How to treat Irritable Bowel Syndrome
The most important thing is to understand what pattern of Irritable Bowel Syndrome is present and causing symptoms. Excluding those conditions that are known as “red flags” or serious health conditions – such as IBD (Inflammatory Bowel Disease) – is vital.
Treatment guidelines based on Irritable Bowel Syndrome patterns are readily available online and from reputable sources based here in Australia.
The following is a summary of treatments already covered in my last article – see What are Irritable Bowel Syndrome Treatments?.
General advice is given to address general lifestyle and diet factors such as:
- Diet – increase dietary fibre, for those for whom it is relevant. Avoid trigger foods that cause gas production. Include caffeine in this category as it accelerates bowel activity that can aggravate IBS – type D.
- Low FODMAP Diet
- Lifestyle advice – regular sleep and exercise has been found to be helpful with Irritable Bowel Syndrome.
- Stress Management and Relaxation Techniques – techniques to help manage stress where this has a clear impact on gut health. Mindfulness therapies to assist with relaxation and gut-related hypnotherapy may be of benefit and as effective as a low FODMAP Diet. (1)
- Medicines – anti-diarrhoeal, antispasmodic medicines, pain killers, antidepressants, and antibiotics are all discussed in “What are Irritable Bowel Syndrome Treatments”.
- Probiotics – this is a contentious area and needs further studies to clarify the efficacy of specific strains of probiotics or a combination of probiotics that are proven to be helpful. This area is full of ongoing studies and there is tentatively some relief for IBS sufferers with some Lactobacillus strains.
- New approaches – enzyme therapy and the impact of herbal extracts – both are novel and require further studies.
- Diet changes: a FODMAP approach may help to identify trigger foods. Avoiding caffeine can alleviate as it increases bowel motility.
- Symptom control using anti-diarrhoeal medications +/ anti-spasm medications or peppermint may also assist with this.
Slightly *alternate view:
- Probiotics: single probiotic therapy – Bacillus Coagulans MCT 5856 has been found in animal studies to relieve diarrhoea (2.a.) A small trial on humans showed a significant decrease in bloating, diarrhoea, abdominal pain and stool frequency in the group receiving Bacillus Coagulans MCT 5856 compared to the placebo group in IBS – Type D sufferers. (2.b.)
Overall relief from bloating, gas, and incomplete evacuation with Bifidobacterium infantis 35625. (2.c)
Combination therapy with a variety of probiotic strains (Lactobacillus acidophilus, L. rhamnosus, Bifidobacterium breve, B. actis, B. longum, and Streptococcus thermophilus) was shown in one particular study was found to provide effective relief for IBS – Type D sufferers. (2.d.)
- Antibiotics: Rifaximin was approved by the FDA in 2015 to treat IBS – Type D. It is given over 10-14 days. (3)
- Faecal Microbial Transplant (FMT): or “poo transplant” has been shown to give symptom relief for IBS – Type D and Type D + C for up to 3 months, but not effective at 12 months. (4)
- Dietary fibre: in the form of soluble fibres such as taking psyllium husks, guar gum or inulin to assist with softening the consistency of the stool.
- Hydration: increase water intake to improve stool consistency.
- Laxatives: can create problems long term with disturbed bowel wall activity. It can lead to a “lazy” bowel thereby worsening the situation.
- Antispasmodics: to relieve cramping pain. Such as Peppermint oil by decreasing the sensitivity of pain fibres in IBS. It is a calcium channel blocker and acts in the smooth muscle of the bowel, thus leading to a decrease in muscular contraction = anti-spasm.
Slightly *alternate view:
- Probiotics: a study showed that a combination probiotic (L. acidophilus, L. reuteri, L. plantarum, L. rhamnosus, and B. animalis subsp. lactis) to help improve bowels movements and stool consistency in a group of IBS – Type C sufferers. (2.e.)
S. boulardii CNCM I-745 was found to decrease substance P (pain fibres and proinflammatory cytokines in an animal study that mimicked the conditions found in IBS – Type C. (2.f.)
Another strain (S.Boulardii I-3856 at a dose of 1,000 mg per day) was found to decrease pain, discomfort and bloating cf to placebo. (2.g.)
- Antibiotics: the use of Rifamxin + Neomycin was found to improve constipation, straining and bloating in a small group of IBS – Type C patients. (5)
- Faecal Microbial Transplant: it appears that IBS C patients have an altered gut flora and may benefit from FMT. (6)
Mainstream focus is on:
- Diet: is focussed on avoiding triggers that exacerbate symptoms. In this case fibre may aggravate symptoms and is best avoided.
Avoid trigger foods!!! An elimination diet to figure out trigger foods. Dairy and caffeine also need to be considered carefully.
- Lifestyle: sleep, regular exercise and stress management are vital. Even consider mindfulness therapies as previously mentioned – see above.
- Medications: the use of antidepressants such as SSRI’s are used to alter the pain signalling associated with IBS.
- Symptom relief: see above.
Slightly *alternate view:
- Probiotics: there is no one probiotic that resolves all symptoms in IBS and there is a lack of consistent data. This link shows a table with probiotic strains and their efficacy. (2.h.)
Strain specificity for symptom relief, single or multiple strains, and dosage are needing further studies to give clear guidelines. (2.i.)
- Antibiotics: see above.
- Faecal Microbial Transplant: so far the general consensus that FMT as a general treatment for IBS is that it has no advantage over a placebo. (7) IBS is a complex condition and it’s management needs to be more specific or targeted.
Summary of How to treat Irritable Bowel Syndrome.
This overview is to give a guide as to what is accepted as evidence-based treatment options for Irritable Bowel Syndrome. Some areas definitely fall into the “grey zone” where the answer is as clear cut. E.g. the concept of a specific probiotic to alleviate specific symptoms.
What I often see in practice are patients are wanting clarity with what is wrong with them and what they need to do next to get better.
They may not be aware they even have Irritable Bowel Syndrome and are relieved to have a diagnosis!
This isn’t a ONE SIZE FITS ALL situation.
What do you do when the above doesn’t work???
Well, this is a controversial area and each case needs to be considered very carefully. An integrative or holistic approach is an individualistic approach in that the focus is looking at that one individual as a whole and trying to find what is unique to that person and what may be of help for them.
The digestive tract is like a factory line, it takes one step in that process to muck up to create dysfunction.
My recommendation is:
- Diagnosis: seek professional advice and guidance to exclude important “red flags” or medical conditions that are serious. This may include seeing a gastroenterologist (or gut doctor).
- Investigations: may include testing to determine exactly what’s going in your gut. This may involve blood testing, stool tests, and possibly breath testing to determine if there is an imbalance in the gut flora (or “gut bugs”).
- Food Diary: where you write down what you’re eating every day and then noting any bowels symptoms. This can help to identify trigger foods for Irritable Bowel Syndrome.
- Elimination diet: involves finding what foods trigger the IBS symptoms and removing them from the diet. A low FODMAP diet is helpful with this.
- Referral: to a dietician or nutritionist familiar in dealing with introducing a low FODMAP diet, to see if this helps. Alternatively, check out what work is being done at https://www.monashfodmap.com/. This has a wonderful guide into the world of FODMAP’s with up to date information and aides.
When nothing else works? Dysbiosis (or bacterial overgrowth) may be the culprit and further investigations – such as breath testing for Hydrogen or Methane production.
Stay tuned for more re: SIBO – or Small Intestinal Bacterial Overgrowth.
References:
1. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients.
Miller V, et al.
Aliment Pharmacol Ther. 2015 May; 41(9):844-55.
2.a. Evaluation of anti-diarrhoeal activity of Bacillus coagulansMTCC 5856 and its effect on gastrointestinal motility in Wistar rats. Int J Pharma Bio Sci 2016; 7: 311–16.
Majeed M, Natarajan S, Sivakumar A, Ali F, Pande A, Majeed S, et al.
2.b. Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant Irritable Bowel Syndrome: a double blind randomized placebo controlled pilot clinical study.
Majeed M, et al.
https://www.ncbi.nlm.nih.gov/pubmed/26922379
2.c. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome.
Whorwell PJ, et al.
https://www.ncbi.nlm.nih.gov/pubmed/16863564
2.d. Effect of administering a multi-species probiotic mixture on the changes in fecal microbiota and symptoms of irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial
Hyuk Yoon, et al.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566021/
2.e. A Randomized, Double-Blind, Placebo-Controlled Trial: The Efficacy of Multispecies Probiotic Supplementation in Alleviating Symptoms of Irritable Bowel Syndrome Associated with Constipation
Valerio Mezzasalma et al.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993960/
2.f. Saccharomyces boulardii CNCM I-745 supplementation reduces gastrointestinal dysfunction in an animal model of IBS
Paola Brun, et al.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181863
2.g. Randomized double blind placebo-controlled trial of Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome: improvement in abdominal pain and bloating in those with predominant constipation
Robin Spiller, et al
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924426/
2.h. https://badgut.org/information-centre/a-z-digestive-topics/probiotics-for-irritable-bowel-syndrome/
2.1. The Role of Bacteria, Probiotics and Diet in Irritable Bowel Syndrome
Ashton Harper, et al.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848117/
3. Rifaximin for Irritable Bowel Syndrome
A Meta-Analysis of Randomized Placebo-Controlled Trials
Jun Li, et al.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291563/
4. Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial.
Johnsen PH, et al.
https://www.ncbi.nlm.nih.gov/pubmed/29100842
5. Antibiotic treatment of constipation-predominant irritable bowel syndrome.
Pimentel M, et al.
https://www.ncbi.nlm.nih.gov/pubmed/24788320
6. Gut Microbiota and Chronic Constipation: A Review and Update.
Ohkusa T, et al.
https://www.ncbi.nlm.nih.gov/pubmed/30809523
7. Systematic review with meta‐analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome
Gianluca Ianiro, et al.
https://onlinelibrary.wiley.com/doi/10.1111/apt.15330
Disclaimer:
This article is written to give an overview of IBS Treatments only. It is meant to be a therapeutic guide that is best used in supervision with an appropriate health professional.
Where treatments are written as an “*alternate view” is to show an area that is not considered a mainstream medical approach to treating this condition. It is an emerging treatment that is under research and not accepted as a generally “accepted” or approved medical therapy.