Treating irritable bowel syndrome (IBS) can be difficult as there are a number of different factors that can cause the condition, some of which can be hard to pinpoint.
Often, someone suffering from IBS will need to try a number of therapies, techniques or lifestyle changes in order to determine what works best for them.
1. Traditional therapies
Traditional therapies that treat the symptoms include:
- Bulking agents for constipation (i.e. Normacol)
- Antidiarrhoeals (such as Loperamide) for diarrhoea
- Antispasmodics (i.e. Brevispas, Colofac) for pain
2. Serotonergic drugs
Prucalopride seems to be effective in IBS patients with constipation and may become an important therapy in the near future.
3. Drugs that increase fluid secretion in the gut
Two new drugs in this category await approval in the USA. They are therefore not yet available in South Africa.
Linaclotideand lubiprostone stimulate the secretion of fluids, improve the ease of stool passage and thus improve colon transit time.
The most promising of the emerging drugs is rifaximin, an antibiotic that is not absorbed from the gut. Studies have found that not only did it improve all the symptoms, but the improvement was sustained for up to three months after stopping the medication. It is however, currently unavailable in South Africa.
6. Natural or alternative treatments
There are many non-medical treatments available.
Probiotics have been proved to be valuable to a certain subset of patients. A combination of two or more organisms seems to be more effective than preparations that contain only one organism. Lactobacillus on its own does nothing for IBS, whereas a combination with Bifidobacterium is quite effective.
Probiotics work via three mechanisms:
- Secretion of small molecules that have antimicrobial activities against other bacteria (direct antagonism).
- Stimulation of immune cells to kill off bad bacteria (immunomodulation).
- Making the gastrointestinal environment inhospitable to certain bacteria (exclusion).
- Peppermint oil can give substantial relief and has been extensively used by medical practitioners.
- Turmeric is also believed to give reasonable relief for symptoms.
Unfortunately, many products such as Slippery Elm have not been medically tested.
Acupuncture is not very successful and hypnosis rarely works, especially in people older than 50.
7. Changes in lifestyle or eating habits
Impact exercises definitely improve symptoms, especially constipation. There are quite a few “gas-forming” foods that can be excluded from the diet (fatty foods, onions, the cabbage family, dried beans and lentils including soy, citrus fruits, oats, nuts, visible fibre, avocado pears, coconut and yeast containing products).
There is now an entity termed non-coeliac gluten intolerance. They are IBS patients that do not have coeliac disease when tested, but respond very well to a gluten-free diet.
When to see a doctor:
IBS is unlikely to be the cause of abdominal symptoms if:
- Nocturnal symptoms are present
- A low albumin or anaemia is detected on blood testing
- There is bleeding
- Weight loss
- Change in bowel habit (new onset diarrhoea or constipation)
If you note these symptoms it is vital to see a trained medical practitioner for investigation with sonography of the abdomen, CT scan and colonoscopy.
Reviewed by Dr Ismail Moola MBCHB (UCT) FCP (SA) Cert Gastro Phys (SA) Specialist Physician / Gastroenterologist Netcare Sunninghill Hospital and part time Lecturer Department of Internal Medicine, Division of Gastroenterology, Wits University February 2015.
Previously reviewed by Dr E. Wilken (MBChB) Mmed (Int), gastroenterologist, May 2011