Use of medications (drugs), whether prescription, over-the-counter, herbs, or supplements should be considered carefully and in consultation with your healthcare provider.
Irritable bowel syndrome (IBS) is a disorder characterized by two key elements:
1. An abdominal component generally described as pain/discomfort and
2. Alterations in bowel, habits including changes in stool texture and/or frequency.
Pharmacologic, or drug, therapy is best used in irritable bowel syndrome (IBS) patients with moderate to severe symptoms which do not respond to physician counseling and dietary manipulations.
What’s a medication?
Anything you take for a therapeutic effect counts as a medicine. It can be readily available over-the-counter, in a pharmacy or grocery store, or limited by prescription only. It might be a drug or a supplement; manufactured or “natural.” It might come in a pill, a liquid, or a food product. When you take something for a long-term therapeutic effect, tell your doctor about it. He or she can help you monitor quality, effectiveness, possible interactions with other medicines you may be taking, or possible side effects.
Remember, all medicines have potential side effects. Before taking any medication, whether over the counter or prescription, talk to your healthcare provider or pharmacist about dosage, other medicines you are taking, or any other questions you might have about the treatment. Otherwise, carefully follow the directions on the drug package or on your prescription label.
Medications for IBS
First line treatment has traditionally been aimed at treating the most bothersome symptom because of the lack of effective treatment for the overall improvement of multiple symptoms in IBS patients. However, new therapies for IBS have been recently introduced and have been shown to effectively treat multiple symptoms of IBS.
Laxatives – a drug that increases bowel function. There are many laxatives available without a prescription.
Secretagogues/Prosecretory agents are a class of drugs which increase fluid secretion and movement in the GI tract. These drugs also can improve pain, discomfort, and bloating. Currently there are 4 FDA approved treatments in this class: lubiprostone, linaclotide, plecanatide, and tenapenor.
Bulking agents – provided they relieve and don’t worsen symptoms, can ease stool passage. Examples include bran or psyllium.
Anticholinergics/Antispasmodics – have limited benefit for treating IBS. In some persons they relieve abdominal pain or discomfort, usually if the symptoms occur soon after eating. Examples include dicyclomine (Bentyl), and hyoscyamine (Levsin).
Anti-diarrheal agents – are drugs which slow gut transit. Transit refers to the amount of time it takes for materials to move through the gut. These also decrease intestinal secretion (movement of fluid into the intestines) and increase the amount of fluid that is reabsorbed by the gastrointestinal (GI) tract.
Anti-anxiety medications – can be helpful for some people with IBS, mainly those with emotional distress.
There are also effective medications available that relieve the pain and improve the changes in bowel habit. They may need to be taken on a more long-term basis. These include low dose antidepressant agents or the relatively newer medications.
Antidepressants – The use of the antidepressant drug class in low doses for treatment of IBS symptoms is not linked to depression, but rather likely to effects on the brain and the gut. Antidepressant medications can reduce the intensity of pain signals going from gut to brain.
Newer IBS-Targeted Medications Available – There are other medications that are either under study, or have been shown to be effective in treating IBS in multi-center, high quality clinical trials. These are prescription medications intended for specific use under a doctor’s supervision.
Advancements in our knowledge of the causes of IBS continues to lead to many more effective treatment options. This is accomplished through research and rigorous clinical trials. Treatments can now improve both the pain/discomfort and bowel symptoms experienced by people with IBS. Nonetheless, there is no cure for IBS. It can be difficult to determine which therapy will provide the best efficacy in a patient with IBS. Choosing an appropriate treatment should be a decision made between healthcare provider and patient.
Adapted from IFFGD Publication #168, “Current Pharmacologic Treatments for Adults with Irritable Bowel Syndrome”. By: Darren M. Brenner, MD, Associate Professor of Medicine and Surgery, Northwestern University – Feinberg School of Medicine, Chicago, Illinois; Adapted from an article by: Tony Lembo, MD, Professor, of Medicine and Rebecca Rink MS, Beth Israel Deaconess Medical Center, Harvard Medical School, MA; Edited by: Lin Chang, M.D., Professor of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA