Patient information from BMJ

Irritable bowel syndrome: what treatments work?

Last published:Nov 30, 2023

Irritable bowel syndrome (IBS) is a condition that can cause stomach pain, cramps, bloating, constipation, and diarrhoea. There isn't a cure for IBS, but lifestyle changes and treatments can improve your symptoms.

Talk to your doctor to decide which treatments are right for you. To learn more about IBS and its symptoms, see our leaflet Irritable bowel syndrome: what is it?

Lifestyle and diet

Keeping a symptom diary

Certain things in your life, such as stress and certain foods, might bring on your IBS symptoms. Your doctor might recommend that you keep a symptom diary.

This will allow you to track when you get symptoms, so you can see whether anything seems to trigger them. Once you identify a possible trigger, you can take steps to avoid it.

Managing stress

Many people get flare-ups of IBS symptoms when they are feeling stressed. So taking steps to manage stress is often one of the first treatments doctors recommend. Things you might try include:

• deep breathing exercises

• meditation

• yoga

• relaxation classes, and

• taking regular exercise.

Talking to a counsellor or joining an IBS support group might also help. Your doctor can help you explore your options. 

Changing your diet

Sometimes people with IBS have difficulty digesting certain foods, which can make their symptoms worse. These foods can include:

• dairy products

• foods that contain a type of sugar called fructose, and

• coffee and other drinks that contain caffeine.

You might need to cut these out of your diet completely if you notice they are causing your IBS to flare-up.

With the help of a symptoms diary you might be able to identify foods that make your IBS worse. But it's a good idea to check with a doctor or a dietitian before you make any changes to your diet. Avoiding certain foods can make your life difficult, and it's easy to miss out on important nutrients.

Some people find that their IBS improves when they cut out a type of carbohydrate that is difficult for the body to absorb. These carbohydrates are called FODMAPs. You can ask your doctor or dietitian for details on a low-FODMAP diet, or look online.

If constipation is one of your IBS symptoms, you might benefit from eating more fibre (specifically soluble fibre, which breaks down in water). Fibre is a bulky substance that your body can't digest. The extra bulk helps make your stools large and soft, and helps your bowels work properly. Good sources of soluble fibre in foods include:

• Barley

• Oat Bran

• Beans, and

• Specific fruits and vegetables (e.g., apples, strawberries, pears, carrots, peas, and avocados).

You can also get fibre supplements from pharmacies or health food shops. Some examples are ispaghula husk and methylcellulose. Make sure you drink plenty of water if you're taking fibre supplements. Fibre sometimes gives people wind or makes them feel bloated.

Probiotic supplements can hep improve IBS in some people. You can buy these as yoghurts or capsules that contain 'friendly bacteria'.

The idea is that these add to the helpful bacteria that live in your bowels and aid in digestion. Research suggests that probiotics with a specific type of bacteria, called Bifidobacterium infantis, might be particularly helpful in IBS.

Exercise

Exercise can be helpful for some people with IBS, especially for constipation. But there’s less evidence that it can help with stomach pain.

Medicines

If lifestyle and diet changes don't do enough to improve your symptoms, medicines can also help. These include:

• anti-spasmodic medicines, which help to control the muscles around your bowel

• medicines for diarrhoea

• medicines for constipation, and

• antidepressants.

Your medicines might change depending on what symptoms you are having (for example, constipation or diarrhoea).

Anti-spasmodic medicines

Anti-spasmodics can help with IBS, especially if your main symptom is pain or bloating. These medicines work by relaxing the wall of your bowel.

People often take anti-spasmodics for a week or so at a time when their IBS gets bad. It's better to take these medicines when your symptoms flare up, rather than to take them every day. Anti-spasmodics can sometimes cause side effects, such as nausea, dry eyes, dry mouth, and dizziness.

Peppermint oil works in the same way as anti-spasmodics. It might help reduce pain and bloating. You can buy peppermint oil as drops or tablets from a pharmacy. Peppermint oil sometimes causes heartburn as a side effect.

Medicines for diarrhoea

Doctors often recommend a medicine called loperamide to treat bouts of diarrhoea in IBS. You can buy it yourself from a pharmacy. Some people get mild side effects from loperamide. These include dizziness, constipation, and nausea.

If loperamide doesn't work for you, there are other options. Talk to your doctor about what might be best for you.

Medicines for constipation

If one of your main symptoms is constipation, you might first want to try eating more fibre or taking fibre supplements. If these don't help, you could also try a laxative to help you go to the toilet.

If you aren't able to take laxatives, or if over-the-counter laxatives don't help enough, your doctor might recommend treatments available only on prescription. 

Antidepressants

Some antidepressants seem to help with IBS. Your doctor might suggest an antidepressant if other treatments haven't helped and you still have pain.

You need to take an antidepressant every day for it to work. You probably won't feel the benefits for at least 2 or 3 weeks. 

Antidepressants can cause side effects, including nausea, weight gain, fatigue, and a dry mouth. However, doctors often prescribe antidepressants at a lower dose for IBS than for depression. So there might be less chance of side effects.

Other treatments

Some research shows that hypnotherapy might help people with IBS to relax and cope with their symptoms. If you have this treatment, a therapist will help you focus on your symptoms and what you can do about them while you're in a relaxed state.

Cognitive behaviour therapy is a talking treatment (a psychotherapy). It aims to change the way you think about your illness and give you more control over it. Studies have suggested that it might help people get fewer symptoms of IBS.

If most of your IBS symptoms are related to pain, you could also be referred to a pain specialist or clinic by your doctor.