Irritable Bowel Syndrome (IBS): Managing Symptoms and Finding Relief

IBS is a disorder of gut-brain interaction (DGBI) with recurrent abdominal pain linked to defecation or bowel habit change (Rome IV criteria). No structural pathology.

Subtypes

• IBS-C (constipation-predominant)
• IBS-D (diarrhea-predominant)
• IBS-M (mixed)
• IBS-U (unclassified)

First-Line Management

• Diet: Low FODMAP diet (fermentable oligo-, di-, monosaccharides, polyols) — 70% respond. Reintroduction phase essential. Soluble fiber (psyllium) for IBS-C.
• Lifestyle: Regular meals, hydration, exercise, sleep hygiene.
• Stress Management: CBT, gut-directed hypnotherapy, mindfulness — strong evidence.

Pharmacologic Options (Symptom-Targeted)

• IBS-C: Linaclotide, plecanatide, lubiprostone, tenapanor.
• IBS-D: Rifaximin (non-absorbed antibiotic), eluxadoline, alosetron (restricted), loperamide (PRN).
• Pain: Low-dose TCA (amitriptyline), SSRI, antispasmodics (peppermint oil, dicyclomine).
• Global: Probiotics (strain-specific evidence).

Red Flags (Need Investigation)

• Onset >50, weight loss, rectal bleeding, anemia, family history CRC/IBD, nocturnal symptoms.

Key Principle

Individualized, multimodal approach. Patient education and validation are therapeutic. No "cure" but effective control achievable.