such as increasing fiber in those with constipation, and eliminating trigger foods, such as fructose and non-absorbable sugars (i.e. the FODMAP diet), which can cause diarrhea and bloating. Over-the-counter medications are sometimes used to decrease diarrhea (e.g., loperamide) or improve constipation (e.g., soluble or insoluble fiber or laxatives).
Antispasmodics can help with pain—these are generally anticholinergic drugs. Narcotics should never be used, secondary to their propensity to decrease bowel motility. For some patients with severe and refractory symptoms, especially pain, low-dose tricyclic antidepressants can be very effective. Probiotics have been helpful for some, though studies on probiotics in the setting of IBS are limited. In certain trials, benefits have also been seen with hypnotherapy, acupuncture, and psychotherapy. There are new prescription medications for those with severe diarrhea (e.g., alosetron) and those with severe constipation (e.g., lubiprostone, linaclotide).
Most persons with IBS have symptoms that vary over time and may improve, worsen, or remain stable. In one systematic review, symptoms remained the same in most (30-50%) or worsened (2-28%). An alternate gastrointestinal disorder was diagnosed in only 5% of cases.