Because there is no cure for irritable bowel syndrome (IBS), treatment consists of controlling its symptoms. For most patients with IBS, this can be accomplished through diet, stress management and/or various medications.

The first step is to identify which foods or activities appear to trigger or aggravate the symptoms of IBS. Symptoms may differ significantly among patients with IBS. It may be helpful to keep a food diary or log of what is eaten each day, the type of symptoms experienced and when they occur and which foods or situations appear to make symptoms worse.

Treatment of IBS symptoms typically involves staying away from foods or behaviors that aggravate symptoms. Some foods may be better tolerated than others. For example, a patient may find that milk aggravates IBS symptoms but that yogurt does not. With the help of a physician, the systematic elimination of certain foods from the diet can also help identify which foods may be related to IBS symptoms.

Specific food and drinks that may worsen IBS symptoms include:

• Fatty foods (French fries, potato chips)
• Dairy products (milk, cheese, ice cream)
• Chocolate
• Caffeinated beverages (coffee, tea, soda)
• Alcohol
• Artificial sweeteners
• Carbonated beverages
• Chewing gum

Patients are at risk of losing key nutrients when they remove certain foods from their diet. A registered dietitian can help with the development of a personalized and healthy food plan.

Patients with IBS may wish to make the following changes to their diet to help alleviate symptoms:

• Consume adequate amounts of fiber. Fiber adds bulk to stool in the digestive tract, speeding digestion and helping to alleviate constipation. In addition, fiber keeps the colon mildly distended, which may help prevent muscle contractions (spasms) in patients with IBS. It may also improve the consistency of stool, helping to alleviate diarrhea. However, too much insoluble fiber may aggravate or cause diarrhea. A patient’s diet should contain enough fiber for easy, painless bowel movements. Fiber should be introduced into the diet gradually to avoid gas and bloating. Fiber supplements may be helpful because it can be difficult to obtain adequate quantities of fiber through diet alone. There are two types of fiber:
  
  
• • Soluble fiber. Fiber that dissolves in liquid, attracts water during digestion and slows the rate of nutrient absorption in the intestines. Thus, soluble fiber may help both diarrhea and constipation associated with IBS. Examples include psyllium, oat bran, oatmeal, barley, rye, fruit flesh (without the skin) and navy, pinto or lima beans.
    
    
  • Insoluble fiber. Fiber that does not dissolve in liquid, speeding digestion and helping to alleviate constipation. Insoluble fiber may worsen diarrhea. Examples include fresh fruit (with the skin), vegetables, whole-grain breads and cereals.
    
    
  It is important to note that most fiber-rich foods contain both soluble and insoluble fiber, but in varying amounts. It is therefore important for IBS patients making dietary changes to learn which foods are most likely to benefit them.

• Eat smaller meals. Eating large amounts of food in a single sitting should be avoided because it may cause cramping and diarrhea. Five or six smaller meals throughout the day may be easier to digest for patients with IBS.
  
  
• Eat slowly. Eating meals too quickly can lead to the unintentional swallowing of air, causing gas and bloating in patients with IBS.
  
  
• Drink plenty of fluids. Six to eight glasses of water a day is recommended for hydration, especially for patients with diarrhea-predominant IBS. 

Patients with IBS may be more sensitive to emotional stress or tension. Stress management is especially important to reduce or prevent the symptoms of IBS. The methods can include:

• Relaxation therapies. Therapies designed to help a person relax. Biofeedback trains patients to alter bodily functions (such as breathing, heart rate and blood pressure) through relaxation or imagery. Progressive relaxation involves a conscious effort to relax muscles in the body, one by one. Meditation, hypnosis, deep breathing and massage may also help a patient with IBS learn to relax so as not to trigger or aggravate IBS symptoms.
  
  
• Counseling. Emotional support usually achieved through communication. This can be done with a mental health professional, in a support group, or with family members or friends. If seeking professional help, cognitive behavior therapy may be especially helpful for patients with IBS.

Patients with IBS should also make an effort to exercise regularly, avoid stressful situations and refrain from smoking, as nicotine may trigger symptoms.

A variety of medications are available to treat the symptoms of IBS. Patients should consult their physician before using any drug (including over-the-counter medications) because it may interfere with current medications or may include serious side effects. Some medications may not be effective for all patients with IBS. As a general rule, medication is used if IBS symptoms do not respond to dietary changes and/or stress management. Medications are most often used for moderate to severe IBS symptoms.

Medications used to treat the symptoms of IBS include:

• Antispasmodics. Drugs that slow or stop intestinal muscle spasms, relieving abdominal pain and cramping and helping to prevent diarrhea.
  
  
• Antidepressants. Low-dose antidepressants act as pain relievers in patients with IBS. One type of antidepressant (tricyclic) also slows the digestive process, which may be helpful for patients with diarrhea-predominant IBS.
  
  
• Tranquilizers. Sometimes used to help patients with IBS avoid emotional distress that may trigger or aggravate symptoms. Tranquilizers are recommended for short-term use only, because they can be habit-forming and may interfere with other medications.
  
  
• Antidiarrheals. Used to treat diarrhea. Some types of antidiarrheals may be more helpful than others for patients with IBS. Ongoing, continual use of these medications is usually not recommended.
  
  
• Fiber supplements/laxatives. Used to treat constipation in patients with IBS. Laxatives should be used with caution, since overuse may cause laxative dependence, constipation and may decrease blood flow to the large intestine.
  
  
• IBS-specific drugs. Designed to affect serotonin receptors in the brain, which in turn affect muscle contractions in the intestines. Drugs known as 5-HT3 antagonists (alosetron hydrochloride) are sometimes prescribed for women with severe diarrhea-predominant IBS. Side effects may include constipation and decreased blood flow to the large intestine. They have not been approved for use by men and are generally used only when other medical therapy for IBS has failed.
  
  Other drugs known as 5-HT4 antagonists (tegaserod maleate, brand name Zelnorn) were prescribed for women with constipation-predominant IBS. However, the manufacturer agreed to discontinue marketing this medication in March 2007 due to a high incidence of adverse cardiovascular events. However, select individuals who do not respond to any other form of treatment may be able to continue taking the medication under a restricted access program. 

Non-traditional remedies have also been used by some people to treat symptoms of IBS. These medications include:

• Oil of peppermint
• Acidophilus (bacteria found naturally in the intestines) supplements
• Chamomile tea
• Evening primrose oil
• Fennel seeds
• Wormwood
• Comfrey

The benefits of these remedies are unproven and in some cases may cause serious side effects or may interfere with other medications. Peppermint oil, for example, is a natural antispasmodic that can help prevent flatulence and cramping. However, it may cause or worsen heartburn. Wormwood may damage the nervous system and comfrey may cause serious liver problems. It is important that patients consult their physician before using any of these alternative therapies.

Acupuncture may provide relief from chronic pain for some patients. Studies on the effectiveness of acupuncture for patients with IBS have been mixed, although some patients have used acupuncture to relax muscle spasms in the intestines and improve digestion.

Surgery does not cure IBS. Patients should obtain a second opinion before considering any type of surgery. Studies have shown that patients with IBS sometimes undergo the unnecessary removal of gallbladders and appendixes, as well as hysterectomies and back surgery with no permanent relief of their IBS symptoms.