Integrative approaches to reduce IBS symptoms

Irritable bowel syndrome (IBS), a gastrointestinal condition that involves abdominal pain and altered bowel habits (constipation, diarrhea, or both), affects over 10% of Americans. Though some find the condition merely a nuisance, for many individuals it can be quite bothersome and disruptive. While medications can sometimes offer relief, some individuals do not respond to medications or find the side effects intolerable. Fortunately, there are several well-studied, nondrug, integrative approaches that can help to reduce IBS-related symptoms and restore a sense of control over one’s life.

Stress reduction

IBS is well known to be aggravated by stress. Moreover, the symptoms and the disruption they cause can themselves become a source of stress, creating a vicious cycle of stress and discomfort. How does stress affect the gastrointestinal system? It turns out that the largest concentration of neurons outside of the brain and spinal cord is in the gastrointestinal tract, making it particularly susceptible to stress and creating a strong brain-gut connection. Stress hormones can alter movement through the gastrointestinal tract (speeding it up or slowing it down) and cause the muscles in the intestines to spasm and cause pain. Thus, for people who experience a lot of stress in their lives, learning stress-reduction techniques can be instrumental in reducing the frequency and severity of IBS-related symptoms.

Several clinical trials have demonstrated that two stress-reduction techniques — meditation and mindfulness-based interventions — can significantly reduce abdominal pain and improve bowel habits. To be most effective, these tools should be practiced daily, as over time they retrain the nervous system and reduce the amount of time that it operates in the stress (fight-or-flight) response. It’s important to remember that meditation and similar techniques are learned skills that take time and practice to build, so you are unlikely to notice an immediate improvement in IBS-related symptoms after the first or second try. There are many meditation apps, internet tutorials, and even evidence-based courses offered through major hospitals that offer opportunities to learn these invaluable skills.

Other stress-reducing approaches have also shown benefit for IBS-related symptoms. These include gut-directed hypnotherapy (a popular protocol in Europe), cognitive behavioral therapy, and possibly yoga.

Special diets

Studies have shown that foods high in FODMAPs (dietary sugars known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can exacerbate IBS-related symptoms by providing fuel for certain bacteria in the gastrointestinal system. The byproducts from these bacteria can cause pain and bloating. On the other hand, low-FODMAP diets can reduce the abdominal pain, bloating, diarrhea, and constipation associated with IBS. Although safe to follow for short-term use, there are no long-term studies of this diet, and sustaining this eating pattern can be challenging.

For some patients with diarrhea-predominant IBS, reducing intake of gluten, a protein found in wheat, rye, and barley, can help. This may be the case even if you do not have celiac disease, as gluten can modify the barrier function of the gut lining.

Supplements

For individuals with constipation-predominant IBS, a soluble fiber supplement (Metamucil or others containing psyllium) can be helpful. Large amounts of fiber can hinder the absorption of medications, so take your medications one to two hours before the fiber supplement. Soluble fiber is also found in foods such as beans, avocados, oats, and dried prunes. Be sure to consume plenty of water with fiber to avoid worsening the constipation.

A recent analysis of nearly 1,800 patients from multiple studies demonstrated that probiotics reduce pain and symptom severity in IBS compared to placebo. Probiotics are “good” bacteria touted to help maintain digestive health. However, given the variety of different probiotics that have been studied, it is difficult to know exactly which ones are most useful or how much to take.

Finally, peppermint oil is well known for its ability to relax the smooth muscles of the gastrointestinal system, and can help reduce the abdominal pain associated with IBS. To reduce the potential for heartburn, enteric-coated capsules (typically containing 0.2 milliliters or 181 milligrams of peppermint oil) are recommended. The dose for adults is one to two capsules up to three times per day.

Mind-body tools, a low-FODMAP diet, and some supplements can help relieve IBS-related symptoms and are generally safe for most people. They can also be used in combination with most IBS medications. If you have IBS, talk with your healthcare professional, as he or she may be able to provide you with resources to help you implement these tools in your life.

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Related Information: The Sensitive Gut

Comments:

  1. Shelly Marie

    Ok everyone: here’s a crazy solution and I’ve found it actually helps. We need to redirect. I think it’s actually a psychological term of sorts. I find I get so worried at work when I’m getting diarrhea that I’m going to have an accident. I sit there getting angry too that I’m going through this once again… so I do something completely different. I take the 4 dose Imodium. Hit the bathroom where I’ll be for a while, and read a Historic Romance Novel. I’m not kidding. It completely takes my stress-filled mind off my present trouble. I completely relax and forget my IBS, getting caught up in the story. Redirect your mind to something completely different. It just might work. The IBS attack comes to a close and it’s no longer the enemy of my day.

  2. Karen

    Thank you for this article Dr. Dossett. As a Registered Nurse working with integrative therapies that are evidence-based as adjuncts to conventional medicine, I have found the stress relief offered through meditation, mindfulness, hypnosis and reiki helpful for reducing symptoms in clients with IBS, and other digestive issues, especially when taught these as helpful ‘tools for self-care.’ A number of clinicians in the U.S. offer hypnosis as adjunctive/supportive therapy for IBS.

    While admittedly difficult, if not impossible to blind patients when studying these therapies, this review of randomized-controlled studies concluded that “hypnotherapy has beneficial short-term effects in improving gastrointestinal symptoms of patients with IBS.”
    (J Neurogastroenterol Motil 2014;20:152-162)

    • Michelle Dossett, MD, PhD, MPH

      You’re welcome, Karen. And thank you for sharing about hypnotherapy. You are correct. There is a particular form of hypnotherapy (gut-directed hypnotherapy) that was developed in the UK (also known as the Manchester protocol) that has good data behind it for helping with IBS-related symptoms. I haven’t seen it used much in the US.

  3. Pat Pauley

    I’ve had IBS since I was in my early twenties. Primarily diarrhea, very rarely constipation or bloating. Have tried numerous meds., diets, fodmap included, probiotics, etc. etc. Nothing has helped much. I did learn that one of my BP meds was exacerbating the diarrhea, so discontinuing that has been helpful. I take a Lomotil almost everyday, which lasts for several hours, so that I can enjoy a few activities outside my house. I am 73 and frankly, I’ve given up on trying to control this disorder. I have tried every suggestion made in this online newsletter. I am tired and old and cannot enjoy traveling or other activities that I thought I might be able to do in my retirement. Essentially, this disorder has controlled my life.

  4. John

    I had IBS associated with extended use of antibiotic. It happened, even though I was taking a multi-strain probiotic. Recently, I read about a study that showed a multi-strain probiotic interfered with the microbiome returning to normal.

    I found Florastor (a single strain yeast) helpful for my mild case of IBSD. I discontinued it after pain subsided. I also thought that rinsing my salad with a vinegar / water solution also helped, and continue to do that.

  5. Frank

    Have you considered digestive aids? I have found broad spectrum helpful.

  6. Lynn

    I find a little OTC Imodium helpful for loose BMs:
    as well as a tiny dose 5-10mg of rx’d amitryptiline
    The latter is long acting whereas Imodium starts working in an hour +…..
    With the above I can be comfortable after the first couple of hours of the day. Of course there are many variables: what you eat (too much fiber), alcohol, Vit C, too much aspirin, and of course stress is the big one… I too run to relieve stress once my gut feels better. In a perfect world I would slow pace & meditate…..
    The biggest problem with the above medications is occasionally getting a little constipated temporarily which is also no good when you’re accustoned to being too loose! Work with the dosaging being aware that Imodium wears off (see directions on label) whereas amitryptine is taken just once or twice a day… People in general vary widely in their sensitivity to the dosages above, So trial and error are required: son, however, you get to know your gut and your ‘head..!’… Chill… is the bottom line, but so hard for many of us to do !! Eating less also helps along with less alcohol. Oh: avoid hot liquids: coffee is the worst: remember most people (without loose IBS) use coffee as a mild laxative every morning the world over! Take Grren Tea capsules if you want the harmless caffeine (or even a No Doz); it’s Not the caffeine that stimulates peristalsis: tea is not as strong (But sone people just drink hot water as a laxative…:-). Coffee is the 1st thing to give up: get your harmless dose of caffeine elsewhere… I know, I know… the coffee smells so good!! I have it up 25 years ago! (Except as a treat if I get constipated by a little too much Imodium!!) (Even then glyce

  7. Sandy

    It’s helpful to keep track of the food you ate when you had a problem. I found that oats are not good for me even though they are always on lists of foods you should eat if you have IBS.

  8. Kathy Moreland

    I am grateful for any suggestions to help me with my IBSD. I started having this after gallbladder surgery. Through the years I’ve taken different meds. And they help for awhile but changes after time.
    My NP suggested I try a gluten free diet and I do try and stick to a gluten free diet but reall hasn’t changed that much. I’m ready to try what you suggest. I’m 76 years old and IBSD leaves me weak and no energy so I hope this will help and I thank you

  9. Barbara Forman

    How can I choose a great probiotic?

    • Michelle Dossett, MD, PhD, MPH

      Unfortunately, it is not a straightforward answer. Different probiotic organisms may be better for different things. In general, I recommend one with a variety of different organisms (including Bifidobacterium) and a larger number of organisms (something in the 30-50 billion range or more). Probiotics also need prebiotics in the form of what we consume in our diet to thrive. Plant-based foods are generally very good for this. Final thing to know is that not all probiotics contain what they claim to. Consumer Labs periodically analyses probiotics and reports on which ones contain what they claim and which ones don’t.

  10. Candice

    I tried everything I could think of or find on the internet and the only thing that helps me is running. I run 5km every other day and my symptoms have pretty much disappeared. If I stop running though for even a week the stomach pain comes back and the diarrhea/constipation starts. I was diagnosed with IBS 8 years ago. My advice, GET MOVING! You probably feel terrible and afraid to leave your house too long so just go around the block.

    • Alex

      Hi, so glad exercise is helpful for you but for me exercise can REALLY trigger a bad bout of horrible cramping and explosive diarrhea. I’ve already had to rush out of the gym to the bathroom where I’m stuck for a half hour or so. Even walking too fast can trigger these bouts as well. I’m trying to find some way to fix this but nothing has worked so far.

    • Michelle Dossett, MD, PhD, MPH

      Candice,
      So glad you found running helpful. Exercise is a great buffer for stress and it also helps to reduce constipation. Others may need to try something else. The causes and solutions for IBS are multifactorial which is why I individualize treatment based on the person in front of me.

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