10-15% of Americans have IBS, or irritable bowel syndrome, which is a condition that affects the large intestine. Those living with IBS may experience cramping, abdominal pain, bloating, gas, and diarrhea or constipation, but only a small number of people will have severe symptoms. While IBS is a chronic condition that you will need to manage long term, some people can control their symptoms by managing diet, lifestyle and stress, while more severe symptoms can be treated with medication and counseling. Read more below to discover new ways of getting relief from some of your IBS symptoms.
What causes IBS?
While the exact cause of IBS isn’t known, there are a number of factors that seem to play a role.
- Muscle contractions : The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Contractions that are stronger and last longer than normal can cause gas, bloating and diarrhea. Weak intestinal contractions can slow food passage and lead to hard, dry stools.
- Nervous system abnormalities : Abnormalities in the nerves in your digestive system may cause you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive process, resulting in pain, diarrhea or constipation.
- Severe infections : IBS can develop after a severe infection that leads to diarrhea. IBS might also be associated with a surplus of bacteria in the intestines, also known as bacterial overgrowth.
- Early life stress : People exposed to stressful events, especially in childhood, tend to have more symptoms of IBS.
- Abnormal gut microbes : Gut microbes normally reside in the intestines and play a key role in health. Research indicates that the microbes in people with IBS might differ from those in healthy people.
What are the symptoms of IBS?
While the signs and symptoms of IBS may vary, they are usually present for a long time.
Among the most common are:
- Abdominal pain, cramping or bloating that is related to passing a bowel movement
- Changes in appearance of bowel movement
- Changes in how often you are having a bowel movement
- Increased gas
- Mucus in the stool
What are some common IBS triggers?
The two main triggers of IBS are stress and food. While the role of food allergy or intolerance in IBS isn't fully understood, many people experience worsening IBS symptoms when they eat or drink certain food and beverages, such as wheat, dairy products, citrus fruits, beans, cabbage, milk and carbonated drinks. Additionally, most people with IBS report worse or more-frequent flare-ups of symptoms during periods of increased stress.
How is IBS treated?
There is no one-size-fits-all treatment plan for IBS. Available treatments target the symptoms to provide relief. Your healthcare provider can help you decide on the most appropriate course of treatment.
Dietary changes It can help to work with a dietitian who can help you with certain diet changes. Foods commonly avoided by IBS patients include:
- High gas foods If you experience bloating or gas, you might avoid items such as carbonated and alcoholic beverages and certain foods that may lead to increased gas.
- Gluten Research shows that some people with IBS report improvement in diarrhea symptoms if they stop eating gluten (wheat, barley and rye) even if they don't have celiac disease.
- FODMAPs Some people are sensitive to certain carbohydrates such as fructose, fructans, lactose and others, known as FODMAPs — fermentable oligosaccharides, disaccharides, monosaccharides and polyols. FODMAPs are found in certain grains, vegetables, fruits and dairy products.
Lifestyle changes Some IBS patients benefit from seeing a therapist for cognitive behavioral therapy, stress management, or relaxation training. Acupuncture and gut-directed hypnotherapy have also shown some positive research results in treating IBS symptoms. You may also consider participating in regular physical exercise, cutting back on caffeinated beverages, or taking probiotics.
Medication Medication can be an important part of relieving symptoms in more severe cases, but there is no one medication that works for all IBS patients. Your doctor may prescribe the following:
- Fiber supplements Taking a supplement such as psyllium (Metamucil) with fluids may help control constipation.
- Laxatives If fiber doesn't help constipation, your doctor may recommend over-the-counter laxatives, such as magnesium hydroxide oral (Phillips' Milk of Magnesia) or polyethylene glycol (Miralax).
- Anti-diarrheal medications Over-the-counter medications, such as loperamide (Imodium A-D), can help control diarrhea. Your doctor might also prescribe a bile acid binder, such as cholestyramine (Prevalite), colestipol (Colestid) or colesevelam (Welchol). Bile acid binders can cause bloating.
- Anticholinergic medications Medications such as dicyclomine (Bentyl) can help relieve painful bowel spasms. They are sometimes prescribed for people who have bouts of diarrhea. These medications are generally safe but can cause constipation, dry mouth and blurred vision.
- Tricyclic antidepressants This type of medication can help relieve depression as well as inhibit the activity of neurons that control the intestines to help reduce pain. If you have diarrhea and abdominal pain without depression, your doctor may suggest a lower than normal dose of imipramine (Tofranil), desipramine (Norpramin) or nortriptyline (Pamelor). Side effects — which might be reduced if you take the medication at bedtime — can include drowsiness, blurred vision, dizziness and dry mouth.
- SSRI antidepressants Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may help if you are depressed and have pain and constipation.
- Pain medications Pregabalin (Lyrica) or gabapentin (Neurontin) might ease severe pain or bloating.
There are also a number of medications approved specifically for IBS. These include:
- Alosetron (Lotronex) Alosetron is designed to relax the colon and slow the movement of waste through the lower bowel. Alosetron can be prescribed only by doctors enrolled in a special program, is intended for severe cases of diarrhea-predominant IBS in women who haven't responded to other treatments, and isn't approved for use by men. It has been linked to rare but important side effects, so it should only be considered when other treatments aren't successful.
- Eluxadoline (Viberzi) Eluxadoline can ease diarrhea by reducing muscle contractions and fluid secretion in the intestine, and increasing muscle tone in the rectum. Side effects can include nausea, abdominal pain and mild constipation. Eluxadoline has also been associated with pancreatitis, which can be serious and more common in certain individuals.
- Rifaximin (Xifaxan) This antibiotic can decrease bacterial overgrowth and diarrhea.
- Lubiprostone (Amitiza) Lubiprostone can increase fluid secretion in your small intestine to help with the passage of stool. It's approved for women who have IBS with constipation, and is generally prescribed only for women with severe symptoms that haven't responded to other treatments.