By Robert Shmuts, MD, Gastroenterologist—Virtua Gastroenterology

If you've recently been diagnosed with irritable bowel syndrome (IBS), then you're probably coping with chronic abdominal discomfort or pain, bloating, and changes in bowel habits. Depending on what type of IBS you have, you may experience constipation, diarrhea, or both. These symptoms can cause physical and psychological discomfort.

If you think you may have IBS but haven't been diagnosed, make sure your healthcare provider checks to see if you have celiac disease, exocrine pancreatic insufficiency, carbohydrate malabsorption or other diseases that can cause similar symptoms. If you're over 45 and experience a sudden change in bowel symptoms, be sure to be screened for colon cancer. IBS most often starts in the teens or early adulthood, not after 50.

Once you've been diagnosed with IBS, it's important to find a management plan that works for you. This likely will involve trial and error at first and changes along the way. 

With IBS, your bowel is extra-sensitive to stimuli. Ordinary things like eating and having gas can trigger symptoms. Identifying what triggers your abnormal bowel function can help prevent or minimize your symptoms. You may want to keep a record of what foods, events and activities trigger your symptoms.

If your symptoms are mild, you may be able to manage your IBS through diet and lifestyle changes. These can include avoiding foods that trigger your symptoms, exercising regularly, drinking a lot of fluids, and getting enough sleep. If your symptoms are more severe, your health care provider may suggest medications.

Here are some options to help you manage your IBS:  

Dietary changes

Avoid high-fat meals. If you have IBS with diarrhea (IBS-D), it's important to limit fats. Most people have an urge to have a bowel movement about 60 minutes after a meal, but for a person with IBS-D, that reaction can occur more quickly and more strongly, and the reaction is related to the amount of fat in the meal. High-fat meals can cause vigorous colon contractions, triggering cramping, and diarrhea in people with IBS-D.

Try eliminating certain foods. The role of food in triggering IBS symptoms is not completely understood, but some people report more severe symptoms after eating certain foods. Your diet should be individualized for you. If you experience bloating, you may want to try limiting foods likely to cause gas, such as carbonated beverages, raw fruits and cruciferous vegetables including broccoli, Brussels sprouts, cabbage, and cauliflower. For some people, a low-fat, higher-fiber diet may help, while others feel better with a high-protein, low-carbohydrate diet. The American College of Gastroenterology suggests that low-FODMAP diets show promise in relieving symptoms. A FODMAP diet is low in fat, high in protein and low in fermentable carbohydrates such as fructose and lactose, called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). FODMAPs are found in some grains, vegetables, fruits and dairy products. You can experiment with a strict low-FODMAP diet. If it helps, you can work with a dietitian to gradually add back foods one at a time and see which ones bother you. A strict FODMAP diet isn't intended to be a permanent eating plan.

Consume dietary fiber. Dietary fiber may provide relief from symptoms, particularly by easing constipation. Whole-grain breads and cereals, beans, fruits and vegetables are good fiber sources. If dietary fiber causes uncomfortable bloating or isn't working, talk to your health care provider about fiber supplements or other medications. Only about one in six people experience improvements from increased dietary fiber, so don't get frustrated if it doesn't help.

Take pre- or probiotics. Some research indicates pre- and probiotics can help IBS symptoms by affecting bacteria in the gut. You can get these in many forms, ranging from live-culture yogurt, such as Activia, to capsules and powders. Start with a cup or two of yogurt a day and see if your symptoms respond. If more is needed, try over-the-counter capsules or packets that you can sprinkle on food. These supplements are available in grocery stores, pharmacies, health food stores and online. Talk to your health care provider about what form and dosage may be right for you.

Medications

Fiber supplements. Over-the-counter fiber supplements taken with fluids can provide fiber and help ease constipation or diarrhea, but studies on their effectiveness in treating IBS are inconclusive. For some people, they may cause discomfort, rather than relief. Talk to your health care provider about what may work best for you.

Laxatives. If supplements don't help, your provider may recommend a laxative for IBS with constipation (IBS-C). There are many types, including osmotic laxatives such as magnesium hydroxide (Milk of Magnesia) and polyethylene glycol (Miralax). Cathartic laxatives (Dulcolax), which usually contain senna or bisacodyl, work by irritating the inside of the colon. They aren't recommended for long-term use because they stop working after a while.

Anti-diarrheal medications. If you have IBS-D, you may try over-the-counter medications, such as loperamide (Imodium) to help control diarrhea. You also may benefit from bile acid binders, such as cholestyramine (Prevalite), colestipol (Colestid) or colesevelam (Welchol). These can cause bloating.

Anticholinergic and antispasmodic medications. These medications can reduce cramping. They may be used if you have diarrhea, but can worsen constipation and may cause difficulty urinating. They include hyoscyamine (Levsin) and dicyclomine (Bentyl). They should be used with caution if you have glaucoma.

Peppermint oil. Over-the-counter time-release capsules may ease cramping and spasms for people with IBS. As a side effect, they may also increase reflux.

Antidepressants. If you have pain or are depressed, talk to your health care provider about antidepressants. Your health care provider may suggest a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), or a low-dose tricyclic antidepressant, such as imipramine (Tofranil) or nortriptyline (Pamelor). In addition, serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Celexa, are shown to be extremely helpful in IBS patients who have an overlap of chronic neuropathic pain as well as depression and/or anxiety. Even if you're not depressed, an antidepressant may help take the edge off your pain. All antidepressants can cause some side effects, so be sure and discuss with your health care provider.

Antibiotics. Your health care provider may prescribe antibiotics such as rifaximin (Xifaxan). More research is needed on treating IBS with antibiotics.

IBS-specific prescription medications.  Several medicines are approved specifically for IBS. These are usually prescribed only when lifestyle changes and other treatments have not been successful.

• Lubiprostone (Amitiza) is approved for women over age 18 who have IBS with severe constipation. It increases fluid secretion in the small intestine to relieve constipation. Side effects may include nausea, diarrhea, and abdominal pain.
• Alosetron (Lotronex and generic) is intended only for women with severe IBS who have diarrhea and haven't responded to other medications. It is supposed to relax the colon and slow movement of waste through your bowel. It isn’t approved for men and has been linked to some side effects.
• Linaclotide (Linzess) is approved to treat IBS-C and chronic idiopathic constipation in women and men over age 18. It increases fluid secretion in the small intestine to relieve constipation. Side effects may include diarrhea.
• Eluxadoline (Viberzi) is used to treat IBS-D in men and women. It's not approved for people who have had their gallbladder removed, those who have a history of pancreatic issues, or those who consume excessive alcohol on a daily basis. It's important to discuss this medication with your physician to see if it's right for you.

Lifestyle changes

Practice stress reduction. Physical, emotional, and environmental stress may make your symptoms worse. Stress-reduction and relaxation strategies can help relieve or prevent IBS symptoms. You can try anything from personal meditation, yoga, or tai chi to stress-management counseling or hypnosis. There are many apps available to guide relaxation and stress reduction.

Get to the root of the problem. If you have a history of abuse or trauma, getting care for the long-term psychiatric effects of that trauma may help your symptoms.

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If stomach issues affect you often, it may be time to call 888-847-8823 to schedule an appointment with a Virtua gastroenterologist. 

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