Demystifying Irritable Bowel Syndrome: Taking Action

Irritable bowel syndrome: it’s likely you’ve heard about it before, and there’s a good chance you or someone you know has experienced IBS.

IBS is a huge topic, and more complicated than you perhaps suspected. That’s why we split this article into two parts. Last week, we explored the basics of IBS—what it is, what it does—and this week, we’re talking about what you can do about it.

But first … what specifically causes IBS? And how do you manage its symptoms?

What causes IBS?

The exact cause of IBS is unknown. And because the causes are so varied, IBS is therefore difficult to prevent.

Possible causes include an overly sensitive colon or immune system. Postinfectious IBS is caused by a previous bacterial infection in the gastrointestinal tract—so an illness you had that went away … and came back as something potentially worse.

IBS triggers and diet

For many people, the key to managing IBS symptoms is to avoid triggers. And one of the biggest triggers is, no surprise, diet.

Certain foods as well as stress and anxiety can be triggers for IBS symptoms for many people.

The usual suspects

Given that triggers are unique to an individual, it’s difficult to list specific items. However, the commonest IBS trigger foods are exactly the culprits you’d expect: foods high in fat, caffeine, carbonation, alcohol, and insoluble fiber.

• Soda and seltzer
• Coffee, tea, soda, and chocolate
• Fried foods

Foods with hard-to-digest carbohydrates are the foods that need avoiding. If your stomach struggles to digest a food, it can irritate the small intestine and cause gas, bloating, and diarrhea.

Unfortunately, many of these foods are also very good for the average person, which necessitates that those with IBS have a very specific, tailored diet.

Common IBS-inciting foods to avoid

It may help to keep a food diary for a period to learn which foods are triggers for you.

Stress and IBS

The automatic movement—or motility—of your digestive system is controlled to a great degree by your nervous system. Stress can affect your nerves, pushing your digestive system into overdrive.

If you have IBS, your colon may be overly responsive to even slight disruption of your digestive system. It is also believed that IBS is affected by the immune system, which is affected by stress.

Know in advance the types of situations that may increase your anxiety levels. This can give you time to either plan to avoid these situations when possible or develop strategies to limit the stress.

IBS medications

If your symptoms do not improve through lifestyle or dietary changes, your doctor may suggest the use of medications. Different people can respond differently to the same medication, so you will need to work closely with your doctor to find the right medication for you.

When considering a new medication, it’s important to tell your doctor what you are already taking, including herbal remedies and over-the-counter medications. This goes for any medication, ever. Having a complete list of what you are already taking will help your doctor avoid any medication that could cause negative interactions.

Here are some commonly recommended and/or prescribed medication treatments for IBS, according to the International Foundation for Functional Gastrointestinal Disorders.

Laxatives

Constipation relief via loosening of the bowels.

• Osmotic (e.g., Miralax)
• Stimulant (e.g., Dulcolax and Correctol)
• Magnesium-based (e.g., milk of magnesia)

Antidiarrheals

Drugs designed to prevent or treat diarrhea.

• Loperamide (e.g., Imodium)

Secretagogues/Prosecretory agents

These are a class of drugs which increase fluid secretion and movement in the GI tract.

• Lubiprostone (e.g., Amitiza)
• Linaclotide (e.g., Linzess)
• Plecanatide (e.g., Trulance)
• Tenapenor (e.g., Ibsrela)

Antispasmodics

As their name implies, antispasmodics are meant to control / lessen spasms, and are widely used to treat IBS’s symptoms.

• Anticholinergics (e.g., Levsin, NuLev, Levbid and Bentyl)
• Peppermint oil (over the counter; found in teas, drops, gels, and capsules)

Antidepressants

A class of drug for treating depression—but used to treat many, many other ailments, such as headaches, chronic lower back pain, fibromyalgia, multiple sclerosis, and yes: irritable bowel syndrome.

Antibiotics

Medicines like amoxicillin that fight bacterial infections.

Rifaximin (e.g., Xifaxan) is the only antibiotic approved by the FDA for treatment of IBS.

Serotonin Agonists/Antagonists

Serotonin—or as it’s casually known, “the stuff in your brain that makes you happy”—has a low-key role in the movement of food through the gastrointestinal tract. Agonists target molecules; antagonists do the opposite and prevent agonists from targeting molecules.

• Tegaserod (e.g., Zelnorm)
• Alosetron (e.g., Lotronex)