Here we are friends – the end of a 4-week series on Irritable Bowel Syndrome (IBS). Let’s finish this topic with a discussion on the available treatment options.
The goal of any treatment plan should be the alleviation of symptoms and return to optimal quality of life. As always, therapy should be individualized to each patient based on the diagnosis AND patient preferences. This is called shared decision making and is incredibly important when treating all health conditions, not just IBS.
The treatment options for IBS can be broken down into a few different categories, listed here:
- Lifestyle changes
- Mental health therapies
The most common lifestyle changes involve dietary adjustments, often starting with avoidance of foods that are known triggers. A high-fiber diet paired with plenty of fluids may also be helpful. There are a few specific dietary recommendations that include elimination of certain foods known to exacerbate IBS from your diet. These include the following:
- High-gas foods – Elimination of carbonated, alcoholic beverages and certain gas forming foods can improve symptoms of bloating and abdominal distention.
- Gluten – Literature has demonstrated that avoidance of wheat, barley and rye may improve certain IBS symptoms, especially for those with IBS-D.
- FODMAPs – Or fermentable oligosaccharides, disaccharides, monosaccharides and polyols (Quite a mouthful if I do say so myself!) FODMAPs are a group of carbohydrates (fructose, fructans, lactose and others) which are found in certain grains, veggies, fruits and dairy products. Some people are especially sensitive to these carbohydrates which cause IBS symptoms to worsen when consumed.
Additional lifestyle recommendations include participating in regular exercise, getting adequate sleep, and employing healthy stress management techniques.
Suggested supplements or over the counter medications may include:
- Fiber supplements which can help with constipation.
- Laxatives to treat constipation.
- Anti-diarrheal medications can help to control diarrhea.
- Probiotics, especially those within the bacteria family, Bifidobacterium, seem to reduce gas, bloating, and inflammation of the intestinal wall.
- L-Glutamine may be recommended for individuals suspected of having a leaky gut. And although there is no research on L-Glutamine for leaky gut, it is safe and known to cause very few side effects, so may be worth a short trial of 5 grams daily for two weeks.
- Zinc has also been investigated in treatment of leaky gut. Like L-Glutatmine, the evidence to support its use in IBS is limited. However, zinc is one of the most common mineral deficiencies in our western diet, and using it for 14-30 days at a dose of 20-35 mg daily may be helpful.
- Peppermint has been studied extensively and has even been described as “the drug of first choice for IBS patients.” Its main role is in relaxing the bowel smooth muscle, reducing cramping and pain. Enteric-coated peppermint is recommended since it dissolves lower in the GI tract, reducing the risk of reflux (stomach contents flowing back into the esophagus). A common dose is 0.2-0.4 ml three times daily of enteric-coated capsules. The dose for children ages 8 and older is 0.1-0.2 ml three times daily. Look for a brand that has at least 44% menthol and less than 1% pulegone.
- Cromolyn Sodium may help reduce inflammation, based on a few small studies demonstrating its effectiveness in reducing IBS symptoms.
A comprehensive and holistic treatment plan for IBS also includes mental health or mind-body strategies. Some of the best studied therapies include Cognitive Behavioral Therapy (CBT) and Gut-directed Hypnotherapy (GDH). It is important to note that although these approaches may require a significant investment of time (and possibly money), research that compared 17 studies using CBT for IBS to studies using drugs commonly prescribed for the disease found that CBT was far better in helping patients than the drugs were. Other therapies in this category include journaling, guided imagery, and breath work.
Finally, for some individuals, prescription medications may be necessary or preferred. There are several and they include anticholinergic medications, which help to relieve painful bowel spasms and diarrhea, tricyclic antidepressants which can help treat depression and have a direct effect on the gut nervous system, SSRI antidepressants, and certain pain medications. There are also a handful of medications that are specifically for IBS. These include Alosetron (for severe cases of IBS-D in women), Eluxadoline (for IBS-D), Xifaxan (used to decrease bacterial overgrowth), Lubiprostone (for women with severe IBS-C), and Linaclotide (for IBS-C).
Patients often need to trial several different approaches and frequently end up employing more than one of the treatment strategies described above. Having a strong relationship with your provider which allows for frequent visits to review and adjust the treatment plan is always helpful!
Have questions? Check out the references below, or contact our office to inquire about a consultation with myself or our Nurse Practitioner, Anna Spoelhof, NP.
- An Integrative Approach for Treating Irritable Bowel Syndrome (University of Wisconsin Integrative Medicine fammed.wisc.edu/integrative)