It is estimated that IBS affects around 10% to 15% of the world’s population. For example, in America, including Texas, it affects up to 45 million people and is reported to be twice as prevalent among women as men.
One myth about IBS is that it is simply an emotional or “psychological” problem. The fact, however, is that it is a complex functional disorder of the bowel. This means that your bowels may seem fine through tests, but they do not function properly.
There are three distinct forms of IBS based on your primary symptoms: IBS-D (Diarrhea), IBS-C (Constipation), and IBS-M (Mixed form).
Since there is no visible structural damage or inflammation to cure in IBS. So, the management of the disorder can be done through treating its symptoms and restoring the gut-brain connection.
IBS Treatment Plan
IBS is a chronic bowel disorder that influences the functionality of your gut. There is no single test for IBS. It is usually diagnosed based on your symptoms and by ruling out other conditions. Your doctor will look for abdominal pain present at least once per week, bowel changes (diarrhea, constipation, or both), or bloating or gas. Your doctor can order blood tests, stool tests, or a colonoscopy (in some cases) to exclude other problems.
Doctors have a rigid treatment protocol to follow before writing a prescription. The first line of treatment is always lifestyle and dietary modification.
The Low FODMAP diet is universally recommended by gastroenterologists. It is a short-term elimination diet that excludes certain forms of fermentable carbohydrates that provide food to gut bacteria and result in severe gas and bloating.
Your provider can also recommend that you take care of your stress, as anxiety is a direct cause of IBS flare-ups via the vagus nerve.
But when you have fixed your diet and solved your stress, but you are still hurting, it is time to proceed to the next level. Your doctor must know what type of IBS you have to find the right IBS medication for you.
1. Medications for IBS-C (Constipation)
When you are mostly struggling with infrequent and difficult-to-move stools and incomplete evacuation, you will be given IBS medications that force water into the bowel and accelerate gut motility.
Linaclotide(Linzess) and Lubiprostone: These are prescription IBS medications that are specifically recommended to treat IBS-C. Their mode of action is to stimulate certain channels in the cells that line your intestines. This causes a constant stream of chloride and water into your gut, which naturally softens your stool and initiates the contractions necessary to expel waste. The most prevalent side effect of these is diarrhea, which is normally temporary as your body gets used to the medication.
Polyethylene Glycol (Miralax): This is an osmotic laxative that attracts water into the colon through the tissues surrounding it to loosen up the stool. Although it is very effective and safe to use on a daily basis, it fails to treat the underlying nerve pain of IBS, so doctors usually combine it with other drugs. It is mostly used by dissolving a dose of powder in water once a day. Some of its uncommon side effects include bloating, excess gas, and loose stools.
Plecanatide (Trulance): This is like Linzess, except that it activates receptors in your bowels to better secrete fluid and help stool pass without causing serious cramping. It is taken as a daily tablet, either with or without food. Its side effects are mostly minimal, with a lot of diarrhea.
2. Medications for IBS-D (Diarrhea)
In case your main symptom is urgent and loose stool, your doctor will prescribe medications that will slow down your digestion. The may include
Rifaximin (Xifaxan): It is a gut-targeted antibiotic. Instead of destroying all the bacteria in your body like the old antibiotics, Rifaximin remains completely in your digestive tract. Clinical trials demonstrate that it changes the gut microbiome to a degree that decreases bacterial proliferation, leading to IBS-D diarrhea, but does not produce systemic adverse effects. It is usually given three times a day over 14 days. The side effects are usually mild and may include nausea, mild infections of the upper respiratory system, and sometimes bloating.
Loperamide (Imodium): It is an over-the-counter medicine that treats IBS by decreasing the rate at which your intestinal muscles contract. This will allow more time for your colon to absorb water in your stool, making it solid and decreasing your urgency.
It is usually used on demand, with a dose immediately following a loose stool. Its most frequent side effects are constipation, dizziness, and mild dry mouth.
Eluxadoline (Viberzi): This is a special prescription that acts on the nerve endings in your intestines. It inhibits bowel contractions and relaxes the anal sphincter, which is useful in preventing the severe cramps and sudden diarrhea of IBS-D.
It should be used twice a day with food. Its side effects include constipation, nausea, and abdominal pain. In some situations, it may lead to severe problems such as pancreatitis; it is mostly given to patients who have no history of the gallbladder or heavy alcohol consumption.
3. Medications for Abdominal Pain
Regardless of whether you have IBS-D, IBS-C, or IBS-M, severe abdominal cramping is typically the most frequent symptom observed in IBS.
Antispasmodics (Dicyclomine/Bentyl, Hyoscyamine/Levsin): These prescription drugs directly block the acetylcholine receptors in your gut muscles. This physically stops your muscles from cramping and spasming. Thus, providing rapid relief from intense belly pain.
It is usually taken 20-30 minutes before meals to avoid meal-induced spasms. Its side effects are annoying, and they include dry mouth, blurred vision, drowsiness, and difficulty in urinating.
Peppermint Oil Capsules (IBgard, Colpermin): Doctors often recommend peppermint oil capsules for IBS pain. Research indicates that it is a highly effective method of preventing stomach cramps. It acts by calming your gut muscles and soothing pain.
You are advised to take one capsule either 30-60 minutes before a meal. Its only real side effect is mild heartburn or peppermint-flavored burps.
4. Medications for Stress-Induced IBS
Neuromodulators may be prescribed by your doctor if your IBS is severely provoked by anxiety and trauma, or extreme stress. Neuromodulators are simply drugs that alter the way your brain and gut interact with each other.
In IBS, your gut becomes hypersensitive. Normal digestion may look painful or uncomfortable. These drugs are given in small doses and not primarily to treat depression.
Low-Dose Antidepressants: Antidepressants such as Amitriptyline or SSRIs such as fluoxetine or sertraline are often given at extremely low doses to treat IBS. They are not being used to treat depression.
At a low dose, these pills block pain signals traveling from your gut to your brain.
You normally take one pill just before sleep. Its side effects may include initial drowsiness, dry mouth, and slight weight changes, which usually disappear in a few weeks.
Finding the Right Care in Houston, Texas
Depending on your particular type of IBS (IBS-C, IBS-D, or IBS-M) and the severity of your symptoms, your doctor will select the appropriate IBS medication.
Remember that what works well for one individual may have adverse effects on you. You also require advanced tests to be certain whether your symptoms belong to IBS or rather to an entirely different gut issue like SIBO.
If you are struggling with your gut health, you need expert help. At Kairos Integrative Care in Houston, Texas, one of our nurse practitioners, Lola, specializes in complex stomach issues. She uses comprehensive testing to find the exact root cause of your gut dysfunction. She builds a highly personalized treatment plan just for you.
If you are in Houston, Texas, and want to finally get your digestion under control, reach out to us today.
