IBS Drug Treatment

IBS Medicine

Conventional treatment suggest medication, fiber, laxatives and exercise as helpful for IBS treatment; the reality is none of these actually solves the underlying problem of IBS.  In addition, most of these options do not offer much relief from the symptoms.

What are the IBS treatment options?

There are list of IBS treatment options to choose from; they are diet, medication, exercise, herbs, homeopathy, yoga, acupuncture, abdominal massage, hypnotherapy, reflexology, biofeedback, emotional freedom technique, etc.

What you eat, how you eat, how you sit (posture), what you drink, when you drink, how you move your body, and how you process stress are much more important for long-term management of IBS than medicines.

Medication certainly has a role to help to get over worst short-term IBS symptoms; however, no single drug is effective in relieving IBS over the long-term. 

The combination of IBS symptoms is different from person to person. The cause of IBS is different from person to person. The triggers are different. Thus, the treatment for IBS is different from person to person.

IBS Medications

 

Medications for IBS:

  • For Constipation, take laxatives and/or bulking agents.
  • For diarrhea, take bulking agents, slow gut transit, bile salt inhibitors, and/or serotonin blockers.
  • For intestinal gas, take alpha-D galactosidase, activated charcoal, and/or simethicone.
  • For abdominal pain, take antispasmodics and/or antidepressants.

Unfortunately, these drugs do not work for most of the people with IBS. In some, no responds at all. In others, it works initially and failed later. Medical professional admit there is no cure for IBS.   

In a survey by the International Foundation for Functional Gastrointestinal Disorders, questioned 350 IBS patients about their drug therapy experiences. Less than one-third of people surveyed reported satisfied with the drug use. 

When IBS medication do not produce satisfactory result, then many doctors assumes that causes of IBS symptoms is psychological, thus they are prescribing antidepressants.

IBS-Diarrhea Medications

Antidiarrheal medications are of several forms, they are:

  • Slow down intestinal transit (Lomotil and Imodium)
  • Bile salt inhibitors (Questran)
  • Bulking agents (Psyllium and Polycarbophil)
  • Serotonin blockers (Lotronex)

Medicines to slow down intestinal transit

Lomotil (diphenoxylate hydrochloride) is the most common anti-diarrhea medicine for IBS-diarrhea. They increase intestinal water absorption and decrease intestinal transit, thereby increasing stool consistency and reducing frequency of bowel movement. Lomotil is habit-forming and an overdose could be fatal.

Imodium (loperamide hydrochloride) is similar to Lomotil and the most commonly used anti-diarrhea medicine for IBS-D. It decreases the intestinal transit, thus enhances the intestinal water absorption, there by normalize stool consistency and bowel movement. Researchers have found Imodium appears to enhance the anal sphincter tone. This means Imodium keeps the anus tight at rest, this prevent stool leakage at night. Imodium can use as a daily maintenance drug.

Bile salt inhibitors

Questran (cholestyramine) is a bile acid binding agent that inhibits bile acids from stimulating the colon. This way, it slows down the intestinal transit, allows time to reabsorb water, and relieves diarrhea. This drug is useful, if other drugs for IBS-diarrhea failed to produce result. One major side effect is malabsorption, because the bile is bind and removed. Unfortunately, other side effects look similar to that of IBS such as abdominal pain, bloating, constipation, gas, a feeling of fullness, and nausea. 

Bulking agents

Natural bulking agent psyllium and two synthetic substances methylcellulose (Citrucel) and polycarbophil (Fibercon) are the main bulk forming agents useful for both IBS diarrhea and constipation. It is useful for IBS-D, IBS-C and IBS-X. This work by absorbing excess fluid that is the main component of diarrhea and help move the waste through the intestines. They tend to cause gas and bloating, so use it cautiously, take minimal dose and slowly rise until your body start accepting it. 

Serotonin blockers

Lotronex (alosetron) useful to treat diarrhea and abdominal discomfort in some women with IBS. It works by blocking particular serotonin receptors in the gut. Serotonin is a neurotransmitter affects the brain and the bowel. Some researchers have noted high amounts of serotonin in IBS patients; this may be a reason for abnormal activity of the muscles and nerves of the GI tract. Lotronex cutoff blood supply to a section of the bowel and causes it to die. It withdrawn from the market because of this life-threatening gastrointestinal side effect called ischemic colitis. In June 2002, it again passed the FDA approval process with restricted use to women with severe IBS-diarrhea who failed to respond other treatments. 

IBS-Constipation Medications

If there is no bowel movement, episodes of straining, and hard or lumpy stools for three or more days is consider as constipation.

Constipation medications are of several forms, they are:

  • Serotonin receptors
  • Bulking agents (Psyllium and Polycarbophil)
  • Laxatives

Serotonin receptors

Zelnorm is specifically for IBS constipation in women prescribed for short-term use. Zelnorm receives the serotonin in the GI tract. As a result, intestinal contractions increase and help relieve constipation. When works, it can decrease constipation, abdominal pain, and bloating. It does not work for men and works for only some women. Only 25 percent of people with IBS have constipation; most people with IBS experience diarrhea. Zelnorm should stop immediately in people who develop low blood pressure or fainting. Moreover, should avoid in patients who have diarrhea or a history of diarrhea.

See constipation medicines for more details about bulking agents and laxatives.

IBS Pain Medications

Pain is an important symptom of IBS, no pain with other IBS symptom would be a completely different condition. The pain is defining as gripping, spasm, and/or sharp pain difficult to cope easily.

Medicine types that are useful for IBS pain are:

  • Antispasmodics
  • Antidepressants

Antispasmodics

Nerves releases acetylcholine to stimulate muscle tissue. Too much acetylcholine may be due to excess intestinal gas makes the muscles go into spasm. Anticholinergics work by diminishing the effects of neurotransmitter acetylcholine. Anticholinergics is antispasmodic drug prevent or relieve painful cramps and intestinal spasm by inhibiting smooth muscle contraction in the GI tract. This drug is effective when taken 30 minutes before a meal to prevent cramps after eating.

Below are the list of anticholinergics or antispasmodic drugs: 

  • Hyoscyamine sulfate (Brands: Anaspaz, Levsin, Cystopaz-M, NuLev, & Levbid
  • Dicyclomine hydrochloride (Brand: Bentyl)
  • Clidinium 
  • Donnatal

It seems to dry up intestinal secretions causing side effects of dry mouth, nose, throat, or skin, decreased sweating, and inability to urinate, drowsiness, nasal stuffiness, rash, itching. This medication may cause or worsen constipation.

Antidepressants

Antidepressants can block the way the brain perceives pain, doctor prescribe this medication to treat IBS for some people. Antidepressants have an effect on neurotransmitters, which play a role in modulating pain. Lower doses are required to relieve pain than to relieving depression, and thus fewer side effects. Additionally, research shows 40 to 60% of IBS patients seek medical treatment for anxiety, panic attacks, and depression. Pamelor, Elavil, and Tofranil belongs to tricyclic antidepressants, can slow down bowel leads to constipation. Other newer antidepressants drugs such as Celexa, Seroxate, and Prozac cause more diarrhea. The most common side effects associated with SSRIs are nausea, headaches, insomnia, and sexual dysfunction. 

Anti-gas Medication

Anti-gas medication help relieve bloating and flatulence, also pain and spasm. Even it may help relieve diarrhea and constipation in some individuals. 

Alpha-D-galactosidase is an enzyme produce by a mold. This enzyme is commercially available as Beano available as liquid or tablet. This enzyme can break down difficult-to-digest polysaccharides in beans and vegetables so that they prevents them from reaching the colonic bacteria and causing unnecessary gas production. Take this enzyme with your first bite of food for it to work effective in decreasing the amount of intestinal gas.

Activated charcoal tablets (CharcoCaps, Charcoal Plus, others) shown to reduce the formation of gas in the colon. It reduce intestinal gas, if you take 2 to 4 tablets before and after a meal.  

Simethicone: Nonprescription anti-gas medications containing simethicone (Mylanta II, Maalox II, Di-Gel) or bismuth (Pepto-Bismol, Bismatrol). It is a foaming agent combine gas bubbles in the stomach to help belching away easily. However, this medicine has no effect on intestinal gas. Take this medicine before meals for best result. Antacids, such as Mylanta II, Maalox II, and Di-Gel, also contain simethicone.