Medication and Other Treatment Options for IBS-D

Medically Reviewed by Arefa Cassoobhoy, MD, MPH on September 24, 2023
5 min read

Irritable bowel syndrome (IBS) can be tough to live with. How tough? A 2015 survey from the American Gastroenterological Association found that 47% of people with IBS would give up their cell phone just to feel 1 month of relief from their symptoms.

In about a third of cases of this digestive disorder, people have frequent loose stools or diarrhea. That's known as IBS-D.

Let your doctor know about your symptoms -- even if talking about them feels uncomfortable. They may first suggest changes to your diet to see if your symptoms get better. There are also more treatment options than ever. You and your doctor can choose the right ones based on your symptoms and how bad they make you feel.

Alosetron (Lotronex): For a long time, this was the only prescription medication approved to treat the condition. It works by blocking messages from the gut to the brain and can help relieve stomach pain and slow your bowels to relieve diarrhea.

But there can be serious side effects, so it’s only to be used by women with severe IBS-D whose symptoms aren’t helped by other treatments.

A similar drug called ramosetron is being studied. It may have fewer side effects, but more research is needed.

Eluxadoline (Viberzi): This signals your nervous system to help stop bowel spasms. It can also ease belly cramps and diarrhea. 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): Though it’s not clear what causes IBS-D, some experts believe the culprit may be too much bacteria in the small intestine. Rifaximin is an antibiotic that changes the amount of bacteria in your intestines. It was approved by the FDA in 2015 to treat IBS-D. It can help with both stomach pain and diarrhea. 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.

Antidiarrheal drugs: In some cases, over-the-counter medicines like loperamide (Imodium, Pepto Diarrhea Control) can improve diarrhea symptoms for people with IBS. They help control your frequent loose stools.

Diphenoxylate with atropine (Lomotil, Lonox): This is an anti-diarrhea medicine available with a prescription.

Bile-acid binders: These drugs help make your bowel movements more solid and less frequent.

Antidepressants: Medicines called tricyclic antidepressants can help reduce belly pain, particularly if you also have depression or anxiety. If you don’t have depression, your doctor may still prescribe these, but in smaller doses.

Low-dose antidepressants may work for IBS 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.

Medications to help cramping: Prescription meds like dicyclomine (Bentyl) and hyoscyamine (Levsin) have long been used to help treat the symptoms of IBS-D by slowing down your bowels to make bathroom visits less frequent and less painful.

You might hear your doctor call them “anticholinergic and antispasmodic drugs.” 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.

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.

Mast cell stabilizers: About a quarter of people with IBS-D also have gastroenteritis, which makes your gut become inflamed. Some experts believe that could be a trigger for IBS. Mast cells control the release of histamine, which causes inflammation. These drugs help lower the amount of histamine your body makes.

K-opioid antagonists: Scientists are doing clinical trials of a promising drug called asimadoline, which may help reduce stomach pain and diarrhea without causing constipation.

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

There’s evidence that two may calm your symptoms:

Peppermint oil: It may 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: Your gut has trillions of bacteria -- some helpful and some harmful. Some people may find that these so-called “good” bacteria offer relief from IBS-D symptoms like bloating and cramping. But more research is needed to find out which probiotic strains are best, and at what doses.

Tell your doctor if you want to take any supplements. Some may interfere with the medication you already take.