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 diarrhea often find relief from several types of treatment.

Treatment options include dietary changes, medication, stress reduction, behavioral therapy, and alternative therapy. You may need to try just one, or your may need a combination of these approaches to get relief.

After all, IBS is a complex syndrome that not only involves problems with bowel movement, but also stomach pain, discomfort, bloating, and gas. The goal of treatment is to improve all of your symptoms.

To find out what treatment is right for you, talk with your doctor. Never attempt to treat yourself for IBS without consulting with a doctor. Some over-the-counter medicines and supplements have health risks if taken for a long time. Your doctor will likely recommend one or a combination of the following treatment strategies.

IBS and Diet

A few changes in your diet may help ease IBS with diarrhea.

Avoid chocolate, alcohol, caffeine, carbonated drinks, the artificial sweetener sorbitol (found in sugarless gum and mints), and fructose (the simple sugar found in honey and many fruits). These can worsen diarrhea symptoms.

So can fried fare, and too much fiber. This doesn't mean you should avoid fiber altogether. This doesn't mean you should avoid fiber altogether. Fiber is an important part of a healthy diet.

With the diarrhea, it's best to consume soluble -- as opposed to insoluble -- fiber. It takes a longer time to leave the digestive system, says Leslie Bonci, MPH, RD, author of the "American Dietetic Association Guide to Better Digestion."

Good sources of the soluble fiber include oat bran, barley, the flesh of fruit (as opposed to the skin), and navy, pinto and lima beans.

It may also help to drink six to eight glasses of plain water a day. Bonci suggests drinking water an hour before or an hour after meals. Drinking water with meals may make the food run through your system a little faster.

Your doctor may evaluate you for lactose intolerance (the inability to properly digest milk products) or celiac sprue disease (a serious disease in which foods with gluten can damage the intestine). These digestive ailments can also cause diarrhea, bloating, and cramping.

It might also help if you keep a record of the foods you eat, and their effect on you. Since different foods can impact people in different ways, keeping a symptom journal can help you and your physician figure out what works for you.

Over-the-Counter (OTC) Medicines

Many sufferers and doctors turn to OTC antidiarrhea drugs such as Imodium and Kaopectate for relief of IBS with diarrhea.

In a 2002 comprehensive report by the American College of Gastroenterology, researchers found these drugs to be effective with slowing diarrhea. These drugs, however, did not help with other IBS symptoms such as stomachaches or swelling.

Side effects of these treatments include stomach cramping, discomfort and enlargement, along with dry mouth, dizziness, and constipation.

If you take an antidiarrheal drug, use the lowest dose possible, and don't take it for an extended period of time, advises the Mayo Clinic.

Other OTC products such as Pepto-Bismol, antacids, and medicines for gas relief are generally safe.

Never take any over-the-counter medicine long term without consulting with your doctor, and return to your doctor for follow-up care, says J. Patrick Waring, MD, a gastroenterologist at Digestive Health Care of Georgia. He notes that IBS symptoms can be caused by other more serious problems. Make sure your symptoms are not caused by another illness.

Prescription Medicines

Doctors may prescribe antidepressants for the abdominal pain associated with IBS. This does not necessarily mean that you are depressed. Low doses of antidepressants are known to block signals of pain to the brain.

For people with IBS diarrhea, doctors may recommend a low dose of a type of antidepressant called tricyclic antidepressants such as Pamelor, Elavil, and Tofranil.

Common side effects of these antidepressants include dry mouth, blurred vision, and constipation.

Studies show that tricyclic antidepressants can improve stomach pain, says Philip Schoenfeld, MD, MSEd, MSc. He is co-author of the American College of Gastroenterology's treatment guidelines.

When IBS patients come into her office, Beth Schorr-Lesnick, MD, FACG, a gastroenterologist at the Montefiore Medical Center in Bronx, New York, tries to review each individual's symptoms to determine the right treatment. Many times, she starts off patients with an antispasmodic drug such as Levbid or Bentyl.

Antispasmodics "relax the smooth muscle of the gut," says Schorr-Lesnick. She says muscle spasms and gas in the gut cause much of the pain IBS. Sometimes, she prescribes the antispasmodic and antidepressant together to relieve stomach cramping.

Side effects of antispasmodics include decreased sweating, constipation, and dryness of the mouth, nose, throat, or skin. The American College of Gastroenterology guidelines found that there isn't enough evidence to make a recommendation about antispasmodics.

On the other hand, the experts found that the prescription drug Lotronex to be effective for treatment of symptoms associated with IBS with diarrhea. The finding, however, was only relevant to female patients.

Lotronex works to block the body chemical serotonin's effect on the digestive system. Serotonin's role in the development of IBS is uncertain, but researchers do know Lotronex somehow calms down the colon and slows down the frequency of bowel movements.

In 2001, the FDA pulled Lotronex from the market, due to its high risk of side effects. As of March 2002, the agency recorded at least 84 cases of ischemic colitis, and 113 cases of serious complications of constipation (needing hospitalization) in connection with the medication. The severe side effects resulted in four deaths.

Yet Lotronex had gained strong support among doctors and patients who saw its value in treating IBS with diarrhea. Because of this, in June 2002, the FDA brought back the drug with several restrictions.

Physicians now need to be enrolled in a special program to prescribe Lotronex. The drug is approved only for women with severe, diarrhea-predominant IBS who have not responded to other treatments.

Patients who are considering Lotronex need to seriously consider the benefit of the drug with its risks, says Schoenfeld.

Stress Management

Everyone feels stressed or worried once in a while. Emotional turmoil, however, seems to affect IBS sufferers more than others.

"Stress seems to complicate or exacerbate IBS symptoms," says Schoenfeld. In the American College of Gastroenterology report, he and other researchers found that a majority of patients who undergo behavioral therapy seem to have improved symptoms.

Behavioral therapy involves a number of techniques to help people better learn how to cope with pain, distress, and stressful situations. It includes relaxation therapy, biofeedback, hypnotherapy, cognitive behavioral therapy, and psychotherapy.

If you consider behavioral therapy, consult with your regular doctor first, and try to find a therapist who will work with your regular doctor, says Schoenfeld.

Outside of the more formal interventions, there are ways to you can try to reduce stress and ease IBS symptoms on your own. Meditation, regular exercise, adequate sleep, and a well-balanced diet for IBS can all help ease symptoms.

Participating in pleasurable activities also helps. Here are some ideas: take a walk, listen to music, soak in a bath, play sports, or read.

Alternative Therapy

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

Keep in mind, however, that most alternative therapies haven't been tested for effectiveness in rigorous clinical trials.

Researchers at the National Institutes of Health (NIH) have found that acupuncture works for chronic pain. For IBS relief, however, the results have been mixed, according to researchers at the Mayo Clinic.

There is also some evidence that giving probiotics ("healthy" bacteria normally found in the gut) help people with IBS. One study discussed at the medical conference Digestive Disease Week 2003 found that probiotic treatment significantly improved IBS symptoms and quality of life. In the study, researchers primarily used the bacteria Lactobacillus acidophilus and Bifidobacteria infantis. People with IBS reported fewer symptoms and, in general, a higher quality of life after taking the probiotics for four weeks.

Studies on herbs have been mixed. Peppermint has been used to relax colon muscles. The Mayo Clinic advises anyone who'd like to try it to get the enteric-coated capsules. A possible side effect is heartburn.

It is really important for people who want to try herbs to go to a trained specialist, says Jonathan Gilbert, who has a diplomate in herbology and acupuncture from the National Certification Commission for Acupuncture and Oriental Medicine.

Going to a registered herbalist, says Gilbert, assures patients that they are receiving the best care for their individual symptoms. "We'll adapt a formula (of herbs) to suit the actual patient," he says. "That will be determined by talking to the patients, looking at their symptoms, and doing a traditional diagnosis."

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

Conclusion

Treating IBS can be frustrating, largely because IBS is a complex syndrome. Not every treatment works for every person. And your symptoms may change as you are treated for IBS. You may have diarrhea now, but suffer from constipation in a few weeks, and then have diarrhea again.

Your best bet? Find a doctor who understands IBS, and work together on your treatment plan, says Waring. Your doctor can help you determine the best course for you.

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."