How is IBS treated?
Though IBS does not have a cure, the symptoms can be treated with a combination of:

• Changes in eating, diet, and nutrition
• Medications
• Probiotics
• Therapies for mental health problems

Eating, Diet, and Nutrition
Large meals can cause cramping and diarrhea, so eating smaller meals more often, or eating smaller portions, may help IBS symptoms. Eating meals that are low in fat and high in carbohydrates, such as pasta, rice, whole-grain breads and cereals, fruits, and vegetables, may help.

Certain foods and drinks may cause IBS symptoms in some people, such as:

• Foods high in fat
• Some milk products
• Drinks with alcohol or caffeine
• Drinks with large amounts of artificial sweeteners, which are used in place of sugar
• Beans, cabbage, and other foods that may cause gas

People with IBS may want to limit or avoid these foods. Keeping a food diary is a good way to track which foods cause symptoms so they can be excluded from or reduced in the diet.

Dietary fiber may improve constipation symptoms in people with IBS, although it may not help with reducing pain.

Medications
Dr. Jones may recommend medications based on a person’s symptoms.

• Fiber supplements may be recommended to relieve constipation when increasing dietary fiber is ineffective.
• Laxatives may help constipation. Laxatives work in different ways, and Dr. Jones can provide information about which type is best for each person.
• Loperamide is an antidiarrheal that has been found to reduce diarrhea in people with IBS, though it does not reduce pain, bloating, or other symptoms. Loperamide reduces stool frequency and improves stool consistency by slowing the movement of stool through the colon.
• Antispasmodics, such as hyoscine, cimetropium, and pinaverium, help to control colon muscle spasms and reduce abdominal pain.
• Antidepressants, such as low doses of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help relieve IBS symptoms, including abdominal pain. In theory, TCAs should be better for people with IBS-D and SSRIs should be better for people with IBS-C due to the effect on colon transit, although this theory has not been confirmed in clinical studies. TCAs work in people with IBS by reducing sensitivity to pain in the G.I. tract as well as normalizing G.I. motility and secretion.
• Lubiprostone (Amitiza) is prescribed for people who have IBS-C. The medication has been found to improve abdominal pain or discomfort, stool consistency, straining, and constipation severity.
• Linaclotide (Linzess) is also prescribed for people who have IBS-C. Linzess has been found to relieve abdominal pain and increase the frequency of bowel movements.

The antibiotic rifaximin can reduce abdominal bloating by treating small intestinal bacterial overgrowth; however, scientists are still debating the use of antibiotics to treat IBS and more research is needed.

Probiotics
Probiotics are live microorganisms, usually bacteria, that are similar to microorganisms normally found in the G.I. tract. Studies have found that when taken in large enough amounts, probiotics, specifically Bifidobacteria and certain probiotic combinations, improve symptoms of IBS. However, more research is needed. Probiotics can be found in dietary supplements, such as capsules, tablets, and powders, and in some foods, such as yogurt. Dr. Jones can give information about the right kind and amount of probiotics to take to improve IBS symptoms. To help ensure coordinated and safe care, patients should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with Dr. Jones.

Therapies for Mental Health Problems
The following therapies can help improve IBS symptoms due to mental health problems:

• Talk therapy may reduce stress and improve IBS symptoms. Two types of talk therapy used to treat IBS are cognitive behavioral therapy and psychodynamic, or interpersonal, therapy. Cognitive behavioral therapy focuses on a person’s thoughts and actions. Psychodynamic therapy focuses on how emotions affect IBS symptoms. This type of therapy often involves relaxation and stress management techniques.
• Hypnotherapy may help a person relax the muscles in the colon.
• Mindfulness training teaches people to focus their attention on sensations occurring at the moment and avoid catastrophizing, or worrying about the meaning of those sensations.