Irritable Bowel Syndrome Treatments
Is there a cure for IBS?
There's actually no cure for Irritable Bowel Syndrome, but there are treatment interventions and management strategies that a patient can do to help control their symptoms and even become asymptomatic, which means that they don't have any more symptoms.
What treatments can relieve IBS symptoms?
There are various treatments that can relieve IBS symptoms. I think the challenge is that some treatments work for some patients, and other treatments work for other patients. We don't necessarily have a treatment that will work on all patients so you basically direct your therapy according to what the patient's predominant symptoms are. We have certain treatments for IBS with diarrhoea; certain treatments for IBS with constipation or treatments that are directed at decreasing pain. I think it is important for successful treatment to discuss the treatment options in that particular patient and for the patient and physician to decide together what is the best treatment for their patient because not every patient wants to take the same treatment. Some patients don't want to take medicines or they have tried certain medicines that you think may be good for them, but they feel that they have already tried it so they want to try something else. It is best to use scientific evidence and medical evidence of what treatments work for that particular patient's symptoms, but also to use your own experience as a physician or anecdotal experience and also the patient's thoughts and interests in a particular type of treatment because if they are motivated to take that treatment, they understand why it might help them, there's a greater chance of success.
Which foods and drinks can make IBS symptoms worse?
There's a lot of interest in what's the IBS diet. And there's no IBS diet, unfortunately. But I do believe that a lot of patients will complain of worsening symptoms, particularly with fatty foods. Some of the patients with diarrhoea actually don't really like spicy or caffeinated drinks or foods, because caffeine tends to stimulate the bowel. Patients with constipation like caffeine sometimes because that can stimulate the bowel and that's what they need. So it can vary depending on what your symptoms are, but in general, fatty and spicy foods are not well tolerated. This hasn't been proven by scientific evidence, but I will say just by experience that patients report a lot of times that when they eat a larger meal, that they get more symptoms. And I think it's because the food itself is a stressor and because it's causing distension of the bowel and probably stimulating the bowel more than you would want it to.
Should I consult with a doctor to see if certain foods trigger my IBS symptoms or make them worse?
To determine if symptoms are worsened by certain foods or certain triggers is really up to the patient. What can really help a patient sometimes is to keep a daily symptom diary, and for them to do that for a couple of weeks to determine whether there are certain triggers or foods that seem to exacerbate or increase your symptoms. It's also helpful for a patient to do that when they're starting a new treatment, so they can determine if there's a significant change in their symptoms.
If I don't have immediate access to a doctor, what's a good way to find out which foods aggravate my IBS?
A patient should determine foods that aggravate their Irritable Bowel Syndrome (IBS)by their own symptoms. So it's not really information they need to get from the doctor. It's really information that they gather from themselves. And by keeping a daily symptom and food diary, they'll be able to determine if there are certain foods that trigger their symptoms in particular. If they want general information about foods that trigger IBS, they can get that information on the Internet. The Internet has a lot of information and education about IBS, or getting books about IBS, while they're waiting for a doctor's appointment. There is one really good website for patients to gather information that I know of. It's the International Foundation for Functional GI Disorders, which is IFFGD. And the website is IFFGD.org. This provides a lot of accurate and scientific evidence and medical information for patients.
Does adding fiber to my diet help reduce the symptoms of IBS?
Fiber can help some patients with IBS, and it specifically helps patients with constipation symptoms. It doesn't really help patients with diarrhoea symptoms because it can actually make it worse. So, when patients have constipation symptoms, fiber can actually help. It's a little tricky using fiber because sometimes it actually increases gas and bloating, so the patients have to be careful on their fiber intake. But it can definitely help constipation symptoms.
How much fiber should I add to my diet to help reduce the symptoms of IBS?
Well in general, most people in America have about five to ten grams of fiber in their diet, and if a patient has constipation, they usually need about 20 - 25 grams of fiber. So that's actually a fair amount higher than I think most of us take, and foods themselves don't have all that much fiber, so sometimes it helps to use fiber supplements, like psyllium or methyl cellulose. These are, over the counter remedies, that patients can use and control the amount they take.
What are some foods that contain fiber?
Well, there's bran. So, there's cereals that can actually have a fiber in them that patients will use.TIP: Good Sources of Fiber are Whole grains; Fruits; Vegetables; Nuts and seed. A lot of fruits and vegetables will have fiber. So, foods like roughage, for example broccoli. Berries have a fair amount of fiber. There's some foods that patients think have a lot of fiber, and they actually don't; food items like lettuce, which actually doesn't contain much fiber. So, salads sometimes don't really help increase fiber. Foods like cabbage do, but cabbage causes a lot of gas, so sometimes it's hard for patients to take that kind of food.
Should I alter the serving size of my meals to help reduce the symptoms of IBS?
It hasn't really been shown that changing your meal portion will actually change your symptoms of IBS, but from my own experience I feel that larger meals seem to exacerbate symptoms more than smaller meals. So many times I will recommend to patients to have smaller, more frequent meals, because I think that large meals are a stressor on the gut and seem to increase symptoms.
Which medicines are commonly used for IBS?
There's different medicines that can be used for Irritable Bowel Syndrome (IBS), but it's important to direct the medication therapy to the patient's predominant symptom. Antispasmodics are probably the most commonly used agents for Irritable Bowel Syndrome (IBS), but there's very little data that suggests it helps the overall symptoms of Irritable Bowel Syndrome (IBS). Sometimes it can help patients with post- toneal pain. For the diarrhoea patients, anti-diarrheal agents can be useful. Also, low dose tricyclic agents which are anti-depressants, but at low doses are not used for mood. They actually decrease diarrhoea and pain. There is also a drug called Alosetron but it's under restricted use and that's used in women with severe diarrhoea predominant Irritable Bowel Syndrome (IBS). For the constipation symptoms we use laxatives or prokinetic agents such as Tegaserod which is right now under restricted use as well.
What are some stress relief strategies that may provide relief of IBS symptoms?
I think there's various stress relieving strategies for patients with Irritable Bowel Syndrome (IBS) and they can really vary. Some patients benefit from relaxation, deep breathing, trying to avoid or reduce environmental or through personal stressors that seem to exacerbate the symptoms. They may change their work or their personal daily activities to accommodate their symptoms, so for example, if their symptoms are worse in the morning, they may choose to take classes later in the day or they may choose to work at home so they are near a bathroom. So there's different lifestyle modifications a patient can make. Also to try other things that haven't actually been proven in IBS, but can reduce stress just in general, such as Yoga or exercise. Some people actually seek behavioural or psychological therapy to help manage a reduction in their stress levels.
Can physical activity help IBS?
Physical activity has actually not been shown to help Irritable Bowel Syndrome (IBS), but that's because it hasn't actually been studied well. Exercise hasn't been shown to improve constipation, however a lot of people still believe this to be true. Although, I think exercise has so many other benefits and it does help reduce stress, so I think it can help patients in general. Not only those with Irritable Bowel Syndrome (IBS), but I imagine it could help. The problem for Irritable Bowel Syndrome (IBS) patients, sometimes is that they don't feel well and they have fatigue, so they don't always feel that they can exercise, and I think that's what the problem is.
Are there studies to support the treatment of IBS with acupuncture?
There is very limited studies of acupuncture treatment and IBS. There's some evidence that it may have some benefit, but some of the studies are very small and don't show benefit, so I think we a need a higher quality, larger sample size studies to determine if it's actually beneficial. A lot of patients were actually used acupuncture whereas far as scientific evidence, we don't have that quite yet.
Are there studies to support the treatment of IBS with hypnosis?
There are actually a lot of studies to support treating IBS with hypnosis. There are actually very good studies. Most of them came from the United Kingdom, from a particular group. That's Doctor Whirl and his colleagues. They have shown with hypnosis that it can actually reduce the symptoms of IBS, and reduce the hypersensitivity of the gut to IBS. So it can be very useful.
Are there studies to support the treatment of IBS with herbal medicine?
There's actually a few studies that have demonstrated ethicacy with herbal medications for IBS, and it's usually a combination of herbs. Pretty typical herbs that would be used for GI symptoms or for a condition like IBS that have been shown, compared to placebo, that they're beneficial for IBS. Since these are, since herbal medicines are usually in combination, you'd have to get a prescription by an herbalist for the particular symptoms. I think the important point to know here though is that there's not a classic herbal remedy for IBS, and for a complementative alternative medicine provider to prescribe a medicine. It's really based on that individual's symptoms and signs. There could be a series of IBS patients, but the herbal remedy is actually designed for specific individual symptoms and characteristics for those patients. So there might be a little bit of adjustment.
Are there studies to support the treatment of IBS with meditation?
There are no current studies that I know of that have shown the benefit of meditation with IBS, but there are ongoing studies with mindfulness meditation, so it's a particular type of meditation to be used in IBS and they've shown it's benefited in other conditions such as cancer. So the patient really focuses on the here and now and not focusing on future consequences of having an exacerbation of the IBS symptoms, and I think that it could probably be very useful.