How to Manage Your IBS-D

There’s no cure for irritable bowel syndrome with diarrhea (IBS-D), but there are ways to calm your symptoms down and get some relief.

First, your doctor may suggest changes to your diet to see if your symptoms get better. Medicines, both over-the-counter and prescription, can also help.

Stress often makes IBS-D worse, so it's important to find healthy ways to manage the tension in your life, too.

Which Medications Can Help Me Feel Better?

You and your doctor can choose the right ones based on your symptoms and how bad they make you feel.

Anti-diarrhea medicines. Loperamide (Imodium, Pepto Diarrhea Control) helps control your frequent loose stools. You can get them at the grocery or drug store.

Another medicine, diphenoxylate with atropine (Lomotil, Lonox), is available with a prescription.

Meds to help cramping. You might hear your doctor call these "anticholinergic and antispasmodic drugs." She’s talking about prescription meds like dicyclomine (Bentyl) and hyoscyamine (Levsin), which lessen bad cramping and unusual colon contractions.

They may help more if you take them before you have symptoms. For instance, if you usually have pain or diarrhea after eating, it’s probably better to take them before a meal.

Low-dose antidepressants. If your doctor prescribes these, you may wonder how they could help you. Some may work because they weaken pain signals your gut sends to your brain. They can also improve diarrhea by slowing the flow of food through your stomach and intestines.

Anti-anxiety drugs. Your doctor might prescribe these if anxiety triggers your symptoms. Clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) can help take the edge off. Usually they’re not used for a long time because of the risk of addiction.

Other prescription medicines. Three other options work in different ways to improve both diarrhea and belly pain in adults.

Alosetron (Lotronex)works by blocking messages from the gut to the brain. It’s used only in women with very bad IBS-D when other medicines don’t work. It can cause serious side effects and should only be considered if your diarrhea makes it impossible to lead a normal life.

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Eluxadoline (Viberzi) works in your digestive system to lessen bowel contractions and slow the motion in your intestines. You take it twice a day with food. It works best if you take it regularly for as long as your doctor feels is needed.

Rifaximin (Xifaxan) is an antibiotic that changes the amount of bacteria in your intestines. You take pills for 2 weeks. It can control symptoms for as long as 6 months. If they come back, you can be treated again.

Remember to follow your doctor’s instructions exactly when taking any medication for your IBS-D.

How Can I Manage My Stress to Feel Better?

Unpredictable symptoms can leave you stressed and anxious, which can lead to more problems. But when you learn ways to worry less, that can break the circle.

Talk therapy. Two types tends to help treat IBS. Cognitive behavioral therapy helps you change negative thoughts and actions. It may focus on stress management or your reaction to anxiety about your symptoms.

Psychodynamic therapy looks at how your emotions affect your symptoms. Often you’re taught ways to help you relax.

Hypnosis. This puts you in a different state of awareness and uses the power of suggestion to help you feel better. The hypnotist may use calm imagery to help relax the muscles in your gut.

Visualization. It’s like taking a mental vacation to distract you from your worries and pain. Imagine yourself in a place you find calm and relaxing. Maybe it’s in a boat on a mountain lake. Feel the warm sun on your face. Dip your toes in the water. Listen to the birds chirp. Smell the mountain air.

Go back to that place every time you feel stressed or when symptoms bother you.

Mindfulness meditation. This can calm your mind, ease stress, and help manage pain. It's taught in a class or group session. You’ll learn breathing, visualization, and relaxation techniques to lessen your stress. The main goal here is to help you focus on the present instead of worrying about the past or future.

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Would Dietary Supplements Help?

There’s evidence that two may calm your symptoms:

Peppermint oil. Itmay ease belly pain, bloating, and gas. But it can also cause heartburn. Look for enteric-coated capsules. They dissolve in the intestines instead of in the stomach. They also don’t trigger indigestion.

Probiotics. They’re live microscopic organisms like those that live in your digestive tract. Some probiotics may improve belly pain, bloating, and gas. But it’s not clear which one is the best for IBS. Talk to your doctor if you want to give it a try.

Also tell your doctor if you want to take any supplement. Some may interfere with medication you’re already taking.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on February 25, 2018

Sources

SOURCES:

National Institute of Diabetes and Digestive and Kidney Disease: “Treatment for Irritable Bowel Syndrome.”

Wolters Kluwer Health: “Patient information: Irritable bowel syndrome (Beyond the Basics).”

Office of Women’s Health, US Department of Health and Human Services: “Irritable Bowel Syndrome (IBS) fact sheet.”

International Foundation for Functional Gastrointestinal Disorders: “Antidiarrheal Agents.”

US National Library of Medicine: “Diphenoxylate.”

International Foundation for Functional Gastrointestinal Disorders: “Anticholinergic/Antispasmodic Agents.”

International Foundation for Functional Gastrointestinal Disorders: “Antidepressant Medications.”

International Foundation for Functional Gastrointestinal Disorders: “Lotronex.”

Prometheus Therapeutics and Diagnostics, “Lotronix.”

International Foundation for Functional Gastrointestinal Disorders: “Eluxadoline.”

International Foundation for Functional Gastrointestinal Disorders: “Rifaximin.”

Salix Pharmaceuticals, “About Xifaxan.”

International Foundation for Functional Gastrointestinal Disorders: “Cognitive Behavioral Therapy for IBS.”

International Foundation for Functional Gastrointestinal Disorders: “Relaxation Techniques to Manage IBS Symptoms.”

Ruth Geller, mindfulness meditation instructor, Central Islip, NY

National Center for Complementary and Integrative Health: “6 Tips: IBS and Complementary Health Practices.”

National Center for Complementary and Integrative Health: “Irritable Bowel Syndrome: In Depth.”

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