How IBS is Treated
It can be dejecting to hear that there is no way of ‘curing’ IBS, but that does not mean that symptoms cannot be minimised and managed. IBS is the most common gastrointestinal issue and, although it be quite distressing and uncomfortable at times, many people with the condition learn to manage their symptoms and lead highly productive, meaningful lives. There are several different approaches to treating IBS and it can take some time to figure out which combination of strategies works best for you. This is where your relationship with your healthcare team (which may include GP, gastroenterologist, psychologist and or dietitian) can help significantly. See below for a summary of common treatment strategies
Developing a unique treatment plan
The triggers and resultant symptoms of your IBS might be different from that of someone else. There are many good starting points when it comes to potential IBS triggers (e.g., caffeine, fatty foods), but ultimately you will need to work with your healthcare team to develop an understanding of your own unique triggers and symptoms.
Modifying the diet is one of the main approaches to reducing IBS symptoms. Dietary management involves a process of monitoring symptoms in response to the foods and drinks that constitute your diet and identifying potential triggers for IBS symptoms. Reducing your intake of fatty or fried foods, caffeine, alcohol, hot/spicy foods/drinks is a good place to start. Finding your triggers can be an involved process and it is important to ensure that you are still eating a diet contains the right balance of macronutrients and are avoiding potential nutritional deficiencies. A dietitian is an excellent source of knowledge and advice in this area. It can difficult to keep track of your food/drink intake, especially when dealing with IBS symptoms and other work, study or home life obligations. Using a food diary can help here by making it easier to identify patterns between potential trigger foods and episodes of IBS symptoms.
Some people with IBS may find it beneficial to follow a low FODMAP diet. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) are short-chain carbohydrates that can cause several gastrointestinal symptoms such as gas, bloating, diarrhoea, constipation, and abdominal pain. Consuming FODMAPs can exacerbate IBS symptoms. Some examples of high FODMAP foods:
A low FODMAP diet can lead to significant improvements for most people with IBS. Reducing FODMAP intake can be challenging and guidance from a dietitian can help ease this process and reduce common barriers/issues. There is a massive volume of material on the internet relating to potential IBS ‘cures’ involving diet change. It is important to treat this type of information with a healthy dose of scepticism. If you are unsure about the credibility or accuracy of information, raise this with your healthcare team. If you would like more information about the low FODMAP diet, visit https://www.monashfodmap.com for one of the most comprehensive FODMAP resources available online.
There are several types of medications available to treat IBS. Medication-based treatments are largely aimed at treating symptoms when they occur (e.g., diarrhoea, constipation). Newer drugs are emerging that aim to prevent symptoms through changes in gut motility (i.e., prokinetic drugs), ormodulating the communication in the neural pathwaysbetween the gut and the central nervous system. Most of these drugs are still going through the regulatory process in Australia and it can take some time to establish whether a given drug is safe and effective. Information about clinical trials and the approval status of drugs can be found at the Therapeutic Drugs Administration website: https://www.tga.gov.au/
Diarrhoea is problematic symptom for those with diarrhoea-predominant or mixed bowel habits IBS. Common treatments to reduce diarrhoea include Loperamide (commonly sold as Imodium) or a combination drug ofAtropine sulfate monohydrate and Diphenoxylate hydrochloride (commonly sold as Lomotil). It can be useful to keep these drugs on hand to minimise the disruption and inconvenience of urgent and/or frequent trips to the toilet. These drugs work by reducing bowel contractions, allowing stool to absorb more water and become more solid, reducing the urgency and frequency of bowel motions.
Ensuring adequate intake of fibre and fluids can reduce instances of constipation for those with constipation-predominant or mixed bowel habit IBS. Nonetheless, constipation can still occur, and laxative drugs can provide much needed relief. Laxatives come in several different varieties, each with their own mechanism of action (e.g., stimulant-based laxative, osmotics, emollients). Some types, e.g., stimulant-based laxatives, are not recommended for long-term use. Your doctor can recommend a good starting point and help you find the right type and dosage, ensuring you get the best benefit with the least likelihood of unwanted side effects (e.g., abdominal cramping, diarrhoea, nausea).
Pain is one of the most common complaints in IBS. One strategy for reducing abdominal pain is to take antispasmodic medications. These work by relaxing the smooth muscle of the intestinal tract, preventing pain-causing spasms. Commonly used antispasmodics include anticholinergics (e.g., hyoscine butylbromide; commonly sold as Buscopan), mebeverine –commonly sold as Colofac, and peppermint oil, an over-the-counter supplement. Codeine-based medications can provide pain-relief and act as an antidiarrheal, however, these should be used cautiously as they can cause constipation and have a dependence risk with long-term use. Research has also found that probiotic supplements based on bifidobacteria may reduce pain in IBS.
Small intestine bacterial overgrowth (SIBO) occurs in some people with IBS and this can exacerbate symptoms such as pain and bloating (i.e., due to bacterial fermentation producing gases). Antibiotics such as rifaximin can help with this by reducing the bacterial concentration in the gut.Tricyclic antidepressants (TCAs) such asamitriptyline, commonly sold as Endep, can also be used to reduce abdominal pain associated with IBS. Although these drugs were originally intended to treat mood disorders, they can be administered in a low dose (i.e., below the dose needed for antidepressant effects) to reduce IBS pain. The combination herbal preparation Iberogast has also been shown to improve symptoms in some patients.
Some physiotherapists have specialised training in incontinence management and pelvic floor issues. These specialists can help patients develop better control of their bowel function (e.g., ‘holding in’ a bowel motion, incomplete bowel evacuation).
Research tells us that the brain and digestive tract share a unique reciprocal relationship. Our thoughts and feelings can modulate the way in which we experience sensations in the gut and, conversely, our mental states can affect the ways in which our digestive tract functions (e.g., motility, intestinal permeability, secretion). Symptoms of psychological distress such as depression and anxiety are common in IBS and, aside from the obvious impact on quality of life, can exacerbate IBS symptoms. High-quality meta-analytic research has shown how psychological therapies (e.g., cognitive behavioural therapy, hypnotherapy) can improve IBS symptoms significantly. Some people can be hesitant to get help from a mental health professional due to fear of stigmatisation or the belief that their issues do not warrant psychological assistance. Even if you think there is nothing ‘wrong’ psychologically speaking, psychological therapy can have a profound impact on the way you live with your IBS by coaching you in valuable, evidence-based techniques to maximise your well-being. Your doctor can arrange psychological consultation if requested.
Complementary treatments for IBS are plentiful. It is not uncommon for people with IBS to search for relief in these treatments. There is some evidence that herbal treatments can improve IBS symptoms but research in this area is very limited. Complementary therapies can be compatible with more ‘traditional’ approaches such as medicines and dietary modification. Nonetheless, it is important to discuss your use of alternative or complementary medicines with your doctor, as some herbal supplements can still interact with other medications you are taking. Some people may be hesitant to discuss these with their doctor, due to the perception that they will dismiss any ‘non-standard’ treatment out of hand. Many doctors understand that there is value in allowing patients to explore complementary medicine and that some treatments can provide relief. The mechanisms behind many complementary medicines remains poorly understood, however this does not mean that they are necessarily ineffective. As with dietary advice, remember to approach information you find on the internet with caution and a sceptical mind. Your doctor can also provide you with a medical perspective on any treatments/information you encounter.