A Guide To Treating IBS (Irritable Bowel Syndrome)

Irritable bowel syndrome can be a tricky disorder to manage, but there are a lot of treatment options. While treatment for IBS isn’t curative, it can help you get the symptoms under control and get back to living your life. Whether you’re newly diagnosed or have been living with IBS for a long time, this guide can help you understand the treatment options out there and what might be the best fit for you. 

What are the symptoms of IBS?

Irritable bowel syndrome (IBS) is a condition characterized by intestinal symptoms that can vary in duration, severity, and type. There are different types of IBS, and the kind that you have will influence the symptoms that you experience.

Common symptoms for IBS patients include:

• Lower abdominal pain or cramping 

• Issues with bowel movements 

• Gas, bloating

• Discomfort or pain related to bowel movements 

Types of IBS

The types of IBS that you can be diagnosed with include:

Constipation-predominant (IBS-C)

One of the more common types of IBS, IBS-C patients experience infrequent stools that are largely hard or lumpy. Because of this, patients with IBS-C are more likely to have:

• Constipation 

• Gas 

• Bloating 

• Abdominal pain 

• Straining while passing stools¹

Diarrhea-predominant (IBS-D)

For patients with IBS-D, loose stools are the main issue. Patients with IBS-D will likely experience the following symptoms:

• Diarrhea

• Abdominal pain

• Excessive gas

• The feeling that you haven’t finished a bowel movement¹

Mixed (IBS-M)

IBS-M combines the symptoms from IBS-C and IBS-D. Patients with IBS-M experience both loose and hard stools, and so their common symptoms often include:

• Constipation 

• Diarrhea 

• Abdominal pain 

• Gas¹

Post-infectious IBS (PI-IBS)

Post-infectious IBS occurs after an infection in the gastrointestinal (GI) tract. It’s thought that infection in this area can lead to inflammation that damages the permeability of the intestine and throws off the balance of gut flora, which then leads to the onset of IBS symptoms.

Patients with PI-IBS often experience:

• Vomiting 

• Diarrhea 

• Lower abdominal pain 

• Bloating²

Research tells us that after a GI tract infection with a very common pathogenic bacteria, 21% of survey respondents had developed post-infectious IBS. The majority of patients (54%) had IBS-M, 38% reported diarrhea-predominant symptoms, and 6% developed IBS-C³. More research is needed to understand how other bacteria might affect post-infectious IBS development. 

Post-diverticulitis IBS

This type of IBS develops in conjunction with diverticulitis, a GI disorder that inflames and may cause infection in tiny pouches that occur in the lower part of the large intestine. The damage resulting from this can then lead to IBS symptoms. Common symptoms of post-diverticulitis IBS include:

• Lower abdominal pain 

• Altered bowel habits, including diarrhea and constipation⁴ ⁵

How to treat IBS

There is a range of treatment options out there for IBS, from medication to therapy. The bad news is that IBS is a chronic condition with no curative fix that, in most cases, will have to be managed in the long term. Treatment options for IBS focus on reducing symptom severity and preventing symptom onset where possible. 

Medication

Medication can help to ease the severity of your IBS symptoms, hopefully leaving you symptom-free for longer. Medications that your doctor might prescribe for you include:

• Anti-diarrhea medication: If you’re experiencing diarrhea as a symptom of your IBS that won’t ease, then you might be prescribed antidiarrheals to help stop it in its tracks. 

• Laxatives: On the flip side, if constipation is one of your primary IBS concerns, then you will likely be given laxatives to help loosen your stools and allow you to go to the bathroom more regularly without issue.

• Antibiotics: Some patients with IBS diarrhea can experience an overgrowth of GI bacteria, so they might be prescribed antibiotics to help keep that growth in check. 

• Antidepressants: There is a strong link between depression and IBS, and antidepressants can be prescribed both to improve mental health and help reduce pain and constipation⁶.

• Pain medication: IBS can cause significant abdominal pain, so patients may be prescribed pain medication to help ease their symptoms and allow them to carry out their daily activities. 

• Anticholinergics: These medications are given to stop the painful intestinal spasms that often occur in IBS.  

Self-care

Stress can be a big trigger when it comes to IBS. Research tells us there seems to be a link between exposure to stressful events and an increase in IBS symptoms. The brain and the gut have strong ties to one another, with interconnecting nerve pathways known as the gut-brain axis. It is thought that this connection might play a role in the impact that stress can have on IBS symptoms⁷.

Because of this, it’s important to take time for yourself to reduce and learn how to manage your stress levels. Stress-reducing self-care techniques that you might want to try include:

• Engaging in regular exercise such as yoga, swimming, running, or boxing

• Meditation and mindfulness practices⁸

• Breathing techniques 

• Getting regular sleep⁹

• Removing stressful triggers from your life where possible 

• Setting realistic goals and expectations¹⁰

Therapy

We know that the brain plays a significant role in IBS, and gut health and psychological therapy are productive in reducing the severity of IBS symptoms. Cognitive-behavioral therapy (CBT), for example, has been shown to significantly improve IBS symptoms¹¹ and quality of life¹² for patients in the long term.

If you’re thinking about trying therapy for your IBS, then look for therapists who have been trained in GI psychology¹³.

Clinical trials

IBS research is a growing field, and many potential treatment options are undergoing clinical trials that might be able to help IBS patients in the future. Promising treatments under investigation include:

Probiotics

Probiotics show a lot of promise in their ability to reduce pain and symptom severity in IBS patients. Probiotics can help encourage gut health by keeping pathogenic bacteria in check, balancing the gut microbiome, and encouraging mucus production to help normalize bowel movements and reduce the symptoms of pain, gas, and bloating¹⁴.

Peppermint oil

Peppermint oil is derived from the peppermint plant and could provide a natural IBS treatment option. When consumed orally, peppermint oil has been effective in reducing IBS symptoms. It has also been shown to be safe for IBS patients¹⁵.

Bile acid binder

Bile acid binders cling to bile acid and reduce the impact of bile acids on the GI tract. This is important as excess bile acid can result in chronic diarrhea and has been linked to IBS. Bile acid binders, therefore, could help reduce the chronic diarrhea that can occur in IBS-D¹⁶.

Acupuncture

Acupuncture could also offer some relief for patients with IBS. Research has shown that acupuncture has demonstrated the ability to reduce IBS symptoms, including abdominal pain, the sensation of incomplete bowel movement, number of stools per day, and the type of stool¹⁷.

How to relieve IBS symptoms

There are many options out there to help relieve the symptoms of IBS, such as:

Diet changes

Diet can have a big impact on IBS symptoms, so it can really make a difference to cut out foods that trigger your IBS. High FODMAP foods, in particular, tend to be especially aggravating for IBS patients. FODMAPs are a specific type of carbohydrate that can alter food absorption.17 Foods to avoid if you have IBS include:¹⁸

• High FODMAP vegetables: mushrooms, garlic, onion, asparagus, cauliflower, green peas

• High FODMAP fruits: apples, peaches, dried fruit, watermelon, mango

• Dairy: specifically cow’s milk products—plant milk and hard dairy cheeses should be tolerable for most people 

• Gluten: wheat, rye, barley 

• Legumes and beans 

• Fried, oily, and highly processed foods 

• Alcohol 

• Caffeine

Lifestyle changes

Small changes to your lifestyle and habits can make a huge difference to your IBS symptoms. Lifestyle changes that you might want to consider making include managing:

• Stress: As we know, stress can have a big impact on IBS. Reducing and learning to manage stress in your life can help to relieve some of the symptoms and improve your quality of life. 

• Sleep: Getting a good night’s sleep won’t just leave you feeling rested; research tells us that disturbed sleeping habits are also linked to increased IBS symptoms¹⁹. 

Medication

Medication can help to relieve various symptoms of IBS. You might be given medication to target:

• Constipation: fiber supplements, milk of magnesia, Miralax, Amitiza, Linzess

• Diarrhea: Imodium A-D, Lotronex, Viberzi 

• Stomach cramping: dicyclomine and other antispasmodics 

• Bacterial overgrowth: rifaximin and probiotics 

How to help IBS pain

Pain is, unfortunately, a common symptom that occurs with IBS. The good news is that there are many options out there to help manage IBS pain. Pain options include:

• Specific nerve pain medications like pregabalin or gabapentin can help you with IBS discomfort.

• Tricyclic antidepressants like imipramine can help to reduce pain and be prescribed even if you have no depression symptoms alongside your IBS²⁰.

Aside from medications, let’s recap the other things you can do to help reduce IBS pain:

• Reducing your intake of foods and drinks that trigger your IBS, such as alcohol, dairy, gluten, and high-FODMAP foods

• Establishing a healthy sleep routine

• Reducing and managing stress in your life

• Exercising more

• Starting therapy, specifically with a therapist trained in GI psychology

Other techniques that IBS patients often find useful to help them ease their pain include:

• Applying a heat pack 

• Drinking peppermint tea 

• Increasing fiber intake 

When to see a doctor

Before diagnosis

If you’re experiencing side effects similar to IBS but haven’t yet been diagnosed, it’s best to set up an appointment with your doctor as soon as you can. Your doctor will then help you to determine whether or not you have IBS and make sure there is no other disease condition responsible for your symptoms. Only around 30% of patients will reach out to their doctor about their IBS symptoms.

The patients who don’t will not receive medical care that might relieve these symptoms and improve their overall quality of life. You don’t have to simply deal with IBS on your own, but it’s best to get in contact with your doctor when you can if you suspect you have IBS symptoms²¹.

After diagnosis

Once you have been diagnosed with IBS and set up with a treatment plan, you should remember to reach out again to your doctor or specialist if any of your symptoms become more severe or new symptoms develop. Things you should look out for that warrant contacting your doctor include:

• Severe and persistent abdominal pain 

• Foul-smelling or painful gas 

• Reduced appetite or inability to tolerate certain foods

• Severe and debilitating cramping 

• Excessive diarrhea or constipation that continues for an extended period

• Significant, unintended weight loss

• Persistent nausea or vomiting

• Blood or mucus in your stool 

• Fevers or night sweats

• An abrupt change in your previous symptoms

• Nighttime symptoms that wake you up²²

The lowdown

IBS is a complicated and long-term condition, but there are a lot of treatment options out there for patients. Medication, diet, and lifestyle changes can all positively impact IBS symptoms and can help patients remain symptom-free for longer and enjoy a better quality of life²³.