Soothing IBS symptoms requires a multidisciplinary approach.
Irritable bowel syndrome is incredibly common in the United States and throughout the world, yet there’s still a lot researchers don’t know about it. It’s not yet crystal clear what causes the chronic digestive symptoms of IBS, considering the condition leaves no evidence of a problem in the digestive tract.
This mystery creates a problem: When doctors don’t know what’s causing a health issue, they usually don’t have a perfect way to treat it.
Treatment for IBS “requires a multidisciplinary approach, and it’s really about focusing on the patient’s symptoms and improvement in their symptoms,” says Benjamin Cohen, MD, gastroenterologist at The Mount Sinai Hospital in New York City. Here’s what doctors recommend:
1. Keep a food trigger diary
After getting diagnosed with IBS, one of the best things you can do is start a food diary to track what foods you’re eating and what symptoms you’re experiencing. While there are certain foods that are common IBS triggers, each person is unique and may be able (or not able) to tolerate different foods.
For the most beneficial food diary, track what you eat for each meal, what time the meal was eaten, what symptoms you experienced afterwards, and what time the symptoms began. This can help you identify patterns, such as which foods are causing which symptoms.
2. Keep a mental health trigger diary
One of the biggest IBS triggers is actually stress. When your body is in a state of stress, almost any food you eat could potentially cause grief. “It’s important to record any psychological triggers—stress, anxiety, depression episodes—because that can also play a role,” says Dr. Cohen.
3. Prioritize stress management
Since stress can trigger IBS symptoms, many people find it helpful to be proactive about their stress management. This might mean working with a mental health professional to learn positive habits like relaxation and breathing exercises, or finding calming hobbies like yoga, meditation, or journaling.
4. Get professional support
Some people with IBS benefit from building up a support team of professional experts. Find a registered dietitian who can help you find a healthy diet that works with your IBS (or to try the low FODMAP diet, which can help with IBS).
You may also benefit from working with a psychologist or therapist to manage your psychological stressors. In particular, cognitive behavioral therapy and hypnotherapy are two promising therapies for people with IBS.
5. Ask your doctor about antidepressants
It might not sound intuitive to take a depression treatment for IBS, but a low dose of antidepressant has been shown to reduce symptoms for many patients. It’s not as crazy as it sounds: The majority of the body’s serotonin receptors are in the digestive tract—not the brain.
6. Soothe symptoms with over-the-counter medications
If your IBS causes predominantly constipation (sometimes called IBS-C), laxatives may be helpful. If you tend to have more diarrhea episodes (IBS-D), antidiarrheals may be helpful. Unfortunately, if you have alternating episodes of diarrhea and constipation (IBS-M, referring to “mixed” bowel problems), neither of these options may be beneficial for you: Taking a laxative may lead to an episode of diarrhea, and taking an antidiarrheal may lead to an episode of constipation.
Ask your doctor which OTC options, if any, are appropriate for you and your symptoms. They can also help set guidelines on how much (and how often) to take.
Learn more about reducing IBS symptoms here:
Dr. Cohen is a gastroenterologist at The Mount Sinai Hospital in New York City.
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Irritable bowel syndrome treatment requires a multidisciplinary approach,
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and it's really about focusing on the patient's symptoms and improvement in their symptoms.
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Number 1 for me is trying to identify triggers for irritable bowel syndrome,
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so keeping a food diary, so for a few weeks at least,
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to write down everything they eat, when they eat it, and then when they have symptoms,
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and what exactly the symptoms are at the time that they have it,
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and that way you can better associate potential food triggers.
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There's no specific irritable bowel syndrome diet,
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but patients who, for example, have more bloating as a part of their irritable bowel syndrome,
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may benefit from a low FODMAP diet.
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Broccoli, cauliflower, things that are generally healthy, can lead to significant bloating.
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In addition to the foods, it's important to record any psychological triggers,
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stress, anxiety, depression episodes, because that can also play a role.
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Reducing stress in life is very important, just for overall health,
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and irritable bowel syndrome definitely can be exacerbated by stress as well.
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Generally, I will work very closely with a nutritionist,
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try and work with a psychologist as well,
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to get at cognitive behavioral therapies for IBS,
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including hypnotherapy, which can be very beneficial for patients.
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Low doses of certain antidepressants to help modulate the brain-gut connection
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and maybe decrease some of the pain response for patients.
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So patients who have constipation-predominant symptoms,
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we can use various over-the-counter osmotic laxatives.
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For diarrhea, there are some antidiarrheal medications
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that can be purchased over the counter and can be used safely.
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Make sure that your doctor is recommending you use these over-the-counter alternatives.
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I try to reassure patients that we can do a lot to manage their symptoms
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and a patient is living day to day with symptoms that affect their quality of life.
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It is a good thing that we haven't found something else that could be even more life-changing.
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Definitions & facts for irritable bowel syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. (Accessed on December 13, 2019 at https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts#types.)
Patient education: irritable bowel syndrome (beyond the basics). Waltham, MA: UpToDate, 2019. (Accessed on November 25, 2019 at https://www.uptodate.com/contents/irritable-bowel-syndrome-beyond-the-basics.)
Treatment for irritable bowel syndrome. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 2017. (Accessed on November 25, 2019 at https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/treatment.)