There are three main IBS types, described by their main symptoms: diarrhoea, constipation or a mixture of the two:
- IBS with constipation. This comes with stomach pain and discomfort, bloating, abnormally delayed or infrequent bowel movement, or lumpy/hard stool.
- IBS with diarrhoea. This comes with stomach pain and discomfort, an urgent need to move your bowels, abnormally frequent bowel movements, or loose/watery stool.
There is no cure for IBS, but its symptoms can be treated with a combination of the following:
- changes in eating, diet and nutrition
- therapies for mental health problems
Certain foods and drinks may cause IBS symptoms in some people, such as
- foods high in fat
- milk products
- drinks with alcohol or caffeine
- drinks with large amounts of artificial sweeteners, substances used in place of sugar foods that may cause gas, such as beans and cabbage
People with IBS may want to limit or avoid these foods. Keeping a food diary is a good way to track which foods cause symptoms so they can be reduced or removed from the diet.
Dietary fiber may lessen constipation in people with IBS, but it may not help lower pain. Fiber helps keep stool soft so it moves smoothly through the colon.
The Academy of Nutrition and Dietetics recommends adults consume 20 grams to 35 grams of fiber a day.3 Fiber may cause gas and trigger symptoms in some people with IBS. Increasing fiber intake by 2 to 3 grams per day may help reduce the risk of increased gas and bloating.
A successful treatment plan should include education, nutrition and appropriate medication.
The health-care provider will select medications based on your symptoms.
- Fiber supplements. Fiber supplements may be recommended to relieve constipation when increasing dietary fiber is ineffective.
- Laxatives. Constipation can be treated with laxative medications. Laxatives work in different ways, and a health-care provider can provide information about which type is best for each person. More information about the different types of laxatives can be found in the National Digestive Diseases Information Clearinghouse (NDDIC) fact sheet Constipation.
- Antidiarrheals. Loperamide has been found to reduce diarrhea in people with IBS, though it doesn’t reduce pain, bloating, or other symptoms. Loperamide reduces stool frequency and improves stool consistency by slowing the movement of stool through the colon.
- Antispasmodics. Antispasmodics, such as hyoscine, cimetropium and pinaverium, help to control colon muscle spasms and reduce abdominal pain.
- Antidepressants. Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) in low doses can help relieve IBS symptoms including abdominal pain. TCAs work in people with IBS by reducing sensitivity to pain in the GI tract as well as normalizing GI motility and secretion.
- Lubiprostone (Amitiza). Lubiprostone is prescribed for people who have IBS-C. The medication has been found to improve symptoms of abdominal pain or discomfort, stool consistency, straining and constipation severity.
The antibiotic rifaximin can reduce abdominal bloating by treating SIBO, small intestinal bacterial growth. But scientists are still debating the use of antibiotics to treat IBS, and more research is needed.
Probiotics are live microorganisms, usually bacteria, that are similar to microorganisms normally found in the GI tract. Studies have found that probiotics, specifically Bifidobacteria and certain probiotic combinations, improve symptoms of IBS when taken in large enough amounts. But more research is needed.
Probiotics can be found in dietary supplements, such as capsules, tablets and powders, and in some foods, such as yogurt. A health-care provider can give information about the right kind and right amount of probiotics to take to improve IBS symptoms. (For more information about probiotics, click here.)
Therapies for Mental Health Problems
The following therapies can help improve IBS symptoms because of mental health problems:
- Talk therapy. Talking with a therapist may reduce stress and improve IBS symptoms. Two types of talk therapy used to treat IBS are cognitive behavioral therapy and psychodynamic, or interpersonal, therapy. Cognitive behavioral therapy focuses on the person’s thoughts and actions. Psychodynamic therapy focuses on how emotions affect IBS symptoms. This type of therapy often involves relaxation and stress management techniques.
- Hypnotherapy. The therapist uses hypnosis to help the person relax into a trancelike state. This type of therapy may help you relax the muscles in the colon.
- Mindfulness training. People practicing this type of meditation are taught to focus their attention on sensations occurring at the moment and to avoid worrying about the meaning of those sensations, also called catastrophizing.