How Does a Gastroenterologist Treat IBS?

The cramps, bloating, gas, and diarrhea that often come with irritable bowel syndrome (IBS) can make you uncomfortable. They also can interfere with your activities.Your gastroenterologist uses diet changes, medicine, and stress-relief techniques to treat IBS. You may need a combination of all three approaches.

Dietary Changes

Many people with IBS are sensitive to certain foods such as beans or vegetables like broccoli and cabbage. Your doctor might suggest you keep a diary to find out which foods bother you. She'll suggest you write down what you eat and when your symptoms start.

Common IBS food triggers include:

  • Fiber. Whole grains, fruits, vegetables, and beans are good for your digestive tract. These high-fiber foods keep food moving through your intestines and prevent constipation. Yet they can also trigger IBS symptoms. Bacteria that live in your intestines break down fiber and produce gas. If fiber aggravates your IBS symptoms, add only small amounts to your diet at a time. Or limit the fiber in your diet. Instead, take a fiber supplement such as methylcellulose (Citrucel) or psyllium (Metamucil). These might be less irritating or stimulating.
  • Dairy. Some people with IBS don't produce an enzyme needed to break down lactose -- the sugar in milk and other dairy foods. If you have lactose intolerance, you'll get symptoms like gas and diarrhea when you eat dairy foods. If you think this is a problem, you can:
    • Cut dairy from your diet
    • Switch to lactose-free dairy
    • Use a lactase enzyme product to break down the sugar
  • Caffeine. Just like it gives your brain a jolt, caffeine stimulates your digestive tract. That can lead to diarrhea and cramps. Try cutting back on caffeinated items like coffee and chocolate. Also limit sodas. Along with the caffeine, the bubbles can make you gassy.
  • Sweeteners. Sorbitol, mannitol, xylitol, and other sugar-free sweeteners ending in "-ol" have a laxative effect in certain people. If they bother you, read labels and avoid foods that contain these sweeteners.

Your doctor might recommend that you eat a special diet called low FODMAP diet. This diet is low in foods that have certain carbohydrates. It limits many of the foods on the IBS trigger list, such as some fruits, vegetables, dairy products, wheat and rye, and sweeteners like sorbitol and high-fructose corn syrup.

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Medicine

No medications can cure IBS. But your doctor may recommend one of the following types of medication if diet alone doesn't work:

  • Laxatives can help with constipation. They include lubiprostone (Amitiza) and linaclotide (Linzess). They can also help with abdominal pain.
  • Loperamide (Imodium), eluxadoline (Viberzi), cholestyramine (Prevalite, Questran), colestipol (Colestid) can help stop diarrhea.
  • Cimetropium, hyoscyamine (Levsin), pinaverium, dicyclomine (Bentyl), mebeverine hydrochloride (Colofac), and cimetropium bromide help ease belly spasms.
  • If other treatments don't work for you, your doctor may suggest you try antibiotics for a few weeks. They may relieve IBS symptoms by lowering the number of bacteria in your intestines.
  • If you have both IBS pain and depression, your doctor may prescribe antidepressants such as imipramine (Tofranil), nortriptyline (Pamelor), fluoxetine (Prozac, Sarafem), or paroxetine (Paxil).

Two medicines are approved for women who have severe IBS:

  • Alosetron (Lotronex) can help with severe diarrhea that hasn't gotten better with other treatments.
  • Lubiprostone (Amitiza) can help with severe constipation.

Any of these drugs can cause side effects. Ask your doctor what to do if you have problems with your medicine.

Stress Relief

Stress doesn't cause IBS, but it can make your symptoms worse. Stress can increase the movement of food through your intestines, which could lead to more diarrhea. Stress can also make you more sensitive to belly pain.

To manage stress, your doctor may suggest you:

  • Try relaxation techniques like deep breathing and meditation.
  • Exercise daily. Activity helps food move more smoothly through your intestines and relieves stress. Some programs like yoga and tai chi combine exercise with relaxation.
  • Get into a sleep routine. Go to bed at the same time each night and wake up at the same time each morning so that you get enough sleep.
  • Try talk therapy with a counselor or therapist. Cognitive behavioral therapy is a form of talk therapy that helps you change the negative thoughts that stress you out.

It can also be helpful to join an IBS support group. You'll meet other people with the same condition. They can offer advice on techniques they've used to relieve their symptoms.

WebMD Medical Reference Reviewed by Lisa Bernstein, MD on April 25, 2017

Sources

SOURCES:

Alimentary Pharmacology & Therapeutics, January 2008.

International Foundation for Functional Gastrointestinal Disorders: "Diagnosis of IBS," "Foods That May Cause Gas," "Stress and IBS."

Mayo Clinic: "Irritable bowel syndrome: Causes," "Irritable bowel syndrome: Coping and support," "Irritable bowel syndrome: Definition," "Irritable bowel syndrome: Lifestyle and home remedies," "Irritable bowel syndrome: Tests and diagnosis," "Irritable bowel syndrome: Treatments and drugs."

PubMed Central: "Diagnosing Irritable Bowel Syndrome: What's Too Much, What's Enough?"

National Institute of Diabetes and Digestive and Kidney Diseases: "Eating, Diet, & Nutrition for Irritable Bowel Syndrome," "Treatment for Irritable Bowel Syndrome."

University of Michigan Health System: "Elimination Diet."

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