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Irritable Bowel Syndrome Living with Irritable Bowel Syndrome

Irritable Bowel Syndrome: Learning to Manage Your Symptoms

Once the patient has been reassured, what is the next step in the control of IBS symptoms?
Lifestyle changes are variably effective. People will often relate flares of their symptoms to stressful events. By increasing their exercise or by getting stress management, people can reduce stress and therefore reduce the stimulus for their symptoms.

As far as dietary changes go, there's not a universal list of foods that cause symptoms. I will always recommend that patients avoid foods that they know affect their gut and set off their symptoms.

Soluble fiber, which can be dissolved, actually works well in patients with diarrhea because it tends to absorb some of the excess fluid and make the stool more formed or bulked. In patients with constipation, it tends to draw more water into the stool so they have softer stool.

I would say probably 20 percent to 30 percent of patients respond to fiber. Now, that may be an underestimation on my part because as a gastroenterologist I tend to see the more severe cases, so it might even be more effective than that in the primary care physician's office—maybe up to 50 percent or more.

What are some strategies if lifestyle changes are not enough?
We start by looking at their specific predominant symptom complex. For a patient with IBS and constipation who doesn't respond to fiber, laxatives may be of use. We try to avoid the stimulant laxatives because there are some concerns about long-term safety, so we use osmotic laxatives, which work by drawing water into the colon. Medications are also available that bind to receptors for serotonin, a chemical in the gut that stimulates the bowel to work better.

How is IBS with diarrhea treated differently?
If a patient's diarrhea does not respond to fiber, then we may try anti-spasmotic medications to slow the gut down by relaxing the smooth muscle of the colon. To some extent, by reducing the contractility of the colon, they also reduce the discomfort.

In patients who have diarrhea, but primarily complain about pain, we might use antidepressant medications that have some pain modulating effects. There are also serotonergic drugs available for the treatment of diarrhea, but they tend to be reserved for younger patients with very severe diarrhea who have tried many medications and don't get better.

What is there a role for mental health counseling for IBS?
Mental health counseling in the average IBS patient is probably not necessary, although it still may be beneficial because it may deal with some of the underlying psychosocial triggers for the IBS symptoms. But I don't that it is something that we should think about except in the minority of patients that have really severe symptoms. Some of these patients may also have a psychiatric disorder.

What new developments in the management of IBS can patients and their doctors look forward to?
I think this is a wonderful time in the course of IBS, particularly IBS therapy. There are drugs that work and there are education initiatives, so patients will start learning about these newer therapies. I'm excited about how patients are going to get better and am anxiously awaiting the newer therapies.

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