Irritating Irritable Bowel Syndrome (Part 3)

Back before I became a diabetes educator, I worked with a team of gastroenterologists. Many of the patients that I saw had IBS. And while medication was often prescribed to try and regulate, if not alleviate, their symptoms, the reason that the physicians referred them to me was to make some nutritional changes; at that time, dietary intervention was the most effective way to manage IBS. Nutritional management is still a key factor in IBS management, but today we’re fortunate to have some other treatments available.

Management of IBS: Parallels to Diabetes
Ask anyone who has IBS and they’ll likely tell you that it’s no fun to have this condition, especially when it acts up. Treatment of IBS can vary from person to person, and is usually based on the severity of symptoms. It’s interesting to note that IBS and diabetes have a few things in common: They are both chronic conditions that, at least at this time, require lifelong management. There may be times when symptoms seem to “flare up,” leaving you feeling frustrated. But, with patience and some trial and error, both conditions can be successfully treated usually with a combination of medication, nutrition, physical activity, and even stress management. Of course, it’s doubly challenging if you have both IBS and diabetes. If you have one or both, you’ll want to have a health-care team that is trained and willing to work with you to tailor your treatment plan as needed.

This week, we’ll look at how IBS can be managed with medication. Please realize that not everyone with IBS needs medication. In fact, many people can manage their symptoms with “lifestyle” measures (again, much like diabetes!) — healthy eating, regular physical activity, and stress management. We’ll talk more about these measures next week.

However, some people, unfortunately, have more severe symptoms of IBS. Medical management depends on the type of symptom one has — for example, diarrhea vs. constipation. Members of the American College of Gastroenterology’s expert panel released revised guidelines for treating IBS, which are published in the January 2009 issue of The American Journal of Gastroenterology. These guidelines are graded, which means that the quality of evidence and the overall expected benefit were taken under consideration (what this really means is that these guidelines can better help your health-care team choose the most appropriate and effective treatment for you).

Here are the available medications used for IBS. Some of these are over-the-counter (OTC), while some require a prescription.

Antidiarrheals
Loperamide (brand name Imodium) can be use to treat diarrhea. This drug reduces stool frequency and improves consistency, but it does little to help pain or bloating. In fact, it does no better than placebo for these issues.

Antispasmodics
Also called anticholinergics, these drugs work on the nervous system to reduce painful spasms or contractions of the bowel. Hyoscine, cimetropium, and peppermint oil may be used, although it’s unclear if they can provide long-term relief of spasms.

Antidepressants
You might be thinking that antidepressants are needed to help you better cope, mentally, with IBS. While that might be true, certain antidepressants, such as imipramine (Tofranil), fluoxetine (Prozac), or paroxetine (Paxil), can reduce pain; the catch is that some of these can actually worsen constipation or diarrhea, so your provider needs to choose carefully, based on your symptoms.

Nonabsorbable Antibiotics
Rifaximin (Xifaxan), an antibiotic that stays in the gut, may help some people with IBS who have bloating and diarrhea by targeting possible small bowel bacterial overgrowth.

IBS Medications
There are now two drugs that are used specifically for IBS: alosetron (Lotronex) and lubiprostone (Amitiza). Alosteron was temporarily removed from the market due to several deaths. Its availability is restricted and is geared for women (not men) whose main symptom is diarrhea. Lubiprostone is used to treat chronic constipation and more recently has become used to treat constipation in women age 18 or older who have IBS (its effectiveness in men with IBS-related constipation hasn’t yet been determined).

Next week: More therapies for treating IBS!

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