Treating constipation
Constipation is sometimes a main symptom of IBS. If so, it often helps to eat foods with plenty of fibre, and to drink plenty (two litres of fluids per day or more - to keep the stools moist). Fibre (roughage) is the part of the food which is not absorbed into the body. It remains in your gut, and is a main part of the stools. You can eat plenty of fibre by eating plenty of fruit, vegetables, cereals, fruit juice, wholemeal bread, etc. Another leaflet called 'Fibre in the Diet' gives more details.
If increasing 'fibre and fluids' does not ease constipation then bulk-forming laxatives (sometimes called fibre supplements) can help. These increase the 'bulk' of your faeces and are not 'medicines' as such. Unprocessed bran is the cheapest. You can sprinkle bran on breakfast cereals, or mix it with fruit juices, stews, soups, yoghurts, crumbles, scones, etc. Alternatives are ispaghula husk, methylcellulose and sterculia. You can buy these from pharmacies and health food shops, or get them on prescription. Their full effect may take some days to develop.
A note of caution: fibre and bulk-forming laxatives partly work by absorbing water (a bit like blotting paper). The combination of plenty of fibre or bulk-forming laxatives and fluid produces soft, bulky stools which should be easy to pass out when you go to the toilet. When you eat a high fibre diet, or take bulk-forming laxatives, you should drink plenty. At least two litres per day (8-10 cups). The faeces may become dry and difficult to pass out if you do not have enough to drink. Very rarely, lots of fibre or bulk-forming laxatives and not enough fluid causes an obstruction in the gut.
Note: fibre or bulk-forming laxatives do not usually help with other symptoms of IBS such as pain or bloating. Also, in some people with IBS, especially those with diarrhoea, extra fibre or bulk-forming laxatives makes symptoms worse (particularly bloating). So, it may not be such a good idea to increase fibre or take bulk-forming laxatives if you are not constipated.
Sometimes other types of laxatives are advised for short periods if the measures above are not enough to ease a troublesome bout of constipation.
Treating diarrhoea
An anti-diarrhoea medicine may be useful if diarrhoea is a main symptom. Loperamide is the most commonly used anti-diarrhoea medicine for IBS. You can buy this at pharmacies (but it is quite expensive). You can also get it on prescription which may be more cost effective if you need to take it regularly.
The dose of loperamide needed to control diarrhoea varies considerably. Many people use loperamide 'as required' but some take it regularly. Many people learn to take a dose of loperamide in advance when they feel diarrhoea is likely to be a problem. For example, before going out to places where they know it may be difficult to find a toilet.
Antispasmodic medicines
These are medicines that relax the muscles in the wall of the gut. Your doctor may advise one if you have spasm-type pains. There are several types of antispasmodics, and they work in slightly different ways. Therefore, if one does not work well, it is worth trying a different one. If one is found to help, then you can take it 'as required' when pain symptoms flare-up. Many people take an antispasmodic medicine for a week or so at a time to control pain when bouts of pain flare-up. Some people take a dose before meals if pains tend to develop after eating. Note: pains may ease with medication but may not go away completely.
Antidepressant medicines
An antidepressant medicine in the 'tricyclic' group is sometimes used to treat IBS. In particular, it tends to work best if pain and diarrhoea are the main symptoms. (Tricyclic antidepressants have other actions separate to their action on depression. They are used in a variety of painful conditions, including IBS.) Unlike antispasmodics, you need to take an antidepressant regularly rather than 'as required'. Therefore, an antidepressant is usually only advised if you have persistent symptoms, or frequent bad flare-ups that have not been helped by other treatments.
Psychological treatments (talking treatments)
Situations such as family problems, work stress, exams, recurring thoughts of previous abuse, etc, may trigger symptoms of IBS in some people. People with anxious personalities may find symptoms difficult to control. The relationship between the mind, brain, nervous impulses, and overactivity of internal organs such as the gut is complex. Some people have found such things as relaxation techniques, stress counselling, cognitive behaviour therapy, psychotherapy, hypnotherapy, and similar therapies useful in controlling symptoms of IBS.
Psychological treatments are generally mainly considered in people with moderate to severe IBS, when other treatments have failed, or when it seems that stress or psychological factors are contributing to causing symptoms. However, some of these treatments may not be available on the NHS in your area, or there may be long waiting lists.
Other treatments
Various alternative and complimentary therapies are sometimes used. For example, studies have shown that certain chinese herbal medicines, and probiotics such as Lactobacillus plantarum LP01 and Bifidocterium breve BR0 may help to ease symptoms in some cases. However, more research is needed to clarify their role and usefulness.
Newer medicines that affect certain functions of the gut are also being developed and may become useful treatments in the future.
What is the outlook (prognosis)?
In most people with IBS, the condition tends to persist long-term. However, the severity of symptoms tends to 'wax and wane' and you may have long spells without any symptoms, or with only mild symptoms. Treatment can often help to ease symptoms when they flare-up. In a minority of cases, symptoms clear for good at some stage.
IBS does not shorten your expected life span, it does not lead to cancer of the bowel, and does not cause blockages of the gut or other serious conditions.
