What can be done to improve Irritable Bowel Syndrome (IBS)?
By Olafur S. Palsson, Psy.D.

Last updated: July 27, 2015

Traditionally, physicians have had a great deal of difficulty coming up with adequate medical treatments for IBS. Until 1999, there were no medications specifically approved for IBS treatment. A wide variety of drugs was used to treat individual symptoms (such as pain or diarrhea) of this complex syndrome, and often proved to have limited effectiveness even on those symptoms. Overall, the response of the syndrome to medication interventions has been inconsistent and disappointing, leaving a substantial proportion of patients with little or no lasting relief.

However, the prospects of effective treatment with medication have been improving for more than a decade, as new classes of medications have emerged that seem to be able to address this disorder better. The past 15 years have seen the arrival of the first few medications approved specifically for IBS treatment, and more are likely to become available in the next few years. However, the beneficial impact of these IBS-approved drugs is limited so far by the fact that they are only approved for use with subsets of IBS patients (restricted by bowel symptom subtype and sometimes gender).

There are currently five medications specifically approved for IBS treatment, all of which can only be used to treat specific subsets of IBS patients:

  • Alosetron (Lotronex): For female IBS patients with treatment-refractory severe diarrhea. The drug slows the movement of stools through the intestines.
  • Lubiprostone (Amitiza): For constipation-predominant IBS (and also chronic constipation without IBS). This medication increases fluid secretion into the intestines, making it easier for stool to pass through the bowels.
  • Linaclotide (Linzess): For constipation-predominant IBS, makes bowel movements more frequent.
  • Xifaxan (Rifaximin): For IBS with diarrhea (IBS-D). This is an antibiotic medication thought to kill bacteria in the bowel that contribute to diarrhea, and it improves IBS-related diarrhea and also has some positive effect on abdominal pain.
  • Eluxadoline (Viberzi): For IBS with diarrhea (IBS-D). The medication lessens bowel contractions, and improves diarrhea and abdominal pain.

Due to the limited medication treatment options for IBS specifically (for example, no treatment for IBS-M, the largest sub-type of IBS!) physicians use a variety of other medications like anti-diarrheals, pain meds, and laxatives to treat individual IBS symptoms. Of other medications than those with specific approval for IBS, the ones with the most consistent effectiveness on IBS symptoms (Camilleri, 1999) are perhaps Loperamide (Imodium) and antidepressants (the latter help not only symptoms of depression in depressed IBS patients, but also seem to improve pain and diarrhea in some individuals who do not have significant depression).

Apart from medications, common methods used to attempt to control IBS include changes in diet, various alternative medicine methods, probiotics, and psychological approaches.

The most common symptom-inducing foods for IBS patients are spicy foods and food with high fat content. Often patients can get at least temporary relief by reducing the amount of such foods in their diet. However, such adjustments in diet rarely lead to lasting improvement in the condition. Increasing fiber in the diet, with fiber supplements of at least 12 g per day (Camilleri, 1999) helps many patients with constipation- predominent IBS.

Many IBS sufferers who have not had good luck with regular medical management of their symptoms try various home remedies and alternative medicine medicine regimens. Unfortunately, they often fall prey to unwarranted claims for symptom relief from anything from herbal and homeopathic medications to colon cleansing, spending a great deal of money and may possibly suffer harm from the effects of such therapies. Among alternatives to medication, only psychological treatments have sufficient research base to back up their use in IBS, although some other options like probiotics and enterically coated peppermint oil capsules also show promise.

Among psychological treatments tested for the disorder, hypnosis treatment has shown the highest success rate in replicated studies, with studies commonly showing an astounding 80% or more of the treated patients improving and improvement commonly lasting for at least a couple of years. The other effective psychological treatment for IBS is cognitive (or cognitive-behavioral) therapy, which has also been found efficacious for IBS symptoms in numerous studies. Brief psychodynamic psychotherapy has shown some success as well, but less research has been done on that form of IBS treatment to date than on hypnosis and cognitive-behavioral therapy.

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