Irritable bowel syndrome (IBS)

There are a number of different treatments and therapies for IBS. ​They are often combined to reduce the pain and other symptoms of IBS, and it may be necessary to try more than one combination to find the one that is ideal.

Treatment is usually a long-term process. During your treatment, it is important to communicate with your healthcare provider about symptoms, concerns, and any stressors or home/work/family problems that develop.

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Monitoring IBS symptoms

The first step in treating IBS is usually to monitor symptoms, daily habits, and any other factors that may affect gastrointestinal function. This can help to identify factors that worsen symptoms in some people with IBS, such as lactose or other food intolerances and stress. A daily diary can be helpful.

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Dietary changes

Try eliminating foods that may aggravate IBS, although this should be done with the assistance of a healthcare provider. Eliminating foods without assistance can potentially worsen symptoms or cause new problems if important food groups are omitted.

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Lactose

Many clinicians recommend temporarily eliminating milk products, since lactose intolerance is common and can aggravate IBS or cause symptoms similar to it. 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 containing these ingredients.

All lactose-containing products should be eliminated for two weeks, with a gradual reintroduction of these products depending upon symptoms. People who avoid lactose should take a calcium supplement that contains at least 1000 mg of calcium and 400 IU of vitamin D.

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Foods causing gas

Several foods are only partially digested in the small intestines. When they reach the colon (large intestine), further digestion takes place, which may cause gas and cramps. Eliminating these 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 patients have trouble with onions, celery, carrots, raisins, bananas, apricots, prunes, sprouts, and wheat.

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Increasing dietary fibre

People with IBS may find relief by consuming foods high in dietary fibre, especially those with constipation. You can determine the amount of fibre present in the product by reading its product information. It may also be helpful in people with diarrhoea, since it can improve the consistency of stools.

A bulk-forming fibre supplement (such as psyllium or methylcellulose) may be recommended to increase fibre intake, since it is difficult to consume enough fibre. It 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 commencing fibre therapy. However, fibre can make some patients with IBS more bloated and uncomfortable. If this happens, it is best to decrease fibre intake and consider other laxative treatments for constipation.

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Psychosocial therapies

Stress and anxiety can worsen IBS in some people. The best approach for reducing stress and anxiety depends on the individual and the severity of symptoms. You should have an open discussion with your clinician about the role that stress and anxiety is having on your symptoms, and decide upon the best course of action.

Some will benefit from formal counseling with or without antidepressant or anti-anxiety medications. Other treatments, such as hypnosis and cognitive behavioral therapy may also be helpful. Participation in a support group can also be valuable.

Many patients find that daily exercise is helpful in maintaining a sense of well-being. Exercise can also have favorable effects on bowel action as well.

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Medications

Although many drugs are available to treat the symptoms of IBS, they do not cure the condition. They are primarily used to relieve symptoms. The type of medication prescribed depends on whether a person has diarrhoea, constipation, or pain-predominant IBS. Furthermore, the effectiveness of drugs varies from one person to another. As a general rule, medications are reserved for people whose symptoms have not adequately responded to more conservative measures such as changes in diet and fiber supplements.