Medications and Supplements for IBS
The contributing factors to the development of IBS are quite complex and include alterations in the bottom up signalling pathways from the gut to the brain. In addition, top down signalling pathways from the brain to the gut are intimately involved in the development of IBS. Given the onset of IBS is attributed to a myriad of factors, there is no one medication that is universally effective for all people with IBS.
Therefore, IBS medical therapies are frequently directed toward the management of symptoms, rather than the root cause of the problem, because the root cause may vary among IBS patients. Medications are likely to have a modest effect, but when used together with diet and behavioural therapies, the effectiveness may be substantially greater.
Prescription Medication for IBS
Prescription medication is a viable option for reducing or alleviating IBS symptoms in some patients. Your doctor will determine if you’re a good candidate for treatment with medication. Before prescribing a prescription medication your doctor is likely to look at your medical history, and/or conduct a physical exam or other tests to rule out other conditions before confirming an IBS diagnosis and prescribing medication. These tests may be required as the symptoms of IBS frequently overlap with symptoms of may other gastrointestinal diagnoses such as celiac disease, Crohn’s disease and even colon cancer. Once the diagnosis of IBS has been confirmed, and you have been started on medical therapies, try logging your symptoms and medications in CDHF’s myIBS app to understand how your IBS symptoms are responding to medication you’ve been prescribed. Creating a before and after record of your symptoms will be important to understand how well the medication is performing.
We recommend that you use myIBS to set reminders for yourself to take your medication according to your doctor’s and pharmacists’ recommendations. This can help you remember to take your medication until it becomes a habit.
Types of prescription medication
There are a few different types of medication. These include:
- The balance of bacteria in the gut may be altered in IBS. A minimally absorbed gastrointestinal targeted or selective antibiotic can be used to treat diarrhea predominant IBS, and acts to influence the gut bacterial imbalances (dysbiosis) and help the gut microbiome. Use of this type of antibiotic does not mean you have an active infection. Selective antibiotics such as this may not only be effective but are associated with fewer side effects as they do not have action outside of the gut.
- Anti-spasmodics to help decrease the spasming of muscles in the intestinal tract
- Anti-depressants to help ease physical pain by boosting levels of neurotransmitters that affect the gastrointestinal tract.
- Neurotransmitter-active compounds are another option. Neurotransmitters pass information from various parts of the body, including the gut, to the brain and vice versa. By damping down the transmission of nerve impulses, neurotransmitter-active compounds affect the contraction of intestinal muscles, which is useful in treating diarrhea.
- Chloride channel activators can be used to treat IBS-related constipation. The activation of chloride channels in the intestine stimulates the flow of intestinal fluids, which can help move food through.
Types of non-prescription medications and/or supplements
There are a few different types of non-prescription medications that are available for the treatment of IBS:
These have been very well studied, and are effective for all IBS sub-types. Various fibre supplements have been studied, with variable support. However, psyllium fibre supplements are easily available, reasonably well tolerated and effective to treat both diarrhea and constipation. When starting a fibre supplement, it is important to start at a low dose, even half of what is recommended on the product label, and then increase the dose gradually over time to the recommended dose. In a sub-group of patients, fibre supplements may not be well tolerated, and if this is the case, it may be related to the types of bacteria in the gut, and their inability to metabolize fibre. If fibre is not tolerated, it can be discontinued and another treatment option pursued.
There is a growing body of evidence for the effectiveness of peppermint oil in IBS treatment. Several studies have demonstrated effect for peppermint oil for overall IBS symptoms, and specifically for abdominal pain and quality of life. It is thought to work by decreasing gut related spasms and therefore decrease cramps. However, some studies have demonstrated that peppermint oil, while effective, may not be any more effective than a placebo treatment. Consult with your doctor to determine the best time in your disease course for peppermint oil trial.
Several clinical studies have been completed with various probiotics, different doses and for varying durations. Overall there appears to be a positive signal for the benefit of probiotics compared to placebo, but it is very difficult to make conclusive recommendations as to the most effective probiotic. Probiotics containing Bifidobacteria, and Lactobacillus are among the most promising agents. Talk to your doctor, or registered dietitian about the right probiotic for you.
When constipation does not respond to dietary changes, laxatives may be used as first line treatment options. Non-stimulant laxatives that work by drawing water in the bowel are the well tolerated and effective. Talk to your doctor about the best option for you.
Tips for Starting a New Medication
When starting any new medication, it is important to stay in communication with your doctor the entire time. Be sure to inform your doctor of any side effects you may experience, even if they are minor.
Be sure to follow the dosage advice accurately and consistently and consult with your doctor or pharmacist if you have any questions.
What to Expect
All of the medications are different, and everyone’s reaction to these medications will also vary.
What is effective for some may not work at all for others, and your doctor may have you try a few different options before finding the one that is most effective for you. Use the myIBS to record your progress on the medication. Keep track of your symptoms before and after starting the medication and use the information you collect to have reliable, fact-based conversations with your doctor about your symptom progression.
This article was made possible due to an unrestricted educational grant from Culturelle Probiotics, IBgard, Bio-K+, and Lupin Pharma Canada Ltd.
Looking for more information on treatment options for IBS? Check out more resources:
CDHF’s myIBS App
MyIBS is our FREE and easy-to-use tracking app for Irritable Bowel Syndrome (IBS). Journal your symptoms, poop, food, sleep, stress and more with this flexible tool that helps you better understand and manage your IBS. Download it today on the App Store, or on Google Play!
LyfeMD empowers people to take control of their wellness through an easy-to-use application. The LyfeMD app provides personalized health coaching to those with chronic digestive and inflammatory diseases. Learn more about the LyfeMD App today!