Treatment for IBS with Diarrhea (IBS-D)

People who have IBS-D can often find relief from several types of treatment. You can make changes to your diet, take medication, find ways to relieve stress, or try behavioral therapy or alternative therapy. You may need a few of these approaches at the same time to get relief.

IBS is a complex condition that not only involves problems with bowel movements but also belly pain, bloating, and gas. The goal of treatment is to improve all of your symptoms.

Don't try to treat your IBS on your own. First, your doctor must make sure that your symptoms are being caused by IBS. Then work with your doctor to find the best treatment for you.

Your Diet

It might help if you keep a record of the foods you eat and how they make you feel. Since different foods can affect people in different ways, keeping an IBS symptom journal can help you and your doctor figure out foods you can eat and which ones to stay away from. Some tips to get started:

• Avoid chocolate, fried foods, alcohol, caffeine, carbonated drinks, the artificial sweetener sorbitol (found in sugarless gum and mints), and fructose (the sugar in honey and many fruits). These can often make diarrhea symptoms worse.
• Be careful with fiber, but you don’t have to avoid it altogether. It’s good for you in other ways, like preventing colon cancer, diabetes, and heart disease. Plus, it keeps your diarrhea from turning into constipation. But too much of it sometimes leads to gas and bloating. For IBS-D, it's best to eat the soluble kind of fiber. It takes longer to leave your digestive system. You can get it in oat bran, barley, the flesh of fruit (as opposed to the skin), and navy, pinto, and lima beans.
• Drink plenty of water every day. Try having a glass an hour before or an hour after meals, instead of while you eat. When you drink water with food, it may make the food move through your system a little faster.

If you have diarrhea, bloating, and cramping, ask your doctor to test you for lactose intolerance or celiac disease.

Over-the-Counter (OTC) Medicines

Your doctor may suggest trying OTC diarrhea medicines such as bismuth subsalicylate (Kaopectate, Pepto-Bismol) and loperamide (Imodium) for relief.

Researchers have found these drugs can help slow diarrhea, but they won’t help with other IBS symptoms like belly pain or swelling.

Side effects of these treatments include belly cramping and bloating, along with dry mouth, dizziness, and constipation.

If you take a diarrhea medicine, use the lowest dose possible and don't take it for a long time.

Some OTC medicines for gas relief, such as simethicone (Gas-X, Mylicon), are generally safe.

Some antacids, especially those with magnesium, can cause diarrhea.

Don't take any OTC medicine for the long term without asking your doctor about it. IBS symptoms can be caused by other, more serious problems. Make sure you and your doctor have ruled out other causes of your symptoms.

Prescription Drugs

Your doctor can recommend different types of prescription drugs to help your IBS-D:

Antidepressants. If your doctor recommends one, it doesn't necessarily mean that you are depressed. These drugs can help with belly pain from IBS. Low doses of them can help block pain signals to the brain.

For people with IBS-D, doctors may recommend a low dose of a tricyclic antidepressant such as amitriptyline, imipramine (Tofranil), or nortriptyline (Aventyl, Pamelor). Common side effects of these meds include dry mouth, blurred vision, and constipation. Your doctor may recommend another type of antidepressant called an SSRI, which includes citalopram (Celexa), fluoxetine (Prozac), and paroxetine (Paxil), if you have depression along with IBS. Side effects of these medicines sometimes include diarrhea, so be sure to let your doctor know if your symptoms of IBS-D get worse while you’re taking any of these medicines.

Drugs that relax muscles, called antispasmodics, such as dicyclomine (Bentyl) and hyoscyamine (Levsin). Muscle spasms in your digestive tract can cause belly pain. Many doctors prescribe these drugs to calm them. But some studies have found there’s no clear evidence that they help everyone with IBS.

Side effects of these drugs include decreased sweating, constipation, dry mouth, and blurred vision.

Other medications include:

Alosetron (Lotronex) is a medication that works by blocking messages from the gut to the brain. It can relieve stomach pain and diarrhea, but side effects can be serious.

Bile acid sequestrants such as cholestyramine control chronic diarrhea.

Stress Management for IBS

Stress tends to make IBS symptoms worse. So therapies that can help you learn to handle these emotions can often help you find relief.

One technique that seems to help most people is behavioral therapy. It teaches you better ways to deal with pain and stress. Types include relaxation therapy, biofeedback, hypnotherapy, cognitive behavioral therapy, and psychotherapy.

If you want to try behavioral therapy for IBS, try to find a therapist who will work with your regular doctor.

Outside of formal therapy, you can try simple ways to reduce stress and ease IBS symptoms on your own. Meditation, regular exercise, getting enough sleep, and eating a well-balanced diet for your IBS can help.

Also, try to do something you enjoy every day. Take a walk, listen to music, soak in a bath, play sports, or read.

Alternative Therapy for IBS

Some people with IBS try alternative therapies such as acupuncture, probiotics, and herbs to relieve their symptoms.

Keep in mind that most alternative therapies haven't been tested for effectiveness in rigorous clinical trials the way other treatments have.

Researchers at the National Institutes of Health have found that acupuncture works for chronic pain. For IBS relief, however, the results have been mixed.

There is also some evidence that probiotics, "healthy" bacteria normally found in the gut, help some people with IBS. A study of one type, Bifidobacterium infantis, found that it greatly improved IBS symptoms and day-to-day life after people took it for 4 weeks. Research on another type, lactobacillus, has had more mixed reviews.

Studies on herbs have been mixed. Some research has shown that peppermint relaxes colon muscles and may improve symptoms of IBS.

If you want to try acupuncture or herbs for your IBS symptoms, talk with your doctor first. Some herbs can affect how well other medications work.

What’s Right for You

IBS-D is a complex condition. It takes time and patience to figure out what will help you feel your best. Not every treatment works for every person. And your symptoms may change while you’re getting treatment. You may have diarrhea now, then constipation in a few weeks, and then diarrhea again.

Your best bet? Find a doctor who understands IBS and work together on your treatment plan.

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