Irritable bowel syndrome (IBS) affects around 25 to 45 million people, and two out of three are female. Plus, according to the IFFGD, the disorder costs the economy around $1.5 to $10 billion (excluding over-the-counter drugs and the cost of prescriptions) per year.
That’s not all.
Irritable bowel syndrome complications also cause people to miss an average of 13 days per year from work or school compared to five days per year for those without a gastrointestinal (GI) disorder. This can cause them to miss important work deadlines and even lose their jobs.
And while there’s no cure for IBS yet, many patients can improve their symptoms through lifestyle changes and medications. Let’s look at the best medication options for IBS patients and understand which ones are “right” for you.
What is IBS?
Irritable bowel syndrome (IBS) is a long-term gut condition characterized by abdominal pain or discomfort, bloating or a feeling of gaseousness, and changes in bowel movements such as diarrhea and constipation. It can affect anybody, although around two-thirds of those diagnosed with IBS are women, and one-third are men.
The exact cause of IBS remains unknown, but its symptoms appear to be related to abnormal digestive tract motility and sensation, which may result from disrupted interactions between the brain and gut, genetic factors, infections, and changes in the bacterial composition of the gut.
Why is there no “cure-all” medication for IBS?
IBS is a complex disease that leads to various functional changes in the body, including brain function alterations, bowel movement changes, and gut sensitivity. However, the underlying causes and processes behind these changes aren’t fully understood.
Moreover, research on the disorder has produced inconsistent results, with IBS causes not correlating with gut symptoms.
This indicates that IBS may manifest differently in each person, requiring personalized management and medication approaches for effective treatment.
This, in turn, means creating a universal “cure-all” solution for IBS might not be possible. However, new studies are showing promise and we may see a breakthrough in the coming days.
But for now, IBS treatment focuses on managing pain, constipation, and diarrhea symptoms, improving quality of life, and controlling the disorder as much as possible through medication use and lifestyle changes.
What are the current prescription medication options for IBS?
While your exact course of treatment will depend on the type and severity of your symptoms, you’ll probably be prescribed one of the following medications to treat IBS symptoms:
Laxatives are medications used to promote bowel movement in people experiencing constipation. There are numerous over-the-counter (OTC) laxatives available, such as:
- Magnesium-based laxatives like milk of magnesia
- Stimulant laxatives, including senna cascara and bisacodyl (e.g., Correctol®, Dulcolax®)
- Osmotic laxatives, such as polyethylene glycol (PEG) 3350 (e.g., Miralax®)
Among these options, polyethylene glycol (PEG) 3350 has been found to improve stool texture and frequency, but it doesn’t effectively reduce abdominal pain or discomfort associated with IBS.
In fact, some people may experience an increase in abdominal symptoms when using this medication. They may also get diarrhea, abdominal cramping, bloating, nausea, dehydration, and electrolyte imbalances.
Antidiarrheals are medications that increase fluid reabsorption in the gastrointestinal (GI) tract, decrease intestinal secretion, and slow down gut transit. If you have IBS-D (the diarrhea-predominant subtype), you might need an antidiarrheal agent like loperamide to slow down your gut.
Loperamide (e.g., Imodium®) is available over the counter (OTC) and is the most frequently used antidiarrheal medication. It works by making sure your large intestine doesn’t leave behind too much water in your stool.
Like OTC laxatives, a few studies have demonstrated loperamide’s effectiveness in firming loose stools and reducing the frequency of diarrhea. However, it hasn’t been shown to provide significant relief for abdominal pain or discomfort associated with IBS.
Common side effects of loperamide include abdominal pain and, in some cases, severe constipation.
3. Prosecretory Agents
A prosecretory agent is a drug that enhances fluid secretion and movement in the GI tract. It has the potential to improve symptoms like bloating, discomfort, and pain associated with GI disorders.
There are three FDA-approved treatments in this class:
- Plecanatide (Trulance®) – It improves fluid secretion in the intestines and gut motility (intestinal movement). Plecanatide has been shown to improve abdominal and constipation symptoms within the first week of treatment, although the maximum effect on pain may take longer to manifest.
- Linaclotide (Linzess®) – It also works by increasing gut movement and fluid secretion. Linaclotide has also been shown to reduce abdominal pain by decreasing the activity of pain-sensing nerves.
- Lubiprostone (Amitiza®) – It works by activating chloride channels in the bowel, leading to increased bowel secretions and movement. Lubiprostone has demonstrated effectiveness in relieving overall IBS symptoms in multiple clinical trials. Common side effects include nausea and diarrhea.
These drugs primarily target the GI tract and have minimal impact on the rest of the body, resulting in a low risk of interactions with other medications.
Antispasmodics suppress smooth muscle contractions in the GI tract. They have three different types:
- Anticholinergics – They reduce intestinal contractions or spasms, alleviating abdominal pain. Some examples include dicyclomine (Bentyl®) and hyoscyamine (Levbid®, NuLev®, Levsin®). Limited clinical studies suggest that anticholinergics may improve cramping pain in people with IBS, but their effectiveness in improving overall IBS symptoms is yet to be established.
- Direct Smooth Muscle Relaxants – Smooth muscle relaxants are less effective in treating overall IBS symptoms than anticholinergics. Some examples include trimebutine, pinaverium bromide, mebeverine, and cimetropium.
- Peppermint Oil – It induces smooth muscle relaxation by blocking calcium from entering intestinal smooth muscle cells. Recent studies have shown that peppermint oil can be used to treat the overall symptoms and pain of IBS.
Antidepressants are medications that affect neurotransmitters, which are chemicals involved in nerve signaling and play a role in pain perception and GI function. They can help alleviate multiple IBS symptoms — such as bloating and abdominal pain — but are usually given to only patients with severe symptoms.
There are two different classes of neuromodulators:
- Selective Serotonin Reuptake Inhibitors (SSRIs) – Some approved SSRIs for IBS include paroxetine (Paxil®), fluoxetine (Prozac®), sertraline (Zoloft®), and citalopram (Celexa®).
- Tricyclic Antidepressants (TCAs) – Some examples of TCAs include desipramine (Norpramin®), nortriptyline (Pamelor®), imipramine (Tofranil®), and amitriptyline (Elavil®).
Rifaximin (Xifaxan®) is an FDA-approved antibiotic specifically indicated for the treatment of IBS-D. While its precise mechanism of action remains unknown, rifaximin provides significant relief of IBS symptoms, including abdominal pain, bloating, and loose stools.
Plus, rifaximin exhibits anti-inflammatory properties and has been shown to improve overall symptoms of IBS-D. However, unlike other treatments for IBS-D, Rifaximin is a short-term therapy typically taken for only two weeks.
7. Serotonin Agonists/Antagonists
Serotonin agonists/antagonists can either block (antagonist) or activate (agonist) serotonin receptors, improving gut secretion, food movement through the GI tract, and gut sensation.
There are two FDA-approved agonists and antagonists for IBS:
- Alosetron (Lotronex®) – It works by delaying gut movement and reducing pain. Alosetron is approved for only women with severe IBS-D symptoms that significantly impact their quality of life and when other conventional treatments have been ineffective.
- Tegaserod (Zelnorm®) – It acts on the nerves and smooth muscles of the GI tract, promoting increased gut movement and intestinal secretions.
What are the complementary and alternative medication options for IBS?
Complementary and alternative medicine (CAM) uses natural methods to improve IBS symptoms and overall well-being. Some commonly explored CAM options for IBS include the following:
1. High fiber intake
Dietary fiber is a plant-derived nutrient that increases stool bulk, decreases the production of gas and short-chain fatty acids, reduces blood cholesterol levels, and improves glycemic control.
The consumption of dietary fiber has a positive impact on various symptoms experienced by IBS patients, including global symptoms, abdominal discomfort/pain, abdominal bloating/distension, and altered bowel habits.
So, if you’re living with IBS, supplementing with soluble fiber should be the first natural remedy to try.
However, make sure to introduce fiber into your diet gradually, with an increase in intake of no more than 5 grams/day/week. This will reduce the likelihood of side effects like abdominal bloating, discomfort, and changes in bowel habits.
You can also talk to your doctor about dietary supplements if your diet is unable to fulfill your fiber needs.
2. Herbal remedies
Herbal medicine involves using medicinal plants to prevent or treat various clinical conditions. Let’s take a look at some herbal remedies for IBS:
- Artichoke Leaf Extract (ALE) – A study involving 279 IBS patients looked at the effects of ALE over six weeks. It showed that over 96% of patients experienced significant symptom relief.
- Turmeric (Curcuma longa) – Turmeric has anti-inflammatory and antioxidant properties. A pilot study conducted over eight weeks found that 75% of IBS patients using turmeric extract showed mild to significant symptom improvement.
- Psyllium – Psyllium is a dietary fiber commonly used to relieve constipation and is an integral part of the diet for IBS. A 2009 study indicated that IBS patients taking psyllium for three months experienced low symptom severity. However, it wasn’t as effective at alleviating abdominal pain.
3. Mind-body techniques
Mind-body interventions (MBI) offer alternative approaches to treatment, helping IBS patients actively engage in their own well-being. They include mindfulness, cognitive behavioral therapy, relaxation, and yoga.
Let’s take a look at the most popular mind-body techniques for IBS:
- Mindfulness – According to a mindfulness trial focused on IBS, mindfulness led to significant improvements in quality of life and GI-specific anxiety, with a considerable decrease in IBS symptoms reported by 42% of participants compared to controls.
- Cognitive Behavioral Therapy (CBT) – It is a therapeutic approach that focuses on identifying and changing unhelpful thinking patterns to reduce stress and enhance self-regulation. Patients who go through a 10-week course of CBT experience ongoing symptom improvement even at a three-month follow-up.
- Yoga – Studies suggest that yoga is a safe therapy for IBS and can lead to improvements in symptom severity, quality of life, physical functioning, and anxiety. However, more high-quality clinical trials are necessary to determine its efficacy.
The best medication for IBS: final words
While there is currently no universal “cure-all” medication for IBS, you can use a combination of prescription and complementary and alternative medicine (CAM) options to manage symptoms and improve quality of life.
However, this depends on your unique IBS subtype, presentation pattern, symptoms, and personal choice. So, discuss your options with your doctor and make sure they enable you to live your life with freedom.
What is the first-line treatment for IBS?
The first-line drug therapy for IBS includes antispasmodics for treating abdominal pain, laxatives for constipation, and loperamide for diarrhea.
What is a good natural treatment for IBS?
A low-FODMAP diet is an excellent natural treatment for IBS. You begin by reducing or eliminating high-FODMAP foods like milk, garlic, onions, wheat, and yogurt from your diet for two to six weeks. This allows your symptoms to improve.
After the elimination phase, you gradually reintroduce one food at a time to identify which triggers flare-ups.
How can I relieve IBS pain fast?
IBS can be very irritating, so if you’re experiencing severe abdominal pain, you should try an OTC laxative to enable the movement of stool through your GI. You could also apply a heating pad, try hypnotherapy, go for a walk, or drink hot water.
But if you’re looking for a painkiller, try paracetamol. It doesn’t cause stomach discomfort or ulcers like non-steroidal anti-inflammatory drugs.
Can IBS lead to hemorrhoids?
Yes, IBS can lead to hemorrhoids if you have the constipation-predominant subtype. Constipation is a known cause of hemorrhoids — it leads to excessive straining, which causes anal cushions to swell and pop out of the anal canal.