How to Manage Your IBS-D

Medically Reviewed by Poonam Sachdev on October 18, 2021

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 will likely 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.

Should I Change How I Eat?

Some simple tweaks may help calm your symptoms. Sugary foods, sodas, caffeine, alcohol, and processed foods may be bad for your digestion. Instead, eat whole, natural foods. Fruits and vegetables, whole grains, and healthy fats found in salmon or nuts are better choices.

Be careful about getting too much fiber, including through fiber powders or drinks. There’s no proof these ease IBS-D symptoms.

Chew food well and take your time to help digest your meals. It’s better to let your teeth and saliva break down your food slowly than to wash it down with water or other drinks.

If you think some eats or drinks may trigger your symptoms, keep a food diary for a few weeks. Write down what you eat and when you have stomach problems. You may discover which meals or treats make you feel worse.

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." They are 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.

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 tend 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.

Exercise. People with IBS who make working out part of their routine have fewer symptoms. You can take walks, train at your local gym, or take exercise classes like gentle yoga.

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.

What About Alternative Treatments

Acupuncture is a Chinese treatment that’s been around for centuries. An acupuncturist or therapist will insert very thin needles into the surface of your skin at particular points. It’s supposed to stimulate and regulate your flow of energy -- you may hear it called “qi” -- to ease pain and anxiety.

Acupuncture may ease your stress and help you relax. If you’re tense, your IBS-D symptoms may flare up. Acupuncture may also calm stomach pain and muscle spasms in your gut.

Chinese medicine also uses herbs to treat IBS-D symptoms. These may contain mixes of things like barley, cardamom, licorice, rhubarb, or tangerine peel.

Show Sources


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International Foundation for Functional Gastrointestinal Disorders: “Antidiarrheal Agents,” “Anticholinergic/Antispasmodic Agents,” “Antidepressant Medications,” “Lotronex,” “Eluxadoline,” “Rifaximin,” “Cognitive Behavioral Therapy for IBS,” “Relaxation Techniques to Manage IBS Symptoms.”

US National Library of Medicine: “Diphenoxylate.”

Prometheus Therapeutics and Diagnostics, “Lotronix.”

Salix Pharmaceuticals, “About Xifaxan.”

Ruth Geller, mindfulness meditation instructor, Central Islip, NY

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