How is IBS with diarrhea treated?
For Irritable Bowel Syndrome (IBS) with diarrhoea, in general, we start with ant diarrheal agents, such as lope amide which you can get over the counter. It comes in tablet or liquid form. And typically, you give it to patients if they have diarrhoea. The way patients take it is by reading the instructions on the label and that's fine. But what it tells you to do is to take the medicine once you have diarrhoea and in Irritable Bowel Syndrome (IBS) patients, that's too late. So what you try to teach the patients is to take it proactively. So, if patients have chronic diarrhoea, like daily diarrhoea, and it's pretty predictable, they can actually take Imodium, or lope amide, on a daily basis at the start of the day. Now, I know a lot of patients, what they'd like to do is they want to have a bowel movement - it makes them feel better. But then afterwards, so you don't want to go multiple times during the day, you can actually take some lope amide or an ant diarrheal agent. They're short acting, sometimes you have to take it later. I usually start at a low dose with my patients, because I don't want them to swing to the constipation side. They're very uncomfortable with that. So I start with a low dose, and then just titrate it up to what they need. Typically, if a patient is going on a long trip or have a long meeting, or they're going out to dinner; it's always much more anxiety provoking when you're outside of your house, because you not close to your bathroom and you're out of your comfort zone. So a lot of times patients will take a proactive ant diarrheal agent ahead of time, because it at least causes them not to have diarrhoea when they go out of their house. The trick is not to give them too much that they become constipated. If someone has more chronic symptoms, you can try a medication like a low dose tricyclic agent i.e. desipramine, amitriptlyne. Those are used because they have what is called an ant cholinergic effect - they slow down the motility of the bowel. So they're constipating, in a sense. For a diarrhoea patient, you're just trying to normalize the bowel movements. So that's often used at low doses. It's only at bedtime dose you can give the patients. Some health care providers use fiber, but it's really not shown that fiber supplementation helps diarrhoea. There is a drug that's FDA approved, only in severe patients with IBS with diarrhoea, particularly women, and that's called alosetron. But it has some side effects, so it's under restricted use, meaning that you have to go to a doctor that's part of the prescribing program and the patient and physician have to sign an attestation form stating that they understand the risks and benefits of the medication. It can be a great medication in patients with severe Irritable Bowel Syndrome (IBS) with diarrhoea, but it's under restricted use by the FDA.
