WebMD Guide

Irritable Bowel Syndrome

What Is IBS Who Is at Risk 10 Questions to Ask the Doctor Coping With IBS IBS Symptom Journal Treating IBS and Constipation Treating IBS and Diarrhea Stress and IBS Therapy for IBS

People who suffer from irritable bowel syndrome (IBS) and constipation often find relief from a combination of therapies. Health care providers may suggest changes in diet, exercise, and stress management, as well as medication. Some doctors may also recommend behavioral therapies such as relaxation, biofeedback, or hypnosis.

The goal of IBS treatment, after all, is to do more than just ease bowel problems. It is also to soothe the stomachaches, pain, and bloating that can come with IBS.

No matter which therapy you consider, remember this: Never attempt to treat yourself for IBS without consulting with your doctor. There are health risks associated with taking laxatives and supplements regularly to ease IBS-related constipation. It is important to speak with your health care providers about safety and what's right for you.

Here are some common IBS treatment strategies that you and your doctor may consider:

IBS and Diet

Dietary changes can help many people with IBS manage their symptoms. Fiber reduces constipation by softening the stool, making it easier to pass. Yet few of us come close to consuming the 20 grams to 35 grams of fiber a day recommended for healthy adults.

If you suffer IBS with constipation, gradually introduce high-fiber foods into your diet, says Leslie Bonci, MPH, RD, author of the American Dietetic Association (ADA) Guide to Better Digestion.

Good sources of fiber include whole-grain bread and cereals, fruits, vegetables, and beans. Dried plums, prune juice, ground flaxseed, and water also help loosen bowels.

Stay away from coffee, carbonated drinks, and alcohol. They can slow the passage of stool. So can refined foods such as chips, cookies, and white rice.

Remember, different foods affect each person with IBS in different ways. Some people develop diarrhea and gas when they eat too much fiber, or certain high-fiber foods. So, it's a good idea to keep a symptom journal to figure out which foods your digestive system can handle. Just jot down your symptoms, then note the type and amount of foods you ate during the meals before your symptoms appeared.

Fiber Supplements

Some people use bulking agents, commonly known as fiber supplements, to treat IBS with constipation. These include:

• Wheat bran
• Corn fiber
• Calcium polycarbophil (Fibercon)
• Psyllium (ispaghula husk, Metamucil, Fiberall, and others)

"You'd like to think that fiber works for everybody, but it doesn't," says J. Patrick Waring, MD, a gastroenterologist at Digestive Health Care of Georgia.

Laxatives

Many people with IBS take laxatives to help them go to the bathroom. But laxatives may offer limited relief and can be harmful if taken regularly for weeks at a time.

Laxatives work well for occasional constipation, but they don't treat all IBS symptoms such as stomach aches and bloating.

Also, some laxatives can be habit-forming and harmful in the long run.

In stimulant laxatives, the ingredient senna triggers muscles in the bowels to contract, moving stool through the bowel. Over time, the chemical can damage nerves in the colon wall. Eventually, these laxatives may stop working in people who take them regularly. Stimulant laxatives include Dulcolax, Senokot, castor oil, and the plant cascara sagrada.

Other laxatives, called osmotic laxatives, pull water back into the colon to soften stool, which makes the stool easier to pass. But research has found that they don't help relieve IBS symptoms other than constipation. In fact, they may actually worsen other symptoms. Side effects include diarrhea, dehydration, and bloating.

Osmotic laxatives include MiraLax, which is available over-the counter, and lactulose, which is available by prescription only.

These types of medications "are fine for a little while, but if you find you need to stay on them, you really just need to make sure you've got the right diagnosis," says Waring at Digestive Health Care of Georgia. It's important to make sure your symptoms aren't signs of another disease.

Prescription IBS Medicine

In March 2007 the irritable bowel syndrome drug Zelnorm was pulled from the market amid new evidence that it raises the risk of heart attacks and strokes. Studies had shown a higher chance of heart attack, stroke, or severe heart-related chest pain in patients treated with Zelnorm compared with those given a placebo.

There's a possibility that the drug could one day be available again on a limited basis. The FDA says it's willing to consider limited reintroduction of Zelnorm at a later date if certain patients can be identified in whom the benefits of the drug outweigh the risks. The FDA gave no timeline on consideration of this issue.

Doctors may use other prescription medications to help relieve some of the symptoms of IBS, such as constipation, diarrhea, or abdominal cramping.

Antidepressants

Your doctor may prescribe a low dose of antidepressants for IBS. This does not necessarily mean that you are depressed.

Antidepressants can block the brain's perception of pain in the gut, says Beth Schorr-Lesnick, MD, FACG, a gastroenterologist at Montefiore Medical Center in Bronx, N.Y.

There are different kinds of antidepressants, and doctors may choose one or the other, depending on whether you suffer from constipation-predominant IBS or diarrhea-predominant IBS.

For IBS patients with constipation, Schorr-Lesnick will sometimes prescribe small doses of SSRI (selective serotonin reuptake inhibitor) antidepressants such as Celexa and Paxil. They do not usually cause constipation. Their side effects include nausea, loss of appetite, and diarrhea.

Other older antidepressants (called tricyclic antidepressants) tend to cause constipation. Doctors usually prescribe them for IBS patients with diarrhea. These drugs include Elavil, Pamelor, and Norpramine. Other side effects of tricyclic antidepressants include dry mouth, drowsiness, and blurred vision.

Antispasmodics

Antispasmodic medicines relieve the stomach cramps brought on by IBS by relaxing the smooth muscle of the gut. But they also may cause constipation, so they aren't usually prescribed for people who suffer IBS with constipation. Other side effects are dryness, drowsiness, and blurred vision. These drugs include hyoscyamine and dicyclomine, also known by the brand names Levbid and Bentyl.

Stress Management

Many experts believe that stress management can relieve IBS symptoms.

"Stress seems to complicate or exacerbate IBS symptoms," says Schoenfeld. He notes that many studies have shown that reducing tension or worry can improve IBS symptoms.

You can reduce stress in many ways. Regular exercise effectively lowers stress. So does yoga and meditation. People with IBS can also ease the pressure through simple activities they enjoy: getting a massage, listening to music, taking a bath, or even reading a good book.

Another stress-busting technique is behavioral therapy. Behavorial therapy teaches you how to change the way your mind and body react to events. It can include cognitive behavorial therapy, psychotherapy, hypnosis, biofeedback, and relaxation therapy. Most of these therapies help people avoid overreacting to stressful situations and people. Studies show that behavioral therapy effectively relieves many IBS symptoms, according to the American College of Gastroenterologists.

Alternative Treatments

Some IBS sufferers turn to alternative therapies such as acupuncture and herbs to relieve their symptoms.

There is not much scientific evidence that these therapies work for IBS, mostly because few clinical trials have been done to assess their effectiveness.

Yet some doctors and patients say alternative therapies offer relief. Schorr-Lesnick, for instance, recommends a little bit of peppermint oil for her patients to help ease muscle spasms in the stomach.

If you want to try acupuncture or herbs for your IBS with constipation, talk with your doctors first. Some herbs can interact with other medications.

Conclusion

Work with your doctor to choose the right combination of IBS treatments for you. Remember, not every treatment works for every person. You may need to try several different therapies before finding relief from your IBS symptoms.

Also, your symptoms may change as you are treated for IBS. You may feel constipated and swollen now, but suffer from diarrhea and cramping in a few weeks, and then go back to being constipated.

Treating IBS can be frustrating, largely because IBS is a complex syndrome. Your best bet? Find a doctor who understands IBS, and work together on your treatment plan, says Waring. With proper treatment -- and some patience -- people with IBS lead full and normal lives.

Reviewed by Benjamin Wedro, MD.
Medically Reviewed April 2008.

SOURCE: Philip Schoenfeld, MD, MSEd, MSc, co-author of American College of Gastroenterology's "Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome in North America." Jeanine Blackman, MD, PhD, medical director of the University of Maryland Center for Integrative Medicine. Jonathan Gilbert, who has a diplomate in herbology and acupuncture from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). The National Center for Complementary and Alternative Medicine Web site: "Acupuncture." Mayo Clinic Web site: "Irritable Bowel Syndrome." WebMD Feature: "Natural Alternatives for IBS." About.com: "Herbs and Supplements for IBS." University of California at Berkeley Wellness Letter Web site. Medscape: "Probiotics Significantly Reduce Symptoms of IBS, Ulcerative Colitis," and "Highlights from Digestive Disease Week: An Expert Interview with Lawrence R. Schiller, MD."