Irritable Bowel Syndrome

Treatment

Treatment for IBS depends on the severity of the disease. It can often be controlled by changes in diet and stress management. Other cases warrant medication — over-the-counter or prescription. For some people IBS can be disabling and for others it is chronic and fluctuates in severity, disappearing temporarily or completely.

Patients may need to be treated for complications of IBS; for instance, hemorrhoids that are irritated by diarrhea and constipation. Other patients may need treatment for depression that sometimes accompanies IBS.

Preventive Treatment

Counseling, biofeedback exercise, yoga, massage and deep breathing are all avenues that patients can try to relieve stress and thus prevent or alleviate symptoms. Other diet and lifestyle changes that help some patients include:

• Experimenting with fiber on a regular basis and increasing use gradually.
• Avoiding problem foods such as chocolate, caffeine, sodas, dairy products and sugar-free sweeteners. Restricting fatty foods also helps some patients.
• Eating at regular times each day and not skipping meals.
• Reducing or eliminating dairy products completely. Patients who use this approach need to get calcium, protein and vitamin B from other sources. Medications can help break down lactose.
• Increasing liquids, especially water.
• Exercising regularly, aiming for 30 minutes of exercise most days.

Medications

For moderate IBS, Mayo doctors may suggest fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) with fluids to control constipation or loperamide (Imodium) to manage diarrhea.

Some patients may need drugs that affect activities of the nervous system (anticholinergics) to relieve painful bowel spasms.

If symptoms include pain and depression, doctors may recommend a tricyclic antidepressant or a selective reuptake inhibitor (SSRI). These medications also inhibit the activity of neurons that control the intestines.

Lotronex, which slows the movement of waste through the lower bowel, is intended only for severe cases that don't respond to other treatments. It is approved for patients with the diarrhea-dominant form of IBS and can be prescribed only by doctors enrolled in a special program.

Zelnorm is prescribed for women with the constipation-dominant form of IBS. It is approved only for short-term use and only for women.