Start right

IBS treatment starts with getting your facts straight. Learn all you can about IBS. Here are some things you need to know.

What it's not:

IBS . . .

• Is not caused by your diet
• Is not caused by stress
• Is not a risk for cancer
• Is not a risk for colitis
• Does not cause malnutrition
• Does not get worse with age, and
• Does not shorten life span

What it is:

IBS . . .

• Is a long-term condition
• Symptoms tend to come and go over time
• Symptoms often change over time
• Symptoms can usually be managed so that you feel better

Investigate

Are there certain things that seem to worsen your IBS? If so, sorting these out can be helpful. This is not always clear-cut. Using a diary for 2-3 weeks can help identify factors that seem to worsen or trigger symptoms. Discuss your findings with your doctor.

Lifestyle factors

Lifestyle habits do not cause IBS. But minimizing excesses may help reduce or avoid symptom flare-ups. Things like lack of sleep and exercise, prolonged stress, or irregular eating habits can worsen symptoms.

Dietary factors

Meals may seem to trigger symptoms. It may be the process of eating and not a certain food that sets off your symptoms. Eating stimulates the digestive tract, which can over-respond because of IBS.

• Try eating smaller meals, more often, spread throughout your day. Instead of 3 meals, try 5 or 6 regularly scheduled small meals.
• Slow down; don't rush through meals.
• Avoid meals that over-stimulate everyone's gut, like large meals or high fat foods.

If you think a certain food is a problem, try cutting it out of your diet for about 12 weeks. (If you suspect more than one, cut out one at a time so you know which one causes you problems.) If there's no change, go back to eating it.

The foods most likely to cause problems are:

• Insoluble (cereal) fiber
• Coffee/caffeine
• Chocolate
• Nuts

Be sure to eat a healthy diet. If food is a major problem for you, talk to your doctor or a registered dietician to work out a meal plan that's best for you. Here are some more general tips that may help you feel better.

Targeted Treatments

IBS is a group of symptoms. Most medicines are aimed at only one symptom. If your IBS is interfering with your daily life, your doctor may suggest or prescribe a medicine based on your most troubling symptom. Effects will vary widely from person to person.

All medicines have possible side effects. Ask your doctor or pharmacist about these including what to watch out for and what to do if side effects do occur.

Here are some examples of treatments that target certain symptoms:

Pain

Antispasmodics and some peppermint oils, taken before meals, may provide short-term reduction of abdominal pain after eating. However, the evidence for their effectiveness is weak.

Probiotics based on bifidobacteria and some combinations of probiotics may help reduce pain and bloating. Probiotics are live microorganisms that may be of benefit, but they must be taken in adequate amounts.

Constipation

A soluble fiber supplement, such as psyllium may help with simple constipation. If fiber doesn't help, talk to your doctor about a laxative. Neither helps with pain.

Diarrhea

Loperamide may help with simple diarrhea, as well as leakage or soiling. It does not help with pain.

Global Treatments

Global treatments affect more than one symptom. Their goal in IBS treatment is to reduce overall symptoms.

Relaxation therapy can be helpful to promote well-being. Hypnosis or cognitive behavioral therapy (CBT), delivered by trained therapists knowledgeable about IBS, has been shown to reduce pain and other IBS symptoms in some people.

Prescription Medicines

Drugs used to treat overall symptoms of IBS, including pain, are prescribed based on the dominant bowel symptom being experienced.

When constipation is the dominant bowel symptom, lubiprostone (Amitiza) may reduce overall IBS symptoms including pain, especially in women.

When diarrhea is the dominant bowel symptom, alosetron (Lotronex) may reduce overall IBS symptoms. This drug is currently available to women only through a special access program because of potential side effects.

Antidepressants

When symptoms are severe or have not responded to other IBS treatments, your doctor may suggest a low-dose antidepressant. These drugs are useful in IBS, not to treat depression, but to reduce pain and also overall symptoms. Doses are much lower than what is used to treat depression.

In general, when constipation is the dominant bowel symptom, a low dose selective serotonin receptor inhibitor (SSRI) may reduce pain and overall symptoms of IBS.

In general, when diarrhea is the dominant bowel symptom, a low dose tricyclic agent may reduce pain and overall symptoms of IBS.

However, either a tricyclic agent or SSRI may be tried regardless of the dominant bowel symptom.

Over-the-counter or prescription medicines

Remember, all medicines have potential side effects. What's a medicine? Anything you take for a therapeutic effect. It can be readily available over-the-counter, in a pharmacy or grocery store, or limited by prescription only. It might be a drug or a supplement; manufactured or "natural." It might come in a pill, a liquid, or a food product. When you take something for a long-term therapeutic effect, tell your doctor about it. He or she can help you monitor quality, effectiveness, possible interactions with other medicines you may be taking, or possible side effects.

Working with your doctor

IBS persists or recurs over time. A long-term relationship with a knowledgeable and empathetic doctor or therapist can be very important. Ideally, your doctor should:

• know your entire medical history,
• recognize the importance of your symptoms,
• empathize with your discomfort, and
• be prepared to spend the necessary time explaining their meaning.

Whether you see a family physician, internist, or other specialist for your IBS, your primary care doctor should help educate you about IBS and work with you, over the long term, to achieve the best possible results.