Global treatments affect more than one symptom. Their goal in irritable bowel syndrome (IBS) treatment is to reduce overall symptoms.
Relaxation therapy can be helpful to promote well-being. Hypnosis or cognitive behavioral therapy (CBT), delivered by trained therapists knowledgeable about IBS, has been shown to reduce pain and other IBS symptoms in some people.
Drugs used to treat overall symptoms of IBS, including pain, are prescribed based on the dominant bowel symptom being experienced.
When constipation is the dominant bowel symptom (IBS-C), lubiprostone (Amitiza) may reduce overall IBS symptoms including pain, especially in women. Linactlotide (Linzess) is a newer medication for IBS with constipation and for chronic constipation. In studies, patients taking Linaclotide experienced improvement in multiple symptoms including pain or discomfort, bloating, and bowel function.
When diarrhea is the dominant bowel symptom (IBS-D), alosetron (Lotronex) may reduce overall IBS symptoms. This drug is currently available to women only through a special Prescribing Program because of potential side effects. Rifaximin (Xifaxan) is an antibiotic FDA approved for treatment of IBS-D in adults. Eluxadoline (Viberzi) is a drug designed for the treatment of IBS-D that may be prescribed to adult men and women. It is in a class of medications called mu-opioid receptor agonists, and works by decreasing bowel activity. [Note: On March 15, 2017, the FDA issued a warning that due to increased risk for serious, potientially life-threatening, pancreatitis eluxadoline (Viberzi) should not be used in patients who do not have a gallbladder.]
When symptoms are severe or have not responded to other IBS treatments, your doctor may suggest a low-dose antidepressant. These drugs are useful in IBS, not to treat depression, but to reduce pain and also overall symptoms. Doses are much lower than what is used to treat depression.
In general, when constipation is the dominant bowel symptom, a low dose selective serotonin receptor inhibitor (SSRI) may reduce pain and overall symptoms of IBS.
In general, when diarrhea is the dominant bowel symptom, a low dose tricyclic agent may reduce pain and overall symptoms of IBS.
However, either a tricyclic agent or SSRI may be tried regardless of the dominant bowel symptom.