Irritable bowel syndrome (IBS) is more than just a pain in the gut.
The gastrointestinal disorder characterized by abdominal pain, altered bowel habits and bloating can have a serious impact on quality of life. Braden Kuo, MD, and Kyle Staller, MD, MPH, gastroenterology experts from the Digestive Healthcare Center at Massachusetts General Hospital, have tips for dealing with IBS.
Treatments range from dietary changes to cholesterol medication and hypnotherapy. Like with many illnesses, your approach depends on the severity of symptoms.
“If symptoms are mild, you have so many resources to potentially treat yourself,” Dr. Kuo says.
What is irritable bowel syndrome?
Abdominal pain is the hallmark symptom of IBS. This starts with a change in form or consistency of stool. The pain improves with defecation.
There are three different types of IBS:
IBS with constipation includes mostly hard or lumpy stools. Loose stools are rare.
IBS with diarrhea comes with loose or watery stools. Hard stools are rare.
Mixed IBS includes a mix of hard and loose stools.
Conditions that can occur alongside IBS include depression, anxiety, fibromyalgia, chronic fatigue syndrome and chronic pelvic pain.
Abdominal pain and stool abnormalities don’t always indicate IBS. It’s worth exploring other causes if there’s a new onset of symptoms at 50 years or older, unintentional weight loss, nighttime diarrhea, anemia, bloody stools or family history of colon cancer, celiac disease or ulcerative colitis. A colonoscopy is useful for patients with alarm symptoms or those over 50.
In fact, most people who suffer from IBS don’t seek medical care. Instead, they may find relief in over-the-counter diarrhea and constipation medications.
People with medium-level symptoms often see their primary care doctor, while severe symptoms call for a multidisciplinary approach, according to Dr. Staller.
Dealing with Diet
Seventy percent of IBS patients point to diet as one cause of their symptoms. Identifying the “problem food” can take time. “One thing causes symptoms one day, but it doesn’t the next day,” Dr. Staller says. It can help to use a food diary to track how you feel after eating certain foods.
Spicy and fatty foods can be problematic. Irritable bowel syndrome patients suffer higher rates of lactose intolerance, so avoiding dairy can be helpful. Avoiding gluten has helped some patients.
Fiber is one known way to address gastrointestinal issues. Dietary fiber is less helpful than soluble fiber, which comes in the form of psyllium (Metamucil), methylcellulose (Citrucel) or calcium polycarbophil (FiberCon). If you’re taking soluble fiber, make sure to increase fluid intake as well, Dr. Staller says. And if bloating is an issue, avoid Metamucil.
IBS Medications
If altering your diet doesn’t do the trick, over-the-counter and prescription medications can help with constipation and diarrhea.
Osmotic laxatives, like polyethylene glycol (Miralax), are probably the safest for long-term use, according to Dr. Staller. Stimulant laxatives may be taken as needed, although there have been concerns about dependence with long-term use. Prescription laxatives are also an option.
For diarrhea, loperamide (Immodium) can improve stool consistency and decrease frequency, but it won’t help with abdominal pain. Cholesterol medication can help with bile acid diarrhea.
Who suffers from irritable bowel syndrome?
As many as 20% of Americans suffer from IBS, according to the Food and Drug Administration.
More women are affected than men.
Adults under 50-years old suffer more than others.
For many IBS sufferers, abdominal pain is more troubling than constipation or diarrhea. Neuromodulators turn down the volume of oversensitive nerves. Dr. Staller says many of those medications are antidepressants, so patients should have an open mind about treatment.
Alternative Treatments
Psychological and behavioral therapy can reduce symptoms, especially if a patient believes there’s a psychological component to their condition. For example, if a patient’s IBS symptoms are triggered by a stressful situation, they may benefit from coping techniques taught at therapy.
Probiotics may be helpful for treating IBS. The hard part is finding the right match for your stomach’s bacteria. “There’s a gazillion,” Dr. Staller says.
Acupuncture did not show benefits in controlled trials, but may be helpful to certain patients, according to Dr. Staller. Hypnotherapy may also be used to reduce symptoms.
For more information about digestive health and treating neurointestinal disorders at Massachusetts General Hospital, please visit the Center for Neurointestinal Health and Digestive Healthcare Center. Your support will help to fund new research to understand the cause of these disorders and to develop novel treatments.