Irritable Bowel Syndrome: Treatment

Dietary changes, sometimes supplemented by drugs or psychotherapy, are considered the key to successful treatment. The following approach, offered by Dalton and Drossman, is typical of the advice found in the medical literature on IBS. The authors tie their approach to the severity of the patient's symptoms:

Dalton and Drossman recommend a low-fat, high-fiber diet. Problem-causing substances such as lactose, caffeine, beans, cabbage, cucumbers, broccoli, fatty foods, alcohol, and medications should be identified and avoided. Bran or 15–25 grams a day of an over-the-counter psyllium laxative (Metamucil or Fiberall) may also help both constipation and diarrhea. The patient can still have milk or milk products if lactose intolerance is not a problem. People with irregular bowel habits—particularly constipated patients—may be helped by establishing set times for meals and bathroom visits.

The advice given by Dalton and Drossman in mild cases applies here as well. They also suggest that patients keep a diary of symptoms for two or three weeks, covering daily activities including meals, and emotional responses to events. The doctor can then review the diary with the patient to identify possible problem areas.

Although a high-fiber diet remains the standard treatment for constipated patients, such laxatives as lactulose (Chronulac) or sorbitol may be prescribed. Loperamide (Imodium) and cholestyramine (Questran) are suggested for diarrhea. Abdominal pain after meals can be reduced by taking such antispasmodic drugs as hyoscyamine (Anaspaz, Cystospaz, or Levsin) or dicyclomine (Bemote, Bentyl, or Di-Spaz) before eating.

Dalton and Drossman also suggest psychological counseling or behavioral therapy for some patients to reduce anxiety and to learn to cope with the pain and other symptoms of IBS. Relaxation therapy, hypnosis, biofeedback, and cognitive-behavioral therapy are examples of behavioral therapy.

When IBS produces constant pain that interferes with everyday life, antidepressant drugs can help by blocking pain transmission from the nervous system. Dalton and Drossman also underscore the importance of an ongoing and supportive doctor-patient relationship.

— Howard Baker