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Fibers

I have heard that fiber is good for IBS. Is that true?

The use of fiber supplements has been part of the standard management of IBS. Research has shown that fiber improves bowel movements by increasing the frequency and bulk of stool as well as decreasing the pressure inside the colon. However, data regarding the effect of fiber in IBS is conflicting. These findings may be due to differences in symptoms and type of fiber used in various studies. Fiber is similar to a sponge. It works by holding and increasing the amount of water in the intestinal lumen. This softens the stool. Considering the "sponge" analogy, fiber would not be very effective in constipation unless it is used with adequate hydration. Interestingly, fiber helps IBS patients with diarrhea via the same mechanism as a sponge. Here, fiber absorbs the extra water in the intestinal lumen and changes a liquid stool into a soft one. Thus, fiber works in either constipation or diarrhea and helps the patient to have a formed and soft stool. Since fiber can be fermented by intestinal bacteria, it can result in production of an excess amount of gas and bloating. This problem is particularly troublesome when a large amount of fiber is introduced into the diet.

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Spasmolytics

This group of medicines relieves the spasms and relaxes your bowel.

Antispasmodics (also known as spasmolytics) are medications that relax the bowel muscle and frequently prescribed for IBS patients with diarrhea and pain. Research has found that these agents were significantly more likely to reduce pain and to improve the patient's overall quality of life. Since these medications reduce bowel contractions, they can potentially result in constipation. Besides, the numerous potential side effects of spasmolytics limit their popularity among physicians and patients. Furthermore, these medications can cause urinary retention, temporary blurred vision, dry mouth and dry eyes and drowsiness. The newer version of spasmolytics medications are expected to have fewer systemic side effects. Their effectiveness as well as complete side effect profile remains to be seen. There are also some herbal medications that have spasmolytics properties, such as spearmint and peppermint oil.

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Antidiarrheal

This group of medicines helps with the loose bowel.

Antidiarrheal agents are helpful in the management of diarrhea and pain in IBS. Loperamide (Imodium®) and other antidiarrheal agents significantly decrease diarrhea and the sense of urgency in patients with IBS. Loperamide is generally preferred to other opiates such as diphenoxylate (Lomotil®) or codeine because it does not directly affect the brain. Furthermore, diphenoxylate, when combined with spasmolytics may cause confusion, particularly in the elderly. Cholestyramine (Questran®) is another antidiarrheal agent that has been used in IBS with variable success. The major disadvantage of Cholestyramine is poor palatability (a bad taste in the mouth). Alosetron hydrochloride (Lotronex®) is a newer drug for IBS that is helpful for controlling diarrhea. It also affects intestinal sensation and improves abdominal pain.

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Laxatives

This group of medicines helps you move your bowel.

Laxatives are divided into two groups based on the mechanisms they use to produce results. Some laxatives improve bowel motility. These agents are called prokinetics; they improve intestinal peristalsis and intestinal transit time. Domperidone (Motilium®) is a prokinetic agent that facilitates gastric emptying. It is effective for reducing bloating and abdominal pain after meals, particularly in non-ulcer dyspepsia. This medicine is not readily available in the United States and should be purchased from abroad. Cisapride (Propulsid®) is a medication that reduces constipation. Due to a rare but serious cardiac side effect, this medication was recalled in the year 2000 by the Food and Drug Administration (FDA) and is no longer prescribed in the United States . Tegaserod (Zelnorm®) is a serotonin-like agent that is helpful for IBS patients with constipation; however, it was also recalled by the FDA due to its rare but life-threatening cardiac side effects. It is now available for treatment of IBS under controlled circumstances. The other group of laxatives works by changing stool consistency. An example of these medicines is Amitiza® (Lubiprostone), a newer medicine that has been approved by the FDA for the treatment of constipation. This medicine has not been approved for the treatment of IBS, but recent clinical trial in IBS subjects showed promising results.

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Antibiotics


There is gathering evidence that subjects with IBS have an imbalance in the bacteria that populates the gastrointestinal tract. A new study showed that a course of treatment with Xifaxan® (rifaximin), a lumenal antibiotic, could alleviate the symptoms of IBS. Xifaxan works differently from other antibiotics because it passes through the gastrointestinal tract without being absorbed into the blood stream. After treatment with Xifaxan, subjects reported significant improvements in their symptoms of gas and bloating.

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Probiotics


Probiotics are beneficial live bacteria that survive the digestion process and therefore are able to populate in the gastrointestinal tract. There are more than a million species of bacteria in our digestive tract, particularly in the large bowel. This population could be affected by diet and various disease states. It is widely believed that a proper balance of these bacteria is interconnected not only to the health of the digestive tract, but also to our sense of well-being. Several studies have shown that abnormalities may occur in the balance of the bacterial population living inside the gastrointestinal tract, and some reports claim that ingestion of live bacteria (probiotics) can restore this imbalance. There are a growing number of commercially available probiotics in the market. However, only a few of them have been standardized and tested in clinical trials. VSL#3® is one of the probiotics that contains almost a half-trillion live lactic acid bacteria that survive the journey through the GI tract and colonize in the colon.

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Psychotropic Agents

This category of medicines helps with pain and other IBS symptoms.

Psychotropic medications are group of antidepressant medicines that are typically used to treat psychiatric symptoms, such as anxiety and depression. There are a number of patients with IBS who also have significant anxiety and depression. However, these are not the only one who benefit from psychotropic medications. This is because these medications can also modify the brain-gut axis by affecting neurotransmitters along the axis and modifying the threshold for pain perception. It is noteworthy that the amount of the antidepressant that is required to effectively treat IBS is significantly less than that which is used for the treatment of depression or anxiety.

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Stress Management

Manage your stress to keep your IBS in check.

Stress Management is the cornerstone of the management of IBS. There are a growing numbers of stress management strategies available. These treatment modalities include progressive muscle relaxation, meditation, yoga, music therapy, biofeedback, cognitive behavioral therapy, hypnotherapy (hypnosis), and psychodynamic psychotherapy. The majority of these interventions are designed to teach patients effective techniques that foster deep relaxation and reduce the daily tensions that increase stress and exacerbate IBS symptoms. Thus, it is not surprising that these interventions can successfully reduce symptoms of IBS. Interestingly, research in this field also has indicated that the benefits of the majority of these interventions are sustained over a long period of time.

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