Irritable bowel syndrome (IBS) is a real pain. You can have difficulty going to the toilet, which gives you a buildup of pain and discomfort in your gut. Or, you need to stay close to the toilet because you can’t contain your bowels when you get the urge.
Either way, it’s an incredibly unpleasant situation.
Ten to 15% of adults and an estimated 6% to 14% of children suffer from IBS. The symptoms can severely impact quality of life, so much so that the condition has been linked to suicidal behavior. That’s why it’s important to know that IBS is considered a real medical condition. And just as crucial, there is help out there for you.
Numerous medications are used to treat the unpleasant condition, but all have side effects you should be aware of. They can be as minor as dizziness and drowsiness, or as severe as muscle cramps, tremor and weight gain. You can find out more below about IBS and the best ways to treat it.
What is IBS?
IBS is termed a “functional gastrointestinal (GI) disorder.” This means that compared to average, the GI tract of people with IBS works more slowly, quickly or differently.
What causes IBS?
The cause is often due to many reasons and can be the result of GI hypersensitivity, small intestinal bacterial growth, psychosocial factors, increased intestinal inflammation and dysregulated communication between the gut and the brain.
What are the symptoms of IBS?
Symptoms include abdominal pain and discomfort, bloating, constipation, diarrhea or both, along with altered bowel function such as frequency, incomplete evacuation, and frequent changes hard/loose stool alteration.
What are the treatment options for IBS?
“I treat a lot of IBS sufferers, and it’s an illness that is quite difficult to treat,” says Jordan Tishler a Harvard-trained physician who focuses on holistic care. Generally, Dr. Tishler recommends a variety of approaches including medications, diet and alternative treatments. “They seem to work additively, [with] some approaches working better for some people than for others.”
Additional fiber is frequently recommended for IBS patients. Though, while “bulk-forming laxatives, like Metamucil, can be quite helpful, even for diarrhea-predominant IBS, they can also provoke gas and bloating,” notes Dr. Tishler.
Registered dietitian Ryan Whitcomb suggests that some individuals may experience additional relief with “galactooligosaccharide (GOS), a prebiotic that may improve stool consistency, flatulence, bloating and overall IBS symptoms.” It is available as a dietary supplement.
Common Medications Used to Treat IBS and their Side Effects
In terms of side effects, “all medicines have them, they come with the territory. However, we must remember that most people do NOT get side effects, or at least not badly enough to stop using the medication,” says Dr. Tishler. “That said, medications need to be viewed as a risk/benefit situation, and trying them with your eyes open and taking stock of their benefit after a while is the best plan.”
|Hyoscyamine||Levsin, Levbid and 25 other brand names||Antispasmodic||RX||Dry mouth, dizziness, blurred vision, nausea, drowsiness, weakness, and nervousness.|
|Loperamide||Imodium, Pepto Diarrhea Control, Diamode||Antidiarrheal||OTC||Dry mouth, dizziness and drowsiness.|
|Diphenoxylate/ Atropine||Lomotil, Lonox, Vi-Atro, Lomocot||Antidiarrheal||RX||Blurred vision, confusion, difficult urination, dry mouth, fever, headache and potentially addictive. Side effects after ceasing meds – sweating, muscle cramps, nausea, trembling and stomach cramps.|
|Amitriptyline/ desipramine||Vanatrip, Elavil, Endep / Norpramin||Tricyclic antidepressants||RX||Tachycardia, dizziness, nervousness, sedation, tremor and weight gain.|
|Duloxetine||Cymbalta||SSRI antidepressant||RX||Insomnia, dizziness, weakness, drowsiness, diarrhea, constipation, headache.|
|Xifaxan||Rifaximin||Antibiotic||RX||Flatulence, headache, nausea, abdominal pain, bowel urgency.|
Newer medications, such as Lotronex (alosetron), Viberzi (eluxadoline), Amitiza (lubiprostone) and Linzess (Linaclotide), have been approved specifically to treat IBS or relate symptoms, but they also have side effects to be aware of. Lotronex has a “black box” warning about the risk of serious gastrointestinal adverse reactions, including colitis and severe complications from constipation. Use of Viberzi can lead to pancreatitis and a muscle spasm in the digestive system. Amitiza can cause nausea, diarrhea and abdominal pain. And Linzess should be not be taken by those under 18.
“Food is a big IBS trigger, and it’s vital to address diet,” says Whitcomb. “When food is the cause of the symptoms, nothing will relieve the symptoms until the foods are identified and subsequently removed.”
Whitcomb suggests that removing inflammatory foods resolves most, if not all, IBS-related symptoms within a matter of weeks. “I use the MRT [mediator release testing] blood test which looks at 120 foods and 30 food chemicals and reports which foods the patient’s immune system is overreacting to, causing inflammation, pain and digestive issues,” he says. “Once we identify these foods, we remove them from the diet and add in the foods we know they are not reactive to.”
Low FODMAP Diet
FODMAPs refer to a group of carbohydrates that may trigger IBS symptoms due to poor absorption in the small intestine, which then leads to increased fermentation in the GI tract. Therefore, eliminating FODMAP foods provides relief.
The low FODMAP diet has been shown to be effective in reducing symptoms in 70%-86% of participants in scientific studies.
Probiotics (Bifidobacterium infantis 35624 and Lactobacillus plantarum 299V) help manipulate the types of bacteria in the gut, which subsequently relieves pain, discomfort, bloating and constipation. Probiotics (Bifidobacterium infantis M-63, breve M-16V and longum BB536) are particularly beneficial in children where other forms of treatment have no benefit. If you want to get more probiotics in your diet naturally, seek out yogurt.
Peppermint oil in capsule form taken 3 times a day 15-30 minutes before meals may help improve abdominal discomfort, bloating and overall symptoms. However, it can cause heartburn in some people.
Ginger and ginger extract may help reduce nausea, decrease inflammation, strengthen the gut lining and stimulate bowel function.
St. John’s wort may help relieve stress-related symptoms associated with IBS.
The only homeopathic remedy with some evidence) of benefits is asafoetida, an herb with a pungent smell.
Dr. Tishler, an expert on cannabis therapeutics, suggests the only therapy he has found to be highly effective is marijuana.
“Cannabis used once daily at bedtime can control symptoms without the side effects produced by laxatives or antidiarrheal medication like Imodium,” he says. “Of course, cannabis has some side effects as well, like intoxication or dry mouth. Though, with care, these side effects can be managed and IBS patients do very well.”