Irritable bowel syndrome treatments. New proof, old remedies.

by James Hubbard, M.D., M.P.H.

I have been treating irritable bowel syndrome, sometimes called spastic colon, since I began practice in the 1980s.  I saw a lot of it when I had a full-time family practice.

Several new treatment drugs have been developed and removed from the market within the past few years, due to bad side effects.  An article in the British Medical Journal shows that really, much has not changed since the 1980s.

The researchers analyzed as many past treatment studies as they could scrape up and found that what we’ve been doing does, in fact, work many times.  But much more needs to be done.

What is irritable bowel syndrome?

We think the IBS patient’s colon is more sensitive to stress and food.  We don’t know the cause. Symptoms are intermittent and include chronic abdominal bloating and cramping, along with constipation or diarrhea, which can alternate.  As many as 20 percent of the United States may suffer–women more than men.

Lifestyle treatments for IBS

Your first step is to see your doctor to rule out things that cause similar symptoms.  Next, see if you can relate the symptoms to eating large meals or foods such as milk, spicy or fatty foods, caffeine, or alcohol.  If so, avoidance is key.  Talk to your doctor about medicines that might trigger it.  Anxiety or stress is a common trigger, and relaxation techniques may help.

Other treatments for IBS

Now for the BMJ article.  Reviewing past studies, they looked at the effectiveness of three common treatments. (Notice that placebo–the fake treatment–had a significant effect in all three).

  1. Fiber. Specifically, psyllium (ispaghula husks in Britain, where the study was done) helped 48 percent of patients and placebo helped 36 percent, giving psyllium a 1 in 6 chance of helping. I didn’t see dosage, but the usual is 1 tablespoon mixed in a full glass of liquids one to three times a day.  Wheat fiber did not help.
  2. Antispasmotics. They looked at many with which I was not familiar (British meds).  Your doctor will help you chose.  Overall, there was a 1 in 5 chance they helped.
  3. Peppermint oil. I knew it is supposed to help some digestive disorders, but I’ve never used it for IBS.  The researchers found it helped 65 percent compared to placebo’s 35 percent.  One in 2.5 patients saw benefit overall.A recommended dosage, at a University of Maryland Medical Center Web site, is 2 enteric coated capsules three times a day between meals.  Don’t take if you have GERD (recurrent heartburn) or are pregnant.

The article did not look into whether a combination of treatments works better.  I’m guessing it does.  Always talk to your doctor for individual advice.   Many people will benefit from these lifestyle changes and old treatments, at least until new, more expensive ones come along.

Has anyone found relief from these or other remedies?


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10 Responses to “Irritable bowel syndrome treatments. New proof, old remedies.”

  1. Super Healthy Kids Says:

    This is a tough one, since everyone is so different. Interestingly I found ibprofen really exascerbated my symptoms. I have ulcerative colitis and the h.pylori bacteria. But I am almost symptom free if I don’t take any type of pain medication! But like I said, everyone is different, you have to find what helps you.

    Super Healthy Kidss last blog post..It looks like ice cream….

  2. James Hubbard Says:

    Super Healthy Kids–Thanks for the interesting perspective. As you know, ulcerative colitis is a different disease with different treatments from IBS, but you are right. We all have to find what works for us.

  3. Ralph Says:

    This confirms what a lot of us feel works. I wonder when they will look at probiotics as well.

    One natural thing that my wife bought at a healhth food store has helped me, it combines peppermint and antispasmodic herbs, it is called IBSuppress or IBS Suppress.

    Just goes to show that expensive does not mean better. And that we may be able to get relief/help without Rx meds that have serious side effects.

    Good luck to all.

  4. Blake Says:

    My wife’s IBS isn’t as bad when she’s getting regular exercise and eating right. She used to be on Doxepin (I think that’s how you spell it) and I think that helped but she went off it before she got pregant. Lately she has been complaining a bit about IBS pain. Anything we should know about IBS and pregnancy? Or do same rules apply?

    Blakes last blog post..Success is a Choice

  5. James Hubbard, M.D., M.P.H. Says:

    Thanks Ralph. I am sure someone is testing probiotics, but I don’t no the results.

  6. James Hubbard, M.D., M.P.H. Says:

    Blake, I think the same rules apply, exercise and eating healthy. She should check with her doctor before any antispasmotic meds, prescription, otc or supplements.

  7. cathy Says:

    Great article! I’ve never heard of using peppermint oil to treat IBS. My husband has IBS. He’s been very successful managing it with diet (he knows his triggers) and exercise, but it can still flare up. Stress is a huge trigger for him. More recently, he’s been taking a probiotic blend that his doctor recommended and has seen positive results.

    cathys last blog post..And the winners are…

  8. James Hubbard Says:

    Thanks Cathy. I am glad he is able to control it well. Keep the stress down.

  9. James Hubbard’s My Family Doctor Blog » Blog Archive » Irritable Bowel Syndrome: Updated recommendations from the American College of Gastroenterology Says:

    [...] Irritable Bowel Syndrome (IBS) affects 20 percent of the adult U.S. population.  Although it does not actually harm the intestines, it can wreak havoc on the sufferer with any combination of abdominal bloating, cramping, diarrhea and constipation.  In a recent post I reported a study showing the old standby treatments of fiber, peppermint oil and…. [...]

  10. Renay Says:

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