What is IBS? Part Two: Treatment and Management

Receiving a diagnosis of IBS can feel like a mixed bag for most. Certainly, there are feelings of relieve to finally have an answer and to know that there is nothing causing harm to your body. But there can also be feelings of frustration and helplessness at having a chronic condition that doesn’t have a cure.

There may not be a cure for IBS at this time, but there are many ways of managing symptoms! And now that you have a diagnosis, you can start really exploring them and find what works best for you.


Lifestyle and dietary modifications:

This is usually the first go to management treatment explored by many physicians. As a registered dietitian, I understand that it is also a very difficult path. But lifestyle and dietary modifications can have great effects on managing symptoms of gas, bloating, and stool consistency and frequency!

Dietary management:
  1. Traditional approach: reducing gas producing foods (such as beans, cabbage, brussels sprouts, onions, etc.), limiting caffeine, alcohol, fatty foods, and spicy foods, as well as avoiding any foods believed to be triggers for your symptoms. Changing meal size and timing may also improve symptoms.
  2. Increase or decrease dietary fibre: decreasing in-soluble fibre (ex. Inulin) and /or increasing soluble fibre (ex. Psyllium) slowly may show improvement to symptoms. Increases in fibre should be gradual to avoid an increase in gas and bloating.
  3. Low FODMAP diet: this diet eliminates carbohydrates that our bodies have difficulty digesting but are then fermented by our intestinal bacteria, resulting in gas, bloating, and possibly excess fluid being drawing into the colon. After about 4-8 weeks of complete elimination of foods containing these specific carbohydrates, each type of these is then challenged to find out which are issues for you. After that the diet is then liberated to include foods that shouldn’t cause you symptoms. This diet is very complex but has had lots of great research proving its benefit for improving abdominal pain, bloating, gas, and stool consistency. It is highly recommended to see a registered dietitian before staring this diet to avoid unnecessary over-restriction and to ensure a nutritionally compete diet is still being consumed.
Physical activity:

Living an active lifestyle has been shown to be beneficial to relief symptoms of IBS. Some light activity can sometimes be enough to get our intestines moving too. This can be beneficial for those with constipation, gas, or bloating.


Pharmacological therapy:

If dietary changes do not show improvement in symptoms or if symptoms are moderate to severe, there are many medications that your physician can trial with you. This approach is symptom based around which type of IBS you have: IBS-constipation predominate or IBS-diarrhea predominate. It can be a difficult approach for those with IBS-mixed (alternate between constipation and diarrhea) because medications tend to be specific for resolving either diarrhea or constipation. (Please note that I am a registered dietitian and cannot provide recommendations for medications. Talk with your doctor if you want to learn more about them.)

Constipation resolving medications:

Some examples are polyethylene glycol (PEG) and guanylate cyclase agonists. These are osmotic laxatives and can improve stool consistency, increase transit time, and reduce straining during a bowel movement. Most do not improve symptoms of bloating though. Some can improve abdominal pain. Other drugs increase colonic motility which can increase frequency of bowel movements.

Diarrhea resolving medications:

Antidiarrheals (ex. Loperamide) inhibit peristalsis (intestinal contractions), prolong transit time, and reduce fecal volume. This can decrease frequency of bowel movements and improve consistency of stool. They typically do not show benefit for reducing bloating or abdominal pain.

Medications for reducing abdominal pain and bloating:

Antispasmodic medications used on an as-needed basis can provide short term relief of abdominal pain. Antidepressants (ex. tricyclic antidepressants TCAs) can have analgesic properties independent of mood improving effects to decrease abdominal pain, and can slow transit time.  The effect of these medications tend be delayed and can take 3-4 weeks to show improvement.

IBS Medication

New researching is always being done on IBS and symptom management for it. We have come a long way in the last 10 years! Moving forward with my blog, it will mostly focus on the Low FODMAP diet and other dietary and lifestyle management for IBS.

Hope you found this post informative!

Disclaimer: This blog is meant to be informative and supportive and in no way be a substitute for medical advice. If you have IBS or you suspect that you have IBS you should speak with your physician about your symptoms and treatment options. I also recommend working with a registered dietitian before making any changes to your diet.