The medical community has not yet determined the cause for Irritable Bowel Syndrome.
A combination of treatments may help a sufferer cope with the symptoms; however given the diverse symptoms of IBS sufferers; diarrhea
, pain, bloating, etc.., and it's chronic nature, none of these treatments at present will ultimately cure IBS.
IBS is a non-life threatening illness. It does not progress or increase your risk of developing Inflammatory Bowel Disease or Cancer. Treatment focuses on the relief of symptoms so you can live your life as normally as possible.
There is much anecdotal information on the internet as to what may relieve IBS symptoms. We recommend that before starting any new dietary, medical food or over the counter (OTC) remedy, that you consult with your physian. Physician's rely on risk and benefit decisions based on reproducible research data when they suggest a treatment for someone suffering from IBS.
Based on your physician's diagnosis
after the appropriate medical tests
, treatment, in our opinion, may be different for those suffering from mild, moderate or severe symptoms; however, they may be summarized as follows.
Mild: manage stress and make changes to your diet and lifestyle
Moderate: As per Mild + fiber supplements, over-the-counter (OTC), anticholinergic, or like, medications.
Severe: As per Moderate + tricyclic or SSRI antidepressants, or 5-HT3 or 5-HT4 or Chloride channel activator or guanylate cyclase-C (GC-C) agonist medication.
Your physician may recommend one or more or none of these treatments. See your physician for all recommendations for treatment. It is very important to follow-up with your physician. Refer to the medication page for an overview of medications for IBS.
Specific Treatments Now and the Future:
Cognitive Behavioral Therapy (CBT) and Hypnosis: There is research evidence that IBS symptoms respond favorably to other therapeutic approaches such as cognitive behavioral therapy (CBT) and hypnosis. As IBS is a chronic condition, with an ongoing fluctuating course, these treatments may help the individual to develop skills for managing the condition over the long haul. Many people with IBS also have a co-existing anxiety or depressive disorder, the symptoms of which also benefit from these types of treatments.
Probiotics: Probiotics (good bacteria) which contain the strain bifidobacterium infantis 35624 have been shown to relieve abdominal pain, bloating, urgency, constipation or diarrhea. Align and VSL#3 are marketed over-the-counter (OTC) with this strain.
5-HT3 antagonist: Lotronex (alosetron), is used for the control of pain and diarrhea associated with IBS in women (IBS-D). It was removed from the market at the recommendation of the United States FDA in Nov. 2000 and re-introduced in June 2002.
5-HT4 receptor agonist: These medications help relieve the symptoms of constipation and pain associated with IBS and constipation (IBS-C), and chronic idiopathic constipation in women. Zelnorm/Zelmac (tegaserod) was approved by the FDA in the United States. Effective April 2, 2008 Zelnorm is only available to patients in the U.S. under emergency situations.
Chloride channel activator: These medications help relieve the symptoms of constipation and pain. Amitiza (lubiprostone) was approved by the FDA in the United States for IBS with constipation and chronic idiopathic constipation.
Guanylate cyclase-C (GC-C) agonist: These medications help relieve the symptons of constipation and abdominal pain. Linzess (linaclotide) was approved by the FDA in the United States for IBS with constipation and chronic idiopathic constipation.
μ- and κ-opioid receptor agonist and δ-opioid receptor antagonist that acts locally in the enteric nervous system, possibly decreasing adverse effects on the central nervous system. Viberzi (eluxadoline) was approved by the FDA in the United States in men and women adults for the treatment of irritable bowel syndrome with diarrhea (IBS-D).
Antibiotics: There is some research evidence suggesting that IBS symptoms may be caused in part by an abnormal growth of bacteria in the small intestine, referred to as Small Intestinal Bacterial Overgrowth (SIBO). A specific regiment of antibiotics, namely Xifaxan (rifaximin) has been approved by the FDA in the United States in men and women for the treatment of irritable bowel syndrome with diarrhea (IBS-D). Rifaximin is marketed by the name Zaxine in Canada, Xifaxnta in the UK and Xifapill and Ciboz in India, but not as of yet, for the indication of IBS-D.
Prescription Medical Food: These products are regulated by the FDA under the Orphan Drug Act and are meant to be used under physician supervision. One prescription medical food is indicated for the clinical dietary management of IBS-D under physician supervision as part of ongoing medical care for a specific condition or disease. Some patients due to chronic conditions, diseases or specific drug therapies have an impaired ability to ingest, digest, absorb, or metabolize food and certain nutrients. This medical food product is prescribed to help people manage their bowel problem.
Mark Pimentel MD, Annals of Internal Medicine vol. 145 no. 8 557-563