Treatment

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Your treatment for irritable bowel syndrome (IBS) will depend on which symptoms you have. Your health care professional and you will work out a personal treatment plan, depending on your specific symptoms. If you suffer from diarrhea, you won't need the same approach as someone who is constipated. And, you might want to consider visiting a specialist. Talk to your health care professional about whether you need a referral to a gastroenterologist.

If your health care professional says the problem is "all in your head," or that there's nothing that can be done, get a second opinion. Many women with IBS manage their condition successfully. Look for a health care professional who explains IBS and is interested in helping you identify the triggers for your symptoms.

Your treatment plan may take into consideration physical triggers as well as psychological and environmental factors. It may include one or more of the following: lifestyle changes, pharmacological treatment and psychological treatment. Discovering an IBS management plan that works for you likely will involve trial and error at first, and changes along the way.

Here are some of the areas your treatment plan may encompass:

Diet

Certain foods may trigger an attack. It is a good idea to keep a journal noting which foods seem to cause distress. To identify foods that trigger your symptoms, maintain your usual diet and note what you were eating when your symptoms developed. Look for patterns. Often, symptoms don't relate to specific foods, rather large amounts of food at one time. You may want to consult a dietitian to help you identify food triggers and develop your treatment plan. He or she may be able to help you assess how your body reacts to certain foods-sometimes a food sensitivity (such as lactose intolerance) may be involved.

Triggers can include caffeine, milk, chocolate, nicotine, alcohol and large, high-fat meals.

Traditional therapies have included dietary fiber, especially for treating constipation. Fiber decreases the transit time through the colon and decreases the pressure in the colon. Increasing your consumption of fresh fruits and vegetables, whole grains and bran may help; your health care professional may also suggest a soluble fiber supplement.

Increased fiber can make symptoms worse for some IBS patients. This is because bacteria in the colon can break down fiber, producing gas, which can make bloating worse. Discuss fiber options with your health care professional. You may need to avoid certain forms of fiber, particularly gas-forming foods such as cabbage, broccoli, cauliflower and beans. But there's no conclusive proof that eliminating certain foods will eliminate your symptoms.

Medications

Your health care professional may suggest certain medications to manage your IBS symptoms. Medications prescribed to treat IBS symptoms once included Tegaserod (Zelnorm), until the drug was taken off the market in March 2007 due to safety issues. An FDA analysis looked at safety data from 29 clinical trials on more than 18,000 patients taking Zelnorm and found an excess of serious cardiovascular events, including heart attack, angina and stroke. If you are currently taking Zelnorm, contact your health care professional to discuss alternative treatments, and seek medical care immediately if you experience any symptoms of a heart attack or stroke, such as severe chest pain, shortness of breath, difficulty walking or talking, or sudden onset of weakness.

Other drug therapies suggested by your health care professional for IBS may include:

• Antispasmodic anticholinergics These medications reduce intestinal spasms and can diminish the pain, bloating and discomfort associated with IBS. Two examples include dicyclomine (Bentyl) and hyoscyamine (Levsin). Studies show these drugs have limited effectiveness and are best used when symptoms develop soon after meals. Side effects may include dry mouth/nose/throat, rapid heartbeat, constipation, blurred vision and problems with urination.

• Antidiarrheals such as loperamide (Imodium). These medications are quite effective for diarrhea, and may be prescribed to help with loose, frequent stools or urgency.

• Bulk laxatives (such as fiber) may be in order if your primary symptom is constipation. Soluble fiber supplements fall under "bulk laxatives". These include psyllium (Metamucil), methylcellulose (Citrucel) and calcium polycarbophil (Equalactin).

• Alosetron (Lotronex) is approved for use in female patients with severe diarrhea predominant IBS. It is a 5HT3 receptor antagonist and inhibits the action of serotonin in the gut. Alosetron is usually prescribed for IBS associated abdominal pain and diarrhea. It should be used only in patients with severe symptoms who are cared for by a gastroenterologist because of the possibility of serious side effects.

• Tricyclic antidepressants are often used for symptoms of pain and diarrhea. They are used in doses lower than the dose used for depression and are believed to work by decreasing the pain signals between the gut and brain. These medications may also help with sleep disturbances as well as fibromyalgia, which is commonly seen with IBS.

• Selective serotonin reuptake inhibitors (SSRIs), medications used to treat depression, may also be prescribed to alleviate the accompanying depression and anxiety suffered by some IBS patients. These drugs include SSRIs such as fluoxetine (Prozac) and paroxetine (Paxil), as well as other types of antidepressants and antianxiety medications, such as bupropion (Wellbutrin) and venlafaxine (Effexor-XR). Studies find these drugs may also have beneficial effects in IBS patients who don't have any anxiety or depression.

Tips for Avoiding or Managing Common IBS Triggers

With IBS, your bowel is sensitive to stimuli. Identifying what triggers your abnormal bowel function can help prevent or minimize your symptoms. Here are some tips that might help:

• Eat at regular hours; chew food slowly and thoroughly; avoid large or high-fat meals or excess caffeine.

• Drink six to eight cups of caffeine-free liquid daily, including fruit and vegetable juices and water.

• Get regular physical activity. It can help relieve the symptoms of anxiety and also promotes good bowel function.

• Avoid delaying the urge to have a bowel movement.

• Avoid straining during a bowel movement; try to relax and take your time.

Because your colon is more sensitive and reactive if you have IBS, ordinary events such as eating and distention from gas or having other material in the colon can trigger symptoms. The following strategies may help prevent attacks:

• An eating schedule. Eating causes contractions of the colon. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. If you have IBS, this urge may come sooner and trigger cramps and diarrhea.

• Smaller meals. The strength of the response is often related to the number of calories in a meal and especially the amount of fat. Also, large meals can cause cramping and diarrhea in people with IBS. Symptoms may be eased if you eat smaller meals more often or just eat smaller portions. But try to stay on a regular eating schedule either way.

• Dietary changes. This approach, combined with a low-fat, higher-carbohydrate diet (pasta, rice, whole-grain breads and cereals, fruits and vegetables), may help. Other people feel better with a high-protein, low-carbohydrate diet. Fat greatly stimulates colon contractions following a meal. Chocolate, milk products or large amounts of alcohol can also increase contractions. Caffeine causes loose stools in many people, but is more likely to affect those with IBS.

• Dietary fiber may lessen constipation in many cases, but does not lessen pain. Whole-grain breads and cereals, beans, fruits and vegetables are good sources of fiber. (Over-the-counter fiber supplements can also provide valuable fiber, but consult your health care professional first before using them.)

• Certain medicines (including antibiotics) may trigger IBS attacks in some people. Be sure to tell all your health care professionals about your condition and discuss other medication options that can avoid triggering IBS symptoms.

• Physical, emotional and environmental stress may exacerbate or trigger symptoms. Stress-reduction/relaxation strategies can help relieve or prevent IBS symptoms. Cognitive/behavioral therapy, stress-management counseling, hypnosis, relaxation and biofeedback may help reduce diarrhea and abdominal cramping.

These treatments also reduce anxiety and other psychological symptoms. Biofeedback and relaxation training can help you become more aware and in control of your physical and emotional responses. You may want to keep a record of what events and activities trigger your symptoms. In the case of IBS symptoms that are linked to childhood abuse or trauma, discovering the connection helps many patients gain better control of the disease.