Irritable Bowel Syndrome medications & treatments
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Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder that affects the large intestine. This condition is estimated to occur in 5-10% of people across the globe and it affects children and adults of both genders. IBS most often occurs in people in their late teens to early 40s. Women are twice as likely as men to get IBS.
Although IBS can be embarrassing and frustrating, it can be managed so that it doesn’t have much effect on your quality of life.
What is IBS?
IBS is a disorder of the digestive system. It mainly affects the large intestine and can cause a wide range of symptoms from abdominal pain, diarrhea, constipation, bloating, and cramping. A very small number of people with IBS have serious signs and symptoms.
Experts are not sure what causes IBS but genetics may play some part. Emotional stress, anxiety, food intolerance, and severe GI tract infection may be other risk factors that play a role in developing IBS.
A very small number of people with IBS have serious signs and symptoms. Most people with IBS can control their symptoms with diet, stress management, probiotics, and medications.
How is IBS diagnosed?
Since there is no known definitive cause of IBS, there isn’t a specific test to determine if you have IBS. If you are having long-term or reoccurring GI tract symptoms, you should contact your doctor for an exam. You may be referred to a gastroenterologist.
To diagnose irritable bowel syndrome (IBS), doctors will review your symptoms and medical and family history and perform a physical exam. In some cases, doctors may order tests to rule out other health problems.
Blood tests, stool samples, X-rays, and a colonoscopy, among other tests, can help rule out other conditions like lactose intolerance, celiac disease, or inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis.
Your doctor will also look for signs and symptoms that might indicate another, more serious condition other than IBS. These symptoms include:
- Over 50 years of age when symptoms started
- Weight loss
- Rectal bleeding
Once you are diagnosed with symptoms of IBS, your doctor will categorize your IBS based on the type of bowel movement issues you have. The kind of IBS you have will determine your treatment. The 3 types of IBS include:
- IBS with constipation (IBS-C)
- IBS with diarrhea (IBS-D)
- IBS with mixed bowel habits (IBS-M)
What are some common IBS treatment options?
IBS treatment focuses on symptom relief during flare-ups. Most patients find relief from mild symptoms by reducing stress and making lifestyle and dietary changes, such as:
- Avoiding foods that worsen symptoms
- Exercise regularly
- Increase fiber in your diet
- Drink plenty of water
- Avoid caffeine and nicotine
- Good sleep routine
If these do not provide relief, your healthcare professional may suggest over-the-counter or prescription medications such as:
- Fiber supplements. Metamucil with plenty of fluid intake may help with constipation.
- Laxatives. If fiber doesn’t work, over-the-counter laxatives such as Miralax and Milk of Magnesia may be recommended. You may also be prescribed meds such as Linzess (linaclotide) and Amitiza (lubiprostone) to help stimulate bowel movements.
- Antidiarrheal meds. OTC options include Imodium A-D (loperamide) may help control diarrhea. Your doctor may also prescribe may include Viberzi (eluxadoline) and Lotronex (alosetron)
- Antidepressants. Treating the underlying stress and depression with selective serotonin reuptake inhibitors (SSRI) or tricyclic antidepressants (TCA) may help to relieve the symptoms of irritable bowel syndrome.
- Anticholinergics/antispasmodics. Medications such as Bentyl (dicyclomine) and Levsin (hyoscyamine) can help reduce spasms in the intestines and help relieve abdominal pain and discomfort.
- Pain medications. Neurontin (gabapentin) and Lyrica (pregabalin) are sometimes used to help relieve pain and severe bloating.
- Antibiotics. Xifaxan (rifaxamin) helps decrease the growth of bacteria in the digestive tract to decrease diarrhea.
What is the best medication for the treatment of IBS?
The best treatment of irritable bowel syndrome will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with IBS medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed FDA-approved IBS medications.
Best medications for IBS
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Lotronex (alosetron)||Antidiarrheal||Oral||0.5mg to 1mg once or twice daily.||Nausea, constipation, stomach pain|
|Viberzi (eluxadoline)||Antidiarrheal||Oral||75mg to 100mg twice daily with food.||Bloating, gas, stomach pain, constipation|
|Xifaxan (rifaximin)||Antibiotic||Oral||550mg three times a day for 2 weeks.||Nausea, vomiting, constipation, swelling|
|Linzess (linaclotide)||Laxative||Oral||72mcg to 290mcg once daily.||Diarrhea, bloating, dizziness, gas, stomach pain|
|Amitiza (lubiprostone)||Laxative||Oral||8mcg to 24mcg twice daily.||Nausea, diarrhea, headache, stomach pain, gas|
|Bentyl (dicyclomine)||Anticholinergic||Oral||10mg to 20mg up to 4 times daily.||Dry mouth, dizziness, blurred vision, nausea|
|Prozac (fluoxetine)||SSRI||Oral||20mg once daily.||Insomnia, headache, dizziness, diarrhea|
|Pamelor (nortriptyline)||Tricyclic antidepressant||Oral||10mg at bedtime. May be increased to over 30mg if needed.||Nausea, drowsiness, dry mouth, vivid dreams, anxiety|
Your healthcare provider will determine the dosage which is right for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist and this is not a complete list.
What are the most common side effects of IBS medications?
The side effects will vary by the class of medication you are prescribed. The most common side effects of antidiarrheals, anticholinergics, and laxatives can include nausea, stomach pain, constipation, bloating, and diarrhea.
Antidepressants’ side effects may include nausea, headache, dizziness, dry mouth, loss of sex drive, and insomnia.
Some of these side effects will occur when starting these medications and go away after a short period of use. If they are persistent or severe, please contact your healthcare professional immediately.
What are some home remedies for IBS?
The most effective home remedies will include lifestyle changes and stress reduction to help reduce the frequency of flare-ups.
Your doctor or dietitian may recommend one or more of the following diet changes:
- Increasing your fiber intake as tolerated.
- Low FODMAP diet. These are found in grains, vegetables, fruits, and dairy products and can cause problems for people who are sensitive to them.
- Avoid gluten.
They may also suggest some alternative therapies such as:
- Hypnotherapy. Hypnosis may reduce stress and be helpful with stomach pain and bloating. Studies support the long-term effectiveness of hypnosis for IBS.
- Peppermint oil. Studies have shown some benefits, especially in patients with IBS-D symptoms.
- Probiotics. By putting more “good” bacteria back into your gut, it may help with stomach pain, bloating, and diarrhea.
- Cognitive-behavioral therapy (CBT). As with hypnotherapy, reducing stress may help alleviate some symptoms of IBS.
Frequently asked questions about IBS
How common is IBS?
IBS is very common and affects up to 10% of the worldwide population.
How serious is IBS?
While IBS is not a fatal illness, it is a long-term, but manageable condition. Over time, the symptoms of IBS typically do not get worse, and with an effective treatment plan, as many as one-third of IBS patients may eventually become symptom-free.
Do certain foods cause IBS symptoms?
This will vary from person to person but a few common foods that may worsen IBS symptoms include gluten, dairy products, fried foods, beans, legumes, caffeinated drinks, and alcohol.
RELATED: What foods to avoid with IBS
Does IBS lead to other more serious diseases or complications?
While IBS can cause pain and stress, it does not cause any permanent damage to the bowel or lead to cancer or any other major illness.
Related resources for IBS
- Irritable bowel syndrome overview. MayoClinic.org
- Irritable bowel syndrome symptoms and causes. ClevelandClinic.org
- Diagnosis of Irritable Bowel Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases
- What is IBS? aboutibs.org
- Top IBS Questions: Answered! Canadian Digestive Health Foundation