IBS

IBS Treatment Options and Prevention Strategies

Dietary changes, medications, and psychotherapy can soothe IBS symptoms.

Quinn Phillips
By Medically Reviewed by 
Reviewed:
Medically Reviewed
woman exercising holding water bottle sitting down
Exercise and hydration are two important parts of managing life with irritable bowel syndrome.iStock
Irritable bowel syndrome (IBS) can involve a number of different symptoms, including abdominal pain, cramping, gas, diarrhea, and constipation, according to the Mayo Clinic.

Since there is no cure for IBS, treatments are geared toward relieving the symptoms of this gastrointestinal disorder and improving your quality of life. The course of treatment that you and your healthcare provider choose will depend on the type and severity of your symptoms.

It’s important to try to develop a good sense of how your IBS is affected by your diet, stress, and any other factors in your life. By paying attention to these factors, you and your doctor can better determine what might improve your symptoms.

It’s also important to freely share information about your symptoms with your doctor. Good communication is key: You both should feel comfortable asking and answering questions about your condition. According to Johns Hopkins Medicine, people with IBS who report better relationships with their doctor also tend to report better symptom control.

That also means that patients should look for doctors who ask open-ended questions, listen closely, and express empathy.

Treatments for IBS fall into a few broad categories:

  • Dietary changes
  • Medications
  • Psychotherapy (talk therapy)
  • Complementary approaches/therapies

Depending on your symptoms, any combination of these options may be part of your treatment strategy.

Once you find a successful strategy for managing your IBS, you may find that it’s possible to take a less-intensive approach that’s geared toward preventing, rather than reducing, your symptoms.

You can improve mild cases of IBS if you:

  • Avoid trigger foods.
  • Increase your fiber intake, which can relieve constipation.
  • Exercise more.
  • Get enough sleep.
  • Drink enough fluids.
  • Avoid and get help to manage stressful situations.

If these simple steps aren’t enough to control your symptoms, a number of dietary changes may be worth considering.

Dietary Strategies for Managing IBS Symptoms

Dietary changes are usually the first line of treatment for IBS. There's no single formula for changing your diet — instead, the approach should be based on your symptoms and any food-related triggers that you notice. It’s worth noting that the American College of Gastroenteorology’s (ACG) 2021 guidelines

do not recommend testing for food allergies and food sensitivities unless there is a reproducible symptom from a certain food.
Avoid gas-producing foods. If bloating and gas are problems for you, it may help to avoid items like carbonated beverages, caffeine, raw fruits, and cruciferous vegetables like cabbage, broccoli, and cauliflower. Though increasing your fiber intake is recommended, go slow when adding foods high in fiber to your diet — too much too soon can cause gas and trigger IBS symptoms.

Add soluble fiber. The ACG 2021 guidelines

advise people who suffer from all types of IBS to explore adding soluble fiber to their diet to treat IBS symptoms in general. Fiber offers a range of health benefits, which is why experts recommend 25–35 grams daily. That means adding fiber from psyllium, oat bran, barley, and beans. They also recommend cutting back on insoluble fiber, which is found in wheat bran, whole grains, and some vegetables.

Cut back on rich foods. Particularly if your symptoms include diarrhea, you may benefit from reducing your intake of fatty foods, which can stimulate contractions in your colon. Caffeine can do the same thing, so reducing your intake can also improve diarrhea.

Explore a gluten-free diet. If diarrhea is a problem, you may benefit from cutting out foods that contain gluten, a protein found in wheat, barley, and rye. The above guidelines also recommend blood tests to formally rule out celiac disease if you have diarrhea and IBS symptoms.

Avoid FODMAPs. Some people with IBS respond negatively to FODMAPs, an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols — which are carbohydrates that aren’t well digested in the small intestine. This group includes fructose, lactose, fructans, and sugar alcohols. The ACG 2021 guidelines

noted that in some trials a low-FODMAP diet was associated with a reduction in IBS symptoms.

You may need to work with a dietitian or nutritionist to drastically reduce FODMAPs in your diet (a form of elimination diet to remove potentially sensitive foods), then gradually reintroduce foods to see if they cause symptoms.

Supplements and Medications for IBS Relief

Medications typically aren’t the first line of treatment for IBS, but they may be helpful for people with moderate to severe symptoms who have tried different dietary strategies without success.

Depending on your symptoms, your doctor may prescribe one or more of the following remedies.

Fiber supplements If increasing fiber in your diet isn’t effective, you can take a variety of supplements containing different forms of soluble fiber. This is particularly helpful for people who experience constipation.

Smooth muscle relaxants These drugs can help with intestinal cramping, abdominal pain, and bouts of diarrhea, but it’s best to talk to your doctor if you plan to use them frequently or regularly. In some cases, though, they may cause constipation. The guidelines “recommend against the use of antispasmodics currently available in the United States to treat global IBS symptoms.”

Antidiarrheal drugs If you experience frequent diarrhea, a drug such as Imodium (loperamide) that slows down the movement of contents through your intestine or improves the consistency of your stools may be useful. But loperamide is not recommended as a first treatment, because it only targets diarrhea and does not improve overall IBS symptoms.

If an over-the-counter treatment isn’t working, your doctor may prescribe Xifaxan (rifaximin), as well as eluxadoline (a drug similar to loperamide).

Antidepressants Even if you don’t experience depression — but especially if you do — your doctor may prescribe certain categories of antidepressants (tricyclic or selective serotonin reuptake inhibitors) to reduce pain or diarrhea by acting on your nervous system. People without depression are usually given a low dose of these drugs. One thing to note: Tricyclic agents were shown to relieve IBS symptoms, but the jury is still out on selective serotonin reuptake inhibitors.

Pain relievers Certain drugs that act on the brain’s pain sensory mechanisms may help ease severe abdominal pain or bloating while the root causes are explored. Opiate medications like oxycodone, codeine, and others are not recommend for chronic use to manage IBS symptoms and can actually worsen the overall disease.

Antibiotics If your doctor suspects that an imbalance of gut bacteria is responsible for your symptoms, you may take drugs designed to kill off certain strains of bacteria. The goal is to let healthy bacteria flourish, not to wipe out all of them.

IBS-specific drugs A number of drugs are designed to treat specific symptoms of IBS. These include: Lotronex (alosetron), Viberzi (eluxadoline), Xifaxan (rifaximin), Amitiza (lubiprostone), and Linzess (linaclotide).

The Benefits of Talking With a Therapist for IBS

For many people with IBS, emotional stress plays an important role in the frequency and severity of their symptoms.

It’s important to have a discussion with your doctor about how stress might be contributing to your symptoms. If you both agree that stress, anxiety, or depression could be affecting your IBS, you may be referred to a mental health professional.

When you see a therapist, the following strategies may be used to improve your symptoms. It could also be beneficial to have a multidisciplinary team to support you, in which your doctor-led care includes a nutritionist and mental health professional, for example.

Cognitive behavioral therapy This type of talk therapy focuses on helping you change your patterns of thought and behavior. Years of research support its effectiveness as a treatment for IBS.

Gut-directed psychotherapy For this treatment, your therapist focuses on relieving the stress on the brain-gut axis. This may include gut-directed hypnotherapy, where your therapist puts you in a trance-like state to help you relax and focus in an effort to improve your symptoms.

Relaxation training Your therapist may guide you through strategies to relax or to reduce the impact of stressful events or thoughts on your body.

Complementary Approaches to Consider

The evidence in favor of various complementary approaches and therapies for IBS is mixed. Talk to your doctor before trying any of the following treatments to understand the potential benefits and risks and how they might fit with your mainstream care plan.

Probiotics Certain probiotics may help control IBS symptoms like abdominal pain, bloating, and diarrhea.

What works for you will depend on your symptoms and the unique makeup of your gut bacteria. ACG guidelines do not recommend the use of probiotics, as their effectiveness has not been proven. The British Society for Gastroenterology's evidence-informed guidelines in 2021 were more positive toward probiotics, saying they “may be an effective treatment for global symptoms and abdominal pain in IBS, but it is not possible to recommend a specific species or strain. It is reasonable to advise patients wishing to try probiotics to take them for up to 12 weeks, and to discontinue them if there is no improvement in symptoms.”

Acupuncture This traditional Chinese medicine practice involves inserting very fine needles into specific areas of the body, and it may help treat anxiety associated with IBS or even potentially have a direct effect on your digestive action. A March 2022 review in BioScience Trends

noted that acupuncture may stimulate and relax organs to relieve IBS-related diarrhea.
Peppermint Because it can relax the smooth muscles in your intestines, peppermint may provide short-term symptom relief. Several studies suggest that peppermint oil capsules help with symptoms of IBS.

The use of peppermint oil is also recommended by the American College of Gastroenterologists since it’s safe, effective, and inexpensive.

Meditation and mind-body practices Activities that relax or focus your mind and body, like yoga and meditation, can help relieve stress. A study in Neurogastroenterology and Motility

found mindfulness practices provided relief to IBS patients, and the benefits continued for months after the mindfulness training ended. Certain therapeutic massage practices may have a similar effect.

Additional reporting by Jordan Davidson.

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