Living with irritable bowel syndrome (IBS) can be stressful and painful, and the condition can affect a person’s quality of life. However, people with IBS can use certain strategies to help reduce uncomfortable symptoms. These include dietary changes and psychological interventions.

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Coping with IBS can be challenging, but certain strategies can help people deal with the associated symptoms.

IBS is a common and chronic gastrointestinal (GI) disorder that affects about 12% of people in the United States. The condition is twice as likely to occur in females than in males. People younger than 50 years of age are more likely to develop IBS than people older than 50 years.

As a functional GI disorder, IBS causes abdominal discomfort, gas, and changes in the patterns of bowel movements, as well as diarrhea, constipation, or both. Some people may refer to IBS as a disorder of the gut-brain interaction, which means that it is related to problems with how the brain and gut interact.

This dysfunction can cause the gut to become increasingly sensitive and make the bowel muscles contract. The increased sensitivity can cause feelings of abdominal pain and bloating, while the muscle contractions can cause diarrhea, constipation, or both.

With IBS, a person experiences uncomfortable symptoms without any visible signs of damage to the digestive tract.

The cause of IBS is largely unknown, which hampers the development of effective treatments.

However, experts have identified some risk factors that may play a role in causing it. These include:

Doctors commonly treat IBS by recommending dietary changes alongside other lifestyle adjustments, medications, probiotics, and mental health therapy.

Keep reading to learn more about the treatment options that can help people cope with and reduce IBS symptoms.

Foods are a commonly reported trigger of uncomfortable IBS symptoms. Identifying foods that are potentially responsible for causing symptoms and making simple dietary changes may help provide relief from IBS symptoms.

Keeping a food diary for a few weeks can help a person who has IBS identify foods that either improve or exacerbate their symptoms. When keeping a food diary, a person should track the foods they eat, the symptoms they have, and other factors that may contribute to symptoms, such as sleep issues and stress.

The International Foundation for Gastrointestinal Disorders (IFFGD) has developed a symptom diary that can help people with IBS determine the best treatment options available to them.

The IFFGD highlights insoluble fiber, chocolate, caffeine, and nuts as foods that are likely to cause IBS problems.

A doctor may also recommend that a person with IBS avoid foods that contain gluten, a protein in wheat, barley, and rye. Most pasta, grains, cereals, bread, and processed foods contain gluten.

Some people who have IBS have increased symptoms after eating gluten despite not having celiac disease. This is called gluten intolerance.

If a person with IBS suspects that a certain food is triggering their IBS symptoms, the IFFGD recommends removing it from their diet for at least 12 weeks. If more than one food is triggering symptoms, the person should cut each food out one at a time so that it is easier to determine which is causing the symptoms.

A person may need to change their diet for several weeks to notice improvements in their symptoms. Some people with IBS may benefit from speaking with a dietitian.

Fiber

Fiber makes stool soft and easier to pass, so increasing fiber intake may help improve symptoms of constipation resulting from IBS.

There are two types of fiber: soluble and insoluble. Soluble fiber is in beans, fruit, fruit, barley, and psyllium, whereas people can get insoluble fiber by including whole grain foods and vegetables in their diet.

Experts believe that soluble fiber is more helpful than insoluble fiber in relieving IBS symptoms. The Dietary Guidelines for Americans recommend that adults consume 22–34 grams (g) of fiber each day.

When adding more fiber to their diet, a person should slowly increase the amount by 2–3 g per day. Adding too much fiber to the diet in one go can cause gas and bloating, potentially resulting in even more abdominal discomfort.

Low FODMAP diet

A special diet called the low FODMAP diet may help reduce symptoms of IBS. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are all carbohydrates that the small intestine absorbs poorly. There are five groups of FODMAPs:

  • fructans, which are in wheat, rye, onion, broccoli, and garlic
  • galacto-oligosaccharides, which people get from chickpeas, lentils, soy products, and kidney beans
  • lactose, which is in cow milk, ice cream, yogurt, and cottage cheese
  • excess fructose, such as in apples, mangoes, pears, watermelon, and honey
  • polyols, which nectarines, peaches, plums, cauliflower, and mushrooms contain

Researchers suggest that FODMAPs increase water in the small intestine, which may contribute to the loose stools and diarrhea that can occur in IBS.

Moreover, FODMAPs pass into the large intestine, where billions of bacteria ferment them, resulting in gas, abdominal pain, and bloating. Reducing FODMAP intake may improve these symptoms.

Although just one or two FODMAPs may trigger symptoms in some people, all five can be problematic for others. A person should only restrict foods that contribute to IBS symptoms.

A doctor may suggest that a person with IBS try a low FODMAP diet for a few weeks to see whether it helps relieve their symptoms.

A doctor or dietitian can help an individual eliminate high FODMAP foods and then slowly reintroduce them to find an acceptable level of tolerance.

Increasing physical activity levels may provide some relief from IBS. Exercise helps stimulate contractions of the intestines and reduce stress, which may lessen some IBS symptoms.

A 2018 review of 14 randomized controlled trials concluded that exercise is a potentially effective treatment for people with IBS. However, it was not possible to draw any firm conclusions because of methodical issues. More studies are necessary before researchers fully understand the effects of exercise on IBS.

Another 2018 study of 109 females with IBS and a sedentary lifestyle found that aerobic exercise training of low to moderate intensity had anti-inflammatory effects and improved symptoms of IBS.

It is best to build up the frequency and duration of physical activity slowly. The American Heart Association (AHA) suggests a goal of at least 30 minutes of exercise five times per week.

Physical or psychological stressors, such as a bowel infection or a major life change, can cause a disturbance in the complex interactions between the brain and the digestive system, thereby exacerbating the symptoms of IBS.

Pain is also an emotional experience, so relaxation techniques, mindfulness, and stress reduction techniques may help improve quality of life for people with uncomfortable symptoms of IBS. Examples of relaxation techniques include abdominal or diaphragmatic breathing, progressive muscle relaxation, and visualization exercises.

A 2020 study involving 68 adults with IBS found that completing an 8-week mindfulness-based stress reduction (MBSR) training course was associated with “robust improvements” in GI symptoms.

Practicing mindfulness can help people with IBS or other chronic pain be aware of sensations that are occurring in the present without becoming stressed about them and worrying about what they might mean. This may help increase physical and mental well-being.

Meditating, getting counseling and support, taking part in regular exercise, and getting enough sleep can also help reduce stress levels.

It is not clear what causes IBS, so treatments aim to relieve symptoms and prevent discomfort. If changes in diet, lifestyle, and stress levels do not alleviate a person’s symptoms, a doctor may suggest medications. The options include:

  • Fiber supplements: These supplements may help control constipation. Examples include psyllium (Metamucil) and methylcellulose (Citrucel).
  • Laxatives: These drugs help promote bowel movements in people experiencing constipation. Examples include osmotic laxatives (Miralax), milk of magnesia, and bisacodyl (Dulcolax).
  • Antidiarrheal medications: Loperamide (Imodium) helps reduce diarrhea by slowing gut transit, which refers to the time it takes for food to travel through the gut.
  • Antispasmodic medications: These drugs prevent smooth muscle contractions in the GI tract to reduce bowel spasms. Examples include hyoscyamine (Levsin) and dicyclomine (Bentyl).
  • Antidepressant medications: Low doses of tricyclic antidepressants and selective serotonin reuptake inhibitors may help with symptoms of pain or depression and potentially help increase or decrease GI function.
  • Antibiotics: Rifaximin (Xifaxan) is an antibiotic that the Food and Drug Administration (FDA) has approved for the treatment of IBS. It could potentially help with treating SIBO and appears to have anti-inflammatory properties, although more research is necessary to confirm this.
  • Peppermint oil capsules: These capsules may reduce IBS symptoms by causing smooth muscle relaxation. Peppermint oil capsules also have anti-inflammatory and anti-gas properties, and they may reduce the amount of serotonin in the gut, which might help people with IBS.

The FDA has also approved drugs that have proved to be effective in treating multiple symptoms of IBS. These include:

  • Alosetron (Lotronex): This drug relaxes the colon and slows the movement of waste through the lower bowel to reduce diarrhea and abdominal pain. As it can cause increased rates of severe constipation, doctors can only prescribe it to females with severe IBS-D, which is a subtype of IBS that primarily involves diarrhea.
  • Lubiprostone (Amitiza): This medication increases fluid secretion in the small intestine to help the stool move along more easily.
  • Eluxadoline (Viberzi): People may find that this drug reduces abdominal pain and diarrhea and improves the consistency of stools.
  • Linaclotide (Linzess): Linzess works by blocking pain signals and increasing the passage of stool through the GI tract.
  • Tegaserod (Zelnorm): This medication increases gut movement and intestinal secretions to relieve pain and bloating.

Some studies suggest that probiotics might help with symptoms of IBS. However, not all probiotics have the same effect, and their benefits are currently unclear.

If an individual is still having trouble with IBS symptoms after exploring all of the methods above, they might wish to consider mental health approaches to help improve their symptoms.

Talking therapy

The most well-studied psychotherapy treatment for IBS is called cognitive behavioral therapy (CBT). There is strong evidence supporting CBT as a treatment for IBS.

CBT therapy for IBS involves understanding how stress and fear are related to GI symptoms and learning how to identify and modify physical stress responses to reduce symptoms.

Researchers have found that CBT is highly effective in improving bowel symptoms, quality of life, and psychological distress in people who have IBS. Importantly, these effects last even after treatment has finished and into the long term.

Gut-related hypnotherapy

Some research suggests that hypnotherapy can improve IBS-related anxiety, depression, gastrointestinal symptoms, and quality of life.

During gut-related hypnotherapy, a therapist uses hypnosis to help a client learn to relax the colon muscles and regain control of their physiological responses.

The treatment typically involves 7–12 weekly sessions during which clients learn to achieve a hypnotic state.

There is no one-size-fits-all approach to dealing with IBS. However, by trying different combinations of dietary changes, exercise, stress management, medications, and psychological therapies, people may be able to reduce the symptoms of IBS.

Anyone who is finding it difficult to manage their symptoms should speak with a doctor.