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How IBS is Treated

Although IBS cannot be cured there are several treatment approaches which, particularly when used in combination, can be beneficial in reducing the severity and frequency of symptoms and improving quality of life. A variety of treatment approaches exist, and a good relationship with your doctor is important to work through these to find the best treatment plan tailored to benefit you. Specialist care by a gastroenterologist in conjunction with your local doctor can be helpful.

Before embarking on treatment, it is critical that a thorough medical assessment is undertaken to exclude other medical conditions. These conditions may cause similar symptoms but will have completely different treatments. For instance, in the young person it is important to exclude coeliac disease and inflammatory bowel disease. In the elderly person it is also important to exclude bowel cancer.

Ways to Manage IBS:

  • Management Strategies

    Management Strategies

    Management strategies need to be individualised and are largely determined by the predominant symptoms a person is suffering. Working with your doctor to identify triggers for symptoms is important, so that you can be in control of your symptoms rather than have them control your life, and to give you strategies to deal with any symptoms that do occur. While some approaches work better than others, this can be highly variable, so you need to be willing to work with your doctor to find the best approach that benefits you the most.

  • Dietary Changes

    Dietary Changes

    Initial management of IBS is often focused on changing the diet and looking for possible symptom triggers. A regular eating routine is important, and ensuring that the diet contains a sensible balance of carbohydrates, fats and protein. Excessive foods high in fat, caffeine, alcohol, spices and sudden changes in dietary routine should be avoided. A gentle increase in dietary fibre (e.g. soluble fibre) such as psyllium, ispaghula and oats may well be appropriate, however excessive amounts can sometimes worsen symptoms such as bloating and flatulence.

    A widespread group of carbohydrates in food called “FODMAPs” (Fermentable Oligosaccharidases, Disaccharidases, Monosaccharides And Polyols) are very common triggers for IBS. FODMAPs may not be well digested and absorbed by some people. Leading to fermentation of the sugars by bacteria in the bowel, with gas production and fluid build-up. This in turn triggers the typical symptoms of IBS such as bloating, pain and altered bowel habits. These effects are exaggerated in IBS patients who have hypersensitive pain pathways. A low FODMAP diet can be very beneficial in these cases. Excess fructose is present in apples, pears, watermelons, mangoes, fruit juice, dried fruit and honey. Vegetables high in FODMAPs include onions, garlic, leeks and green beans, and some wheat products. Some diet soft drinks and sugar-free confectionary may contain sorbitol or mannitol (two unabsorbed sugars) and should be avoided, as should milk products in people with lactose intolerance. Given the complexity of the diet, guidance by a specialist dietitian is recommended. This diet can lead to a significant reduction of symptoms in approximately 75% of patients with IBS. Once symptom control is achieved, dietary restrictions can be relaxed over time. Many IBS patients improve on a low wheat diet although this effect is probably due to the reduced fructan content and not the gluten content as some people assume.

    Other food chemicals such as salicylates, amines, and glutamate have been proposed as triggers of IBS-like symptoms although high quality evidence is lacking. Keeping a food diary and recording symptoms may help dietitians identify a common trigger. Strict elimination diets are generally not recommended unless undertaken with the support of a dietitian as they can be overly restrictive.

  • Pharmacological Therapies

    Pharmacological Therapies

    The type of pharmacological therapy depends on the predominant symptom – pain, diarrhoea, or constipation. The drugs typically help control the severity of the symptoms but do not reverse or “cure” them. Drugs are being developed that selectively target the underlying problem with the gut nervous system (for instance, by acting on the serotonin pathways controlling how fast or slow the gut moves, and how it “experiences” pain). Hopefully these new agents will be more effective at managing the problems of pain, diarrhoea, and constipation, but drug development and testing takes many years to be sure that the drugs are safe and effective.

    Pain

    Typical pain relieving medication such as paracetamol is generally ineffective for pain from IBS. Stronger agents such as codeine and morphine should be avoided as they can end up worsening abdominal discomfort, and exacerbating constipation.

    Anti-spasmodic agents can be of benefit – particularly for troubling symptoms in the short term. These include Buscopan, colofac and Peppermint oil which may help relieve some of the uncomfortable bloating in IBS. Antibiotics may be useful in the subset of patients with IBS and bacterial overgrowth, which can be assessed using special breath tests. Probiotics may “re-balance” the bacterial populations in the bowel essential for normal gut function, and there is some evidence certain varieties can be helpful in IBS.

    A European herbal preparation made up of various active ingredients (Iberogast) appears to be of benefit for some patients. As the brain and gut share chemicals, tricyclic antidepressants such as Endep may have beneficial effects on the gut nervous system. Although these drugs have antidepressant properties at high doses, the lower doses used for IBS symptoms do not have antidepressant effects, but do have beneficial effects in calming the gut and pain relieving actions. As with all medications they can have side effects and should be started at a very low dose, which is increased slowly to see how much benefit you can obtain.

    If your doctor believes that anxiety and/or depression are major factors in your symptoms, you will probably be prescribed one of the more recent classes of antidepressant, which have less in the way of side effects at doses that have beneficial effects on depression.

    Diarrhoea

    Anti-diarrhoeal medication such as loperamide (e.g. Imodium or GastroStop) can limit excessive diarrhoea, and may be especially useful in situations when access to a toilet may be unpredictable, such as during travel. If the diarrhoea occurs in the morning, taking loperamide at night may be useful. Sometimes cholestyramine, a drug used to bind bile salts in the bowel which can trigger diarrhoea, can be helpful.

    Constipation

    Laxatives can be useful when adequate fibre (dietary and/or supplements) and sufficient fluid intake does not help. Varieties are available, however non-stimulant, osmotic laxatives are typically preferred for longer term use (e.g. Movicol, Epsom salts, Colocaps). Some people with IBS suffer both constipation and diarrhoea, meaning that finding the “optimal” dose of laxative to produce a regular bowel action without causing diarrhoea can be challenging.

  • Physiotherapy

    Physiotherapy

    Physiotherapists with additional training in the management of incontinence and pelvic floor muscle dysfunction, are able to help people learn ways to use these muscles to improve their control over bowel function. They are also able to help with bladder control problems.

  • Psychological Therapies

    Psychological Therapies

    People manage chronic symptoms differently, and depression and anxiety is common in IBS. IBS symptoms often increase during times of stress. Recognition and treatment of these issues is very important for the management of IBS in conjunction with dietary and pharmacological measures. Smoking can be a trigger in IBS and should be stopped. A variety of approaches have shown benefit in IBS such as cognitive behavioural therapy (CBT) and hypnotherapy. A counsellor or psychologist who is familiar with IBS and who can work with your GP and specialist can be very beneficial. A free CBT based psychological intervention program for IBS is available here.

    START THE IBSCLINIC PSYCHOLOGICAL ASSESSMENT AND TREATMENT PROGRAM

  • Other Complementary Therapies

    Other Complementary Therapies

    Often patients with IBS can become frustrated with the ‘Medical System’ that does not seem to understand or be able to treat their problems and turn to complementary medicines or practitioners. Some treatments provided by alternative paractioners can provide valuable relief, sometimes by mechanisms that are poorly understood by conventional medicine (e.g. acupuncture) or using medications containing pharmacologically active ingredients which have yet to be characterized by conventional medicine (for example some herbal/plant products such as slippery elm or aloe vera). Some therapies probably act via similar mechanisms to those that might be delivered by a psychologist (e.g. stress reduction due to meditation)

    Doctors are aware that a high proportion of patients with IBS do use alternative therapies, and it is important that your doctor knows all of the medications that you are on (e.g. St Johns Wort) as some prescribed medications can interact with alternative therapies, and some alternative therapies can lead to side effects or toxicities (such as abnormal liver tests).




MORE LINKS

If you are interested in other gastrointestinal-focused information and intervention websites developed and hosted at
Swinburne University of Technology,
please go to:

IBDclinic.org.au for individuals with Inflammatory Bowel Disease

Gastroparesisclinic.org for individuals with Gastroparesis

DISCLAIMER

This website and its content is not intended or recommended as a substitute for medical advice, diagnosis or treatment. Always seek advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

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