Discover why irritable bowel syndrome (IBS) is a challenging condition to treat along with Western and complementary treatments that can improve your symptoms.
- Irritable bowel syndrome (IBS) is a functional disorder, meaning there’s no currently known biochemical or structural cause, and that makes it difficult to treat.
- Current medical approaches use a “package” of treatments to reduce and manage pain, discomfort, and other IBS symptoms.
- Complementary and alternative medicine (CAM) therapies are a popular option as they’re non-invasive and often align with current medical approaches.
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a gastrointestinal disorder that’s classified as a functional disease, meaning that doctors aren’t able to diagnose the precise cause.
It’s estimated that between 10% and 15% of the population suffer from IBS, but only between 5% to 7% are properly diagnosed.
What causes irritable bowel syndrome?
IBS can have multiple possible causes, including psychiatric, immune, genetic, inflammatory, and allergic components. Complicating the issue is that different treatment approaches yield different results in patients. Some approaches can nearly resolve symptoms in one person but are less effective in another.
What we now call “IBS” may, eventually, turn out to be a set of different diseases with similar symptoms.
What are the symptoms of irritable bowel syndrome?
IBS is divided into four categories:
- IBS-D: Diarrhea is the most common symptom.
- IBS-C: Constipation is the most common symptom.
- ISB-M or IBS-A: Also called “mixed” or “alternating.” Both diarrhea and constipation are common.
- IBS-U: Neither diarrhea nor constipation is common.
Symptoms of an IBS attack that are common to all four types are abdominal pain, bloating, and a feeling that the bowel is not completely emptied. Some sufferers also experience the following symptoms, but so far, there is no evidence that they’re directly related to IBS:
- Acid reflux
- Genitourinary concerns
What are the risk factors of irritable bowel syndrome?
The most common medical risk factor is a severe gastrointestinal infection. IBS sufferers are also likely to have another functional illness, and IBS tends to run in families. Researchers don’t know yet if there’s a genetic component to IBS.
Here’s what we do know:
Depression and anxiety are also associated with IBS. They don’t appear to cause symptoms, but they can make the sufferer feel the discomfort more intensely.
How is irritable bowel syndrome diagnosed?
IBS can’t be diagnosed with a blood test or a scan. Instead, doctors usually use either their own experience or the Rome IV diagnostic criteria.
Under Rome IV, a person may have IBS if they experience both:
- Abdominal pain related to bowel movements at least once a week, on average, over the previous three months.
- A change in either the frequency of bowel movements or appearance of stool.
The “syndrome” part of IBS means a group of symptoms that often appear together, but we don’t always know why. For this reason, IBS is a “diagnosis of exclusion,” meaning that doctors make this diagnosis after ruling out other potential causes. If a patient has symptoms of blockage or colon cancer, Rome IV criteria dictates that the patient should be examined for those conditions first.
A Danish cohort study on whether IBS raises the risk of colon cancer found that there was substantial misdiagnosis between the two conditions that was only clarified by further testing or other symptoms. Fortunately, it also concluded that IBS sufferers are at no greater risk for colon cancer than the general population.
However, this overlap of symptoms makes IBS hard to diagnose. To further complicate diagnosis, IBS can cause other problems, such as hemorrhoids, that can cause blood in the stool.
What are the complications of irritable bowel syndrome?
IBS doesn’t have many notable physical complications, although there are related conditions — again, such as hemorrhoids. Some experts believe that IBS may lead to other inflammatory bowel diseases like ulcerative colitis due to some overlap in symptoms and possible causes. But so far, researchers haven’t found a link.
IBS can interfere with mental health and well-being, however. Depression and anxiety are common. Loss of libido among both men and women is another related symptom. Symptoms can interfere with work or even force people to give up certain jobs.
What Western treatments are available for irritable bowel syndrome?
Because IBS sufferers will have different symptoms, treatment plans will also vary. Most of the time, they will include a mix of lifestyle changes and medication. For patients who have mostly mild to moderate discomfort, doctors will usually recommend lifestyle changes first and medication second. In the most painful cases, they may start with medication.
Doctors will also consider other health problems a patient may have. If a patient has a more serious condition than IBS, doctors are more likely to prioritize that condition and suggest lifestyle changes for the IBS symptoms.
Lifestyle changes that can improve IBS symptoms include:
There are anecdotal reports that gluten-free and low-FODMAP (fermentable oligo-, di-, monosaccharides and polyols) help with IBS symptoms, but more research is needed. Many of these diets eliminate foods such as high-fructose corn syrup and artificial sweeteners that are known to be harmful, so most doctors view these diets as healthy for everyone.
Other foods to avoid with IBS include milk, caffeine, and artificial sweeteners.
Soluble fiber comes from plant pectin and can be used to either bulk up or soften stool naturally. Studies so far have found that it doesn’t tend to alleviate pain, but it can mitigate digestive symptoms. Again, as there’s widespread agreement that everyone needs soluble fiber in their diet, doctors often recommend it as a low-risk, low-cost form of treatment.
Based on the belief that IBS is a reaction to stress or extreme emotion, medical providers are increasingly recommending stress management techniques such as tai chi, yoga, and meditation.
The following medications are currently used to treat IBS:
- Antispasmodics: For more severe cases of IBS, doctors may prescribe antispasmodics, which relax the smooth muscle of the bowel. Due to the side effects, though, not all patients respond well, so these are best used only when absolutely necessary.
- Antidepressants: Both selective serotonin uptake inhibitors (SSRIs) and tricyclic antidepressants can be effective for IBS. Doctors are more likely to consider this treatment if patients are already taking antidepressants for other reasons.
- Osmotic laxatives: These laxatives draw water from the surrounding tissue to soften stool. They include polyethylene glycol, sorbitol, and lactulose. Stimulant laxatives aren’t recommended, and your doctor will likely suggest that you avoid them.
- Eluxadoline: Approved for IBS-D in 2017, eluxadoline (brand name Viberzi) reduces bowel activity.
What treatments for IBS are in the pipeline?
Because IBS doesn’t have a precise cause, treatments are experimental and may be focused on a specific IBS type. Here are a couple that are currently being researched:
In a fecal transplant, feces from a healthy individual is removed, treated, and placed in the colon of the patient who’s suffering various conditions. The idea for the treatment is that the micro-organisms in the donor feces may be beneficial to the recipient’s gut health. While results have been promising for treating IBS, there are still concerns about potential infections that need to be worked out before the procedure becomes commonplace.
Mesalazine is an anti-inflammatory that has been in use for decades, and research is increasingly pointing towards its potential effectiveness for IBS. More research is needed, although as the drug is well understood, it may be approved for IBS treatment fairly soon.
What complementary and alternative therapies are available for irritable bowel syndrome?
Many people who suffer from IBS turn to CAM therapies to manage their symptoms. Therapies that people find most helpful include:
As discussed above, many people with IBS find that dietary changes significantly improve their symptoms. Sometimes a nutritional therapist or dietitian can have more specialized knowledge than a primary care provider, and using the two together can be beneficial.
Cognitive behavioral therapy (CBT)
Providers often recommend psychological treatment for people with IBS. A 2020 review of 41 randomized controlled trials found that CBT is one of the most effective and long-lasting psychological treatment methods.
Supplements when used with extreme caution
There is limited evidence that some herbal treatments can help manage symptoms. Many practitioners also recommend probiotics, and the evidence suggests that their use is a safe and effective treatment for IBS symptoms.
A 2017 clinical trial found evidence that treatment including feeling for small lesions in the gut, then massaging to promote healing was successful in treating IBS-associated pain.
There is some evidence, such as this 2016 study, that gut-based hypnosis can help with IBS pain.
While there are reports that people use homeopathy for IBS symptoms and find it effective, there’s very little high-quality evidence for it at this time. We recommend discussing any homeopathic treatment you may be considering with your primary provider before you begin therapy. Some homeopathic substances can have harmful interactions with medications.
While the studies are small, there is some evidence that acupuncture can assist with treating some IBS symptoms, most notably pain. Due to the nature of IBS, acupuncture is best used as a complementary treatment, to be used alongside lifestyle changes and stress management.
As states have implemented rigorous licensing standards, providers are slowly becoming more accepting of holistic therapies such as acupuncture. Your doctor may even have a preferred acupuncturist to recommend.
We recommend never stopping a treatment your doctor has prescribed for you without clearing it with him or her first.
Tips for living with irritable bowel syndrome (IBS)
The key point to remember when living with IBS is that you can take immediate steps to begin seeing what changes work best for you. Many recommended approaches in both Western and complementary medicine are low-risk, do not require a prescription, and have overall benefits to your health.
Holistic approaches like practicing yoga, meditation, and nutritional therapy, such as eliminating excessive sugars from a diet, are examples of steps you can take that are widely recommended as safe and potentially helpful.
With approaches like these, you can take an active part in managing your condition. You can make changes and see what improves your symptoms and what doesn’t. This can often be done with a small investment in time, money, and effort. Steps such as working with a nutritionist for IBS can also be helpful in managing your symptoms.
The first step is to discuss with your doctor where you most need relief, steps to take, and in what order. If your main concern is bloating and diarrhea, your approach will be different than if you have regular abdominal pain or constipation.
In the long term, managing your IBS will likely involve multiple approaches that draw from various treatment modalities. There is no one treatment that works for everyone, so you’ll need to develop approaches that include lifestyle changes and treatments that work best for you.
You may have IBS, but you also have the power to control it.
Bright Belly can help
Choosing the right complementary or integrative practitioner may feel challenging. Let us be your ally on your way to better holistic health. Follow our blog for more information on complementary and alternative therapies, and visit our provider directory to find a practitioner near you.