Our expert says:
Dawn, stress may definitely worsen IBS. It sounds like your GP has made the correct diagnosis and you can try his treatment for a week or two. If it doesn’t improve within two weeks, the best would be to contact him and let him now, as there are more potent drugs available. In general, a normal diet should be followed. If you suffer from abdominal distention and increased flatulence, you may benefit from dietary reduction or elimination of beans, cabbage, and other foods containing fermentable carbohydrates. Reduced intake of apple and grape juice, bananas, nuts, and raisins may also lessen the incidence of flatulence. Patients with evidence of lactose intolerance should reduce their intake of milk and dairy products. Bowel function may also be disturbed by the ingestion of sorbitol, mannitol, fructose, or combinations of sorbitol and fructose. Sorbitol and mannitol are artificial sweeteners used in dietetic foods and as drug vehicles, whereas fructose is a common constituent of fruits, berries, and plants. Patients with postprandial abdominal pain may try a low-fat diet supplemented with increased protein.
Increasing dietary fiber can help many patients with IBS, particularly those with constipation. A bland bulk-producing agent may be used (eg, raw bran, starting with 15 mL [1 tbs] with each meal, supplemented with increased fluid intake). Alternatively, psyllium hydrophilic mucilloid with two glasses of water tends to stabilize the water content of the bowel and provide bulk. These agents help retain water in the bowel and prevent constipation. They also can reduce colonic transit time and act as a shock absorber to prevent spasm of the bowel walls against each other. Fiber added in small amounts may also help reduce IBS-induced diarrhea by absorbing water and solidifying stool. However, excessive use of fiber can lead to bloating and diarrhea. Fiber doses must therefore be adjusted to individual patient needs.
Anticholinergic (antispasmodic) drugs (eg, hyoscyamine 0.125 mg 30 to 60 min before meals) may be used in combination with fiber agents. The use of narcotics, sedative hypnotics, and other drugs that produce dependency is discouraged. In patients with diarrhea, diphenoxylate 2.5 to 5 mg (one to two tablets) or loperamide 2 to 4 mg (one to two capsules) may be given before meals. Chronic use of antidiarrheals is discouraged because tolerance to the antidiarrheal effect may occur. Antidepressants (eg, desipramine, imipramine, and amitriptyline 50 to 150 mg daily) help many patients with either type of IBS. In addition to constipation and diarrhea, abdominal pain and bloating are relieved by antidepressants. These drugs can also reduce pain by down-regulating the activity of spinal cord and cortical afferent pathways arriving from the intestine. Finally, certain aromatic oils (carminatives) can relax smooth muscle and relieve pain caused by cramps in some patients. Peppermint oil is the most commonly used agent in this class. Let me know if you have more questions. (just post them as new questions to ensure that I get them Good luck.
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