IBS: The Old and The New

IBS (irritable bowel syndrome) is functional disorder of the gastrointestinal tract, meaning it is caused by a problem with the way the gastrointestinal tract works.  People who suffer from IBS do not have intestinal tract damage, but rather suffer from a constellation of symptoms that occur together.

For those people recently diagnosed with IBS or those who have suffered for many years, it remains important to understand that IBS is a chronic but manageable condition. There is no single treatment or medication for IBS. Successful treatment depends on a close and on-going relationship with your physician as well as lifestyle and dietary changes and the use of medications.

Lifestyle and Dietary Changes

Keeping a dietary log will help you recognize foods that may trigger symptoms. Limiting caffeine and alcohol intake, minimizing dairy products, and avoiding sugar substitutes and artificial sweeteners can significantly decrease the frequency and urgency of diarrhea.  Avoiding beans, uncooked vegetables and lowering the fat content of your foods may alleviate gassiness and bloating. Daily fiber supplements and increased water intake help with constipation-predominant IBD (IBS-C).

In addition to dietary changes, lifestyle modifications help reduce symptoms in IBS as well.  Smoking cessation is critical for overall health as well as the health of your intestinal tract. Regular physical exercise has been shown to reduce the frequency of symptoms and protect against symptom deterioration. Several studies have also demonstrated the benefits of stress management through behavioral modification on the symptoms of IBS.

Medications for IBS

Keeping in mind that the treatment of IBS is multi-faceted, medications play an important role.  Traditionally anticholinergic medications such as Bentyl and Nulev have been used to help temporarily alleviate bloating and discomfort.  Imodium can be helpful for those with frequent diarrhea and urgency. Fiber supplements seem to benefit those with constipation and alternating IBS-D and IBS-C. Antidepressants and anti-anxiety medication may also provide some benefit for more chronic symptoms.  Within the last several years, probiotics and even antibiotics have been used with some success in IBS. This benefit may be due, in part, to bacterial imbalances in the intestine that may exist in patients who suffer from IBS.

Some of the recently approved medications for IBS have a more specific focus. Several years ago, Lotronex (Alosetron) was approved for women with IBS and diarrhea; this medication is designed to relax the intestine and slow the transit of stool thereby helping with diarrhea and bloating.  Only a gastroenterologist should prescribe this medication. Amitiza (Lubiprostone) is prescribed for adult women and men who have IBS with constipation. It is taken twice a day and works by increasing the fluid secretion into your intestine thereby softening your stool and increasing bowel movements. This medication has a long track record and has been shown to be safe and effective in patients with IBS-C and also those with chronic constipation as well. The “new kid on the block” is Linzess (Linaclotide). It is a novel medication that gained FDA approval in late 2012 to treat patients with chronic constipation and those with IBS and constipation. Linzess is taken once daily and has been shown to relieve discomfort associated with IBS-C and help with more complete evacuation of stools.

IBS Symptoms Can Be Treated

Estimates suggest that IBS affects up to 15% of Americans. Because of its chronic and episodic nature, IBS has considerable impact on its sufferers’ lives. The most important thing to keep in mind is that IBS symptoms can be treated. Establish a good relationship with your physician and make sure you are fully evaluated for other potential underlying diseases. Treatment of IBS involves long-term strategies using a combination of lifestyle changes, dietary modifications and medication to minimize symptoms.