Treatment

Currently, there are no curative treatments for IBS; Management is focused on treating the associated symptoms.

• Dietary adjustments

  • Soluble fiber supplements (e.g., psyllium)

  • Avoidance of trigger foods (e.g., trial of elimination diet)

    • Low FODMAP diet: diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

    • Consider support of a registered dietician.

• Lifestyle changes

  • Regular physical activity

  • Stress management (e.g., relaxation techniques)

• Psychobehavioral therapy

  • Patient-centered care, strong therapeutic alliance

Elimination diets that restrict fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (i.e., a low FODMAP diet) should be undertaken with the support of a registered dietitian in order to avoid nutritional deficiencies.

• Evidence for pharmacological therapy is mixed and recommendations vary between guidelines.

Diarrhea

• Loperamide

• Rifaximin

• Alternative medications: include alosetron (a selective 5-HT3 receptor antagonist), eluxadoline (opioid agonist/antagonist)

When treating IBS-associated diarrhea, use caution to avoid constipation as an adverse effect, especially in patients with IBS-M or IBS-A.

Constipation

• Polyethylene glycol (PEG)

• Alternative medications:

  • Intestinal secretagogues

  • Tenapanor: a sodium-hydrogen antiporter 3 inhibitor

  • Tegaserod: a partial 5-HT4 receptor agonist

Abdominal pain

The following can be considered to treat associated abdominal pain:

• Antispasmodics: e.g., dicyclomine, hyoscyamine

• Tricyclic antidepressants: e.g., amitriptyline