The treatment should be targeted at the dominant symptom of irritable bowel syndrome, which can be pain, diarrhea or constipation. Along with it, the psychosomatic component of the disease needs to be tackled.
Since symptoms can be brought on by any change in psychological, social or environmental factors like stress, hormones, medications or foods, they need to be found and addressed. For instance, stress can be controlled by relaxation therapy, yoga and meditation. Adopting certain healthy lifestyle habits like regular exercise, and adequate rest and sleep can be very beneficial.
Also, you have to realize that irritable bowel syndrome is a chronic disease characterized by remissions and exacerbations, in which the cause often cannot be found. So you may have to face up to this fact and learn to cope with the disease rather than look for a permanent cure.
Acute attacks of abdominal distension or pain can be controlled by anticholinergic agents such as hyoscyamine (0.125 mg), dicyclomine (10–20 mg) or methscopolamine (2.5–5 mg) 30 minutes before taking meals and before retiring to bed. Some of their side effects are dry mouth, constipation, urinary retention and increased heart rate.
Medications for Irritable Bowel Syndrome
Diarrhea can be tackled with loperamide 2 mg 3–4 times/day. It reduces the urgency, frequency and liquidity of stools. If constipation is present, osmotic laxatives like polyethylene glycol, milk of magnesia, lactulose and sorbitol are preferable. Polyethylene glycol at a dose of 17–26 g/day has been shown to be effective in these cases. These increase the frequency and consistency of stools and reduce the associated straining.
Tricyclic antidepressants may be beneficial in patients with abdominal distension or pain. Amitriptyline in doses lower than those used to treat depression, 10–25 mg at night, given for several months is beneficial. Side effects are mild and include dry mouth and drowsiness. It acts by altering the sensation and motility of the bowel.
Other tricyclic antidepressants that can be tried are nortriptyline, desipramine or imipramine at doses of 50 to 150 mg/day. Selective serotonin reuptake inhibitors like sertraline (50–150 mg/day), fluoxetine (20–40 mg/day) or paroxetine (10–20 mg/day) can make you feel better, but they do not have appreciable effect on pain or other bowel symptoms.
Since anxiety and stress underlie and accompany irritable bowel syndrome, hypnotherapy and cognitive-behavioural therapy have been found effective in some patients.
Due to their adverse effects, most of these agents are no longer recommended. The sole exception is alosetron (1 mg 2 times/day), but its use is restricted to women with severe diarrhea-predominant irritable bowel syndrome not responding to other medications. It reduces cramps, pain and diarrhea. However, its side effects include severe constipation and ischemic colitis (a serious inflammatory disorder of colon).
Rifaximin 400 mg 3 times/day for 10 days can help by inhibiting the growth of intestinal bacteria. It can relieve abdominal distension and flatulence.
Probiotics are live or attenuated bacteria or bacterial products. Bifidobacterium infantis has been found to help in some cases by suppressing the inflammation and reducing the production of bacterial gas. Gut sensitivity, abdominal distention and flatus are decreased by this probiotic. It is safe and well tolerated. Dose is one capsule (containing 100,000,000 bacteria) daily.
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