IBS treatment is, unfortunately, a fairly hit and miss affair. The bad news is that there is no easy cure, and in fact there is not really even a set course of treatment. The good news is that most sufferers do find something that helps them, whether it be through a special diet, or a particular medicine, or a supplement, or a combination of several different things.
You may never be completely free of IBS, and you may have to try several things to find something that works for you, but don't stop looking for the IBS treatment that is right for you. On this page I have described some of the main approaches to the treatment of IBS.
Food intolerance is gaining ground as a possible cause for IBS symptoms in many people. Sufferers find that by cutting out particular types of food such as dairy or gluten they reduce their symptoms, or they may find that they have certain 'trigger' foods that always set off symptoms.
One way to find out what foods are hurting you is to follow an exclusion diet, where you gradually cut out different foods for a week or so and see if you feel better. This should be carried out with the help of a nutritionist to make sure you don't end up with a diet that hurts you more than it helps!
There are also various food intolerance tests available, which offer to identify what foods affect you by testing your blood, your skin or sometimes even your hair. Some companies are well established and offer case studies and statistics about their success rates, but others seem to offer very little science behind their claims and are probably best avoided. As always, it's important that you ask any company to prove that their treatment methods are based on real evidence, not just on the fact that IBS sufferers are desperate for a cure.
Medicines and drugs
You may be offered various medicines by the doctor. Sufferers are often given anti-spasmodic drugs such as mebeverine to try to calm the spasms in the gut, although the success of these drugs can be limited.
Imodium is a popular drug for diarrhea and is effective, but more for occasional use than as a long-term solution. Laxatives you may be given for constipation include Lactulose and magnesium oxide solution (milk of magnesia). You can also buy laxatives, of course, and there are hundreds available, such as the senna-based laxative Senokot or Exlax. You may find that this type of laxative works well but gives you stomach cramps.
Strong laxatives are not suitable for long-term treatment as they will eventually stop working and cause the bowel to become even more constipated. It is generally considered that milk of magnesia is the gentlest laxative if you really need to take one for a longer period of time, but please be careful.
Your doctor may also offer anti-depressants. Don't be alarmed by this - your doctor is not just dismissing you as someone who is mentally rather than physically ill. Anti-depressants can actually be helpful to IBS sufferers as they have recognised gastrointestinal effects. They are generally taken in much lower doses than those given to depressed patients.
Recently there have also been two new major drugs specifically designed for IBS treatment: Lotronex for diarrhea-predominant IBS, and Zelnorm (or Zelmac) for constipation-predominant IBS. Although the original clinical trials showed these drugs to be fairly effective, and many patients found them helpful when they were released for prescription use, there have been some unwanted side effects reported, and this has resulted in an ongoing battle between patient groups and regulatory bodies about whether the drugs should be in use.
Vitamins, minerals and supplements
Fiber supplements are commonly used. Examples include Citrucel and Fibercon (in the US) and Normacol and Celevac (UK). They are normally advertised as bulk laxatives (because they ‘bulk’ up the stool and make it easier to pass) but they can be useful to diarrhea sufferers as well because the bulking effect can make more solid stools. These kind of products, as long as they do not have any additional ingredients (some have added laxatives rather than just simple fiber) can be used over long periods of time as they are not actually medicines, just fiber.
Watch out for added artificial sweeteners as these can, ironically, cause stomach problems in some people. You may find that you have to try one or two different products before you find the best one for you, as they contain different ingredients - some sufferers find that psyllium products such as Metamucil cause them stomach problems, but methylcellulose products such as Citrucel and Celevac do not.
Calcium supplements, specifically calcium carbonate, can be used by diarrhea sufferers as they can have a constipating effect. Many sufferers in the US use a product called Caltrate Plus which contains calcium and vitamin D. Magnesium supplements in pill form, such as magnesium oxide, can be useful as a mild laxative for constipation sufferers.
Flaxseed (also known as linseed) can act as a bulking agent in a similar way to fiber supplements. They can be swallowed whole with water or soft food such as yogurt, or some people prefer to grind them before eating. High doses of vitamin C, such as 1,000mg, can have laxative effects.
Hypnotherapy is a fairly well-established treatment for IBS. There are practitioners who offer specifically gut-directed hypnotherapy for IBS sufferers, and studies have shown that some sufferers do respond well to treatment. Dr Peter Whorwell is a leading expert on IBS and hypnotherapy in the UK, and a study he conducted in the 1980s found that a group of IBS sufferers who had failed to respond to other treatments showed dramatic improvements when treated with hypnotherapy.
The treatment is not, of course, the kind of 'when I clap my hands you will bark like a dog' kind of stage hypnotherapy used for entertainment, and patients remain in control of their actions. This is a quote from A complete guide to relief from irritable bowel syndrome by Christine P Dancey and Susan Backhouse:
'Hypnosis can be described as an altered state of conscious awareness. It is a natural state of relaxation, similar to daydreaming or the condition of complete absorption in an activity, such as reading, watching television, etc...Hypnotherapy is not a miracle cure: rather it is a state of awareness that can be used for self-help.'
One of the UK's leading hypnotherapists, Michael Mahoney, has developed The IBS Audio Program, a self-hypnosis program specifically developed to treat IBS. The program is available on audio CD and cassette, and has a greater than 80% success rate in treating symptoms of IBS. It is highly regarded within the online IBS community and I have heard from many people who have benefited from it. The CD version of the program comes with an added disc which explains IBS and its impact to non-sufferers.
This covers everything from well-respected disciplines such as acupuncture, to disputed disciplines such as homeopathy, right through to ridiculous things that call for two gophers and a lamp shade and are clearly absolute tripe. As far as I know there's really no particular evidence to show that one kind of complementary therapy works best for IBS, and if you would like to try one it's probably best to look for referrals from IBS sufferers who have tried it with success.
Don't be afraid to ask the practitioners some searching questions before you start - what is their success rate with IBS (and if they say 100% guaranteed cure you might want to leave immediately - they're lying), why does their therapy work for IBS and what is the theory behind it, can they put you in touch with someone they have helped, what organizations and professional bodies do they belong to, and how soon will you see improvements.
One thing that complementary medicine may be able to do far better than your hard-pressed doctor is give you the time and space to really explain all your symptoms, physical and emotional, and feel like someone is genuinely going out of their way to help you. Although Western doctors may find it difficult to explain the success of the therapies in traditional scientific ways, they do have to accept that something like acupuncture, for example, has helped many people with a range of medical conditions.
This is what Heather Van Vorous says about acupuncture in her book The First Year - IBS:
'Personally, I am more than willing to simply accept that, for whatever reasons, these practices are truly effective. I have also been quite unimpressed by the Western approach to IBS, which until very recently dismissed it outright as a psychosomatic problem, and has not yet even come close to thoroughly understanding the underlying dysfunction or developing an effective form of treatment for it - let alone a cure.'
Emotional effects of IBS
There's no doubt that IBS can have a huge impact on your mental and emotional health as well as your physical health. One of the reasons why people assume that IBS is caused by stress is that IBS sufferers can appear so stressed. But is this really surprising? If you had explosive diarrhea, never-ending constipation or stabbing stomach cramps you'd be a bit stressed too!
The nature of IBS symptoms can mean that they are very difficult to deal with, both practically, in terms of being afraid to go out because of fear of diarrhea, and emotionally, because of embarrassment and the sometimes unsympathetic reactions of others.
Sufferers find that their social lives quickly diminish to nothing, or that they can no longer eat the food at restaurants or dinner parties without ending up in pain. Work or school can become a chronic struggle as you drag yourself in on days when you feel ill, knowing that if you didn't you'd get fired or kicked off your course.
You may also feel that you have to pretend to be healthy most of the time in spite of how you really feel, because people get tired of hearing about your condition or begin to say things like 'Well why don't you go to the doctor' or 'My mum had that and ate lots of bran and now she's fine. That's what you should do.'
It can be very hard to bite you tongue and stop yourself answering back. 'Oh, go to the doctor, I see, that's where I've been going wrong all this time, I thought you had to go to the greengrocer. I shall now be cured.'
What is important to remember is that anyone who is battling with IBS is going through a very difficult time, and deserves some genuine support, as does anyone with a chronic, long-term condition. Hopefully, if you explain your condition to family and friends, support will be forthcoming, but you may also want to talk to fellow sufferers as they will recognize your own feelings.
This is what Heather Van Vorous says in The First Year - IBS:
'You may even have friends or family dismiss your problem as all in your head. It's up to you to educate these people, and then dump them if they persist in their ignorance at the expense of your health.'
If they are truly your friends then they will want to learn about the condition and be ready to accept that their views are based on prejudice and assumption rather than fact. Ask them to read some of the stories on IBS Tales, and if they still think that you're exaggerating then ask them to explain exactly why they believe that IBS is simply psychosomatic, what scientific studies they are basing their views on, why every leading gastrointestinal institution disagrees, and how they explain the successes of new drugs such as the selective 5-HT3 antagonist Lotronex.
That should keep them quiet.