Many people with mild irritable bowel syndrome (IBS) symptoms don't need any treatment. No treatment is likely to take away symptoms completely; however, treatment can often ease symptoms and improve your quality of life.
What lifestyle changes can help?
- Exercise. Regular exercise is known to help to ease symptoms.
- Managing stress levels. Stress and other emotional factors may trigger symptoms in some people. So, anything that can reduce your level of stress or emotional upset may help.
- Keeping a symptom diary. It may help to keep a food and lifestyle diary for 2-4 weeks to monitor symptoms and activities. Note everything that you eat and drink, times that you were stressed, and when you took any formal exercise. This may identify triggers, such as a food, alcohol, or emotional stresses, and may show if exercise helps to ease or to prevent symptoms.
What dietary changes can help?
Some people with irritable bowel syndrome (IBS) find that certain foods can trigger symptoms or make symptoms worse. See separate leaflet called Irritable Bowel Syndrome Diet Sheet for more details.
What medicines may help treat irritable bowel syndrome?
Antispasmodic medicines for tummy (abdominal) pain
These are medicines that relax the muscles in the wall of the gut. There are several types of antispasmodics. For example, mebeverine, hyoscine and peppermint oil. The pain may ease with medication but may not go away completely.
Constipation is sometimes a main symptom of IBS. If so, it may help if you increase the fibre in your diet. Sometimes laxatives are advised for short periods if increasing fibre is not enough to ease a troublesome bout of constipation. It is best to avoid lactulose if you have IBS.
A medicine called linaclotide works in a completely different way to other medicines for treating constipation. It has been shown to reduce pain, bloating and constipation symptoms.
An antidiarrhoeal medicine (for example, loperamide) may be useful if diarrhoea is a main symptom. The dose of loperamide needed to control diarrhoea varies considerably.
Clinical Editor's note
November 2017 - Dr Hayley Willacy read the recently released technology appraisal from NICE for Eluxadoline - see Further reading below. This is an option for treating irritable bowel syndrome with diarrhoea in adults, only if the condition has not responded to other medicines or they are contraindicated or not tolerated, and it is started by a specialist. Eluxadoline should be stopped after 4 weeks if there is inadequate relief of the symptoms of irritable bowel syndrome with diarrhoea. The most common side-effects are nausea, constipation and abdominal pain.
Peppermint oil may help with bloating and wind. For some people peppermint oil also helps with tummy pains and spasms.
A tricyclic antidepressant is sometimes used to treat IBS. An example is amitriptyline. Tricyclic antidepressants are used in a variety of painful conditions, including IBS. SSRI antidepressant medicines (for example, fluoxetine) can also be used for IBS. They may work by affecting the way you feel pain.
What else might help with treating irritable bowel syndrome?
Any stressful situation (for example, family problems, work stress, examinations) may trigger symptoms of irritable bowel syndrome (IBS) in some people. Examples of psychological therapies are cognitive behavioural therapy (CBT), hypnotherapy and psychotherapy. Psychological therapies can be very effective for some people with IBS.
Further reading and references
Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care; NICE Clinical Guideline (February 2008, updated April 2017)
Irritable bowel syndrome; NICE CKS, February 2013 (UK access only)
Ruepert L, Quartero AO, de Wit NJ, et al; Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2011 Aug 10(8):CD003460.
Bohn L, Storsrud S, Liljebo T, et al; Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015 Nov149(6):1399-1407.e2. doi: 10.1053/j.gastro.2015.07.054. Epub 2015 Aug 5.
Didari T, Mozaffari S, Nikfar S, et al; Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World J Gastroenterol. 2015 Mar 1421(10):3072-84. doi: 10.3748/wjg.v21.i10.3072.
Irritable bowel syndrome (diarrhoea) - eluxadoline [ID870]; NICE Technology appraisal (in development) expected publication August 30th 2017
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