IBS Treatment Plan for Bloating, Constipation, and Diarrhea

How Diet, Lifestyle, and Treating Dysbiosis Can Relieve IBS Symptoms

ibs treatment: woman suffering from abdominal pain

If you have chronic digestive symptoms that are the hallmark of irritable bowel syndrome (IBS), you have probably searched far and wide for a good IBS treatment plan. You might wonder about the best way to approach IBS treatment.

Your ideal IBS treatment plan will depend on your particular IBS symptoms and causes, because these are unique for each IBS patient. But the general approach to treating IBS is the same as treating any other digestive symptoms or diseases:

  1. Eat an anti-inflammatory diet.
  2. Support your digestion with probiotics and other basic digestive supports.
  3. Include behavioral supports such as a stress relief practice if indicated.
  4. Treat any underlying dysbiosis if diet and digestive support don’t resolve symptoms.
  5. Maintain normal gut motility with natural items or prescription medications if necessary.
Steps involved in IBS treatment plan

What Is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome (IBS) is one of the most common digestive system disorders, affecting approximately 10-15% of Americans [1]. IBS is not a specific disease with a specific cause — it’s a collection of digestive, immune system, and nervous system symptoms [2 Trusted SourcePubMedGo to source].

IBS Symptoms

Common symptoms of IBS include the following:

  • Cramping or abdominal pain
  • Gas
  • Bloating
  • Diarrhea (IBS-D)
  • Constipation (IBS-C)
  • Food allergies

IBS can also have some non-digestive symptoms including:

The official Rome IV criteria [11 Trusted SourcePubMedGo to source] for diagnosing IBS is “Recurrent abdominal pain on average at least one day/week in the last three months, associated with two or more of the following criteria:

  1. Related to defecation
  2. Associated with a change in the frequency of stool
  3. Associated with a change in the form (appearance) of stool” [12 Trusted SourcePubMedGo to source].

Essentially, changes in your bowel movements coupled with frequent abdominal pain from an unknown cause are called IBS.

How Is IBS Diagnosed?

There are no specific blood tests or other diagnostic tests for IBS. Research tells us that IBS symptoms are common in other digestive diseases such as inflammatory bowel disease (IBD) [13 Trusted SourcePubMedGo to source] and celiac disease [14 Trusted SourcePubMedGo to source]. Usually, an IBS diagnosis is made after your doctor or gastroenterologist rules out other causes for your digestive symptoms. 

Care providers may run basic blood tests, SIBO breath tests, or a colonoscopy to check the large intestine for visible problems. If nothing clear emerges from the testing and you meet the Rome IV criteria for IBS [15 Trusted SourcePubMedGo to source], you’ll be diagnosed with IBS [16 Trusted SourcePubMedGo to source].

IBS Causes

Research suggests there are many possible reasons why a digestive system develops IBS [17 Trusted SourcePubMedGo to source]. It has recently become clear that a portion of IBS cases are caused by bacterial infections. One study estimates that 5%-32% of IBS cases are caused by food poisoning [18]. Several other studies suggest a significant portion of IBS patients also have small intestine bacterial overgrowth (SIBO) or other types of bacterial imbalance [19 Trusted SourcePubMedGo to source, 20 Trusted SourcePubMedGo to source, 21 Trusted SourcePubMedGo to source].

Leaky gut [22 Trusted SourcePubMedGo to source, 23 Trusted SourcePubMedGo to source] or immune system imbalance [24] may be other causes of IBS. Other research suggests the neurotransmitter serotonin plays an important role in gut motility, and a serotonin imbalance may affect bowel function and IBS pain symptoms [25 Trusted SourcePubMedGo to source]. Fortunately, you don’t need to know the specific cause of your IBS to create an effective treatment strategy. Let’s discuss how to approach IBS treatment.

ibs treatment:  assorted healthy food in a table

Home Remedies and Lifestyle Changes for IBS Treatment

A few targeted diet and lifestyle changes can make a big difference in your IBS symptoms. Let’s review the approaches that have been validated by scientific studies.

Dietary Changes

Adopting an anti-inflammatory diet is one of the most accessible steps you can take to reduce digestive system inflammation. Removing foods that may be irritating your digestive tract can help improve your quality of life and your IBS symptoms.

One of the most scientifically validated diets for IBS patients is the low FODMAP diet [26 Trusted SourcePubMedGo to source, 27]. FODMAP is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are complex natural sugars and starches that can be difficult for some people to digest.

Some IBS patients are sensitive to one or more FODMAP categories. FODMAP foods, such as those high in fructose, can cause digestive tract irritation.

Research shows removing high FODMAP foods can improve symptoms for IBS patients. Two systematic reviews and meta-analyses showed that the low FODMAP diet reduced digestive symptoms and abdominal pain, and increased quality of life [28 Trusted SourcePubMedGo to source, 29].

Other studies show that the low FODMAP diet:

Other dietary changes that may be helpful for IBS symptoms include the Paleo diet and the elemental diet.

Digestive Support Supplements for IBS Treatment

Along with dietary changes, a few particular digestive health supplements may be useful for IBS.

Probiotics, Bloating, & IBS

Probiotics have been shown in five separate meta-analyses (the highest quality scientific evidence) and multiple clinical trials to improve IBS symptoms, especially bloating and abdominal pain [33 Trusted SourcePubMedGo to source, 34 Trusted SourcePubMedGo to source, 35 Trusted SourcePubMedGo to source, 36 Trusted SourcePubMedGo to source, 37 Trusted SourcePubMedGo to source]. These studies showed probiotics improved the following IBS symptoms more than a placebo:

  • Diarrhea, or loose stools
  • Constipation
  • Bloating and abdominal pain
  • Flatulence or gas
  • Fatigue and difficulty sleeping

Probiotics may also improve non-digestive IBS symptoms, including joint or body pain [38 Trusted SourcePubMedGo to source, 39 Trusted SourcePubMedGo to source, 40 Trusted SourcePubMedGo to source] and brain fog [41 Trusted SourcePubMedGo to source, 42 Trusted SourcePubMedGo to source].

Research suggests that probiotics generally improve IBS symptoms, but there aren’t yet recommendations about specific probiotic species or strains [43 Trusted SourcePubMedGo to source]. This is likely due to the fact that probiotics don’t work like medications but instead generally improve gut health.

chart of how probiotics work

Two systematic reviews and meta-analyses indicate that multi-strain probiotics are more effective than single-strain probiotics in the treatment of IBS [44 Trusted SourcePubMedGo to source, 45 Trusted SourcePubMedGo to source]. Multi-strain probiotics were also found to perform better in a meta-analysis of studies using probiotics to treat constipation [46 Trusted SourcePubMedGo to source].

My experience in the clinic mirrors this research. When patients use three types of probiotics together, they often see symptom improvement they didn’t see by using only one probiotic.

Digestive Enzymes

Many IBS patients have symptoms flares because they have trouble digesting certain foods, like FODMAPs or dietary fats. A potential cause of IBS-D symptoms is exocrine pancreatic insufficiency (EPI), where the body doesn’t produce enough pancreatic enzymes [47 Trusted SourcePubMedGo to source]. A meta-analysis showed that pancreatic enzyme replacement therapy improved symptoms compared to a placebo [48 Trusted SourcePubMedGo to source]. One additional small study found that digestive enzymes improved symptoms for IBS and IBD patients [49 Trusted SourcePubMedGo to source]. Including digestive enzymes may improve IBS symptoms for some IBS patients.

What About Fiber Supplements?

Fiber supplements like psyllium or Metamucil are often recommended for people with constipation. Research supports this practice [50 Trusted SourcePubMedGo to source]. A meta-analysis concluded that soluble fiber, like psyllium, improved global IBS symptoms [51 Trusted SourcePubMedGo to source]. Several individual studies support this conclusion [52 Trusted SourcePubMedGo to source, 53 Trusted SourcePubMedGo to source]. However, fiber supplements should be used with caution by IBS patients. For a significant portion of them, fiber triggers an increase in bloating, gas, and abdominal pain [54 Trusted SourcePubMedGo to source]. If you’re interested in trying fiber supplements, start low and slowly increase.

If you notice negative side effects, discontinue use immediately and try again when your gut has done some healing.

ibs treatment: girl meditating in bed

Lifestyle Changes for IBS Treatment

Successful treatment of IBS often includes lifestyle changes to reduce stress. Stress is a common trigger for IBS symptoms like diarrhea and constipation, and behavioral strategies can improve symptoms for some patients.

There are many ways to reduce stress, including time in nature, exercise, or spending time with a loved one. However, some people may find they need a higher level of support.

Some preliminary research suggests relaxation techniques such as cognitive behavioral therapy [55 Trusted SourcePubMedGo to source, 56 Trusted SourcePubMedGo to source], hypnotherapy [57 Trusted SourcePubMedGo to source, 58 Trusted SourcePubMedGo to source], and meditation [59 Trusted SourcePubMedGo to source] in your IBS treatment plan are likely helpful complementary therapies for IBS, improving symptoms by 20%-65% [60 Trusted SourcePubMedGo to source].

A systematic review suggested that exercise can also help reduce bloating, stress, and gas, but it concluded more high-quality research needs to be done [61 Trusted SourcePubMedGo to source].

Treatment of Underlying Dysbiosis

IBS symptoms have been shown to correlate with dysbiosis [62 Trusted SourcePubMedGo to source], particularly SIBO [63 Trusted SourcePubMedGo to source, 64 Trusted SourcePubMedGo to source, 65 Trusted SourcePubMedGo to source]. Dysbiosis is an imbalance in your normal gut flora. One study showed that one-third of IBS patients also tested positive for SIBO [66 Trusted SourcePubMedGo to source]. Another study concluded that IBS patients were five times more likely to test positive for SIBO than controls [67 Trusted SourcePubMedGo to source].

It’s common opinion that probiotics should not be used during SIBO treatment, but a meta-analysis clearly showed that probiotics help improve SIBO treatment outcomes [68 Trusted SourcePubMedGo to source]. This may be part of the reason why probiotics improve IBS.

Probiotics have been shown to help improve various types of dysbiosis, including SIBO [69 Trusted SourcePubMedGo to source, 70, Trusted SourcePubMedGo to source71 Trusted SourcePubMedGo to source], H.pylori infections [72 Trusted SourcePubMedGo to source, 73 Trusted SourcePubMedGo to source], parasitic infections [74 Trusted SourcePubMedGo to source], and fungal infections [75, Trusted SourcePubMedGo to source76 Trusted SourcePubMedGo to source]. For this reason, probiotics should be included in your IBS treatment plan early, as they can crowd out infections, and improve your overall gut health. 

But if you don’t experience much relief from diet changes, probiotics, and digestive support, or you reach an improvement plateau after giving them an appropriate trial, treating dysbiosis with herbal antimicrobials or prescription antibiotics can be an important part of your IBS treatment plan.

Talk with your doctor, or refer to my book Healthy Gut, Healthy You for more specifics about how to use antimicrobial treatment for IBS.

IBS Treatment: Using Medication to Maintain Gut Motility and Relieve Symptoms

Sometimes, despite their best efforts with diet and lifestyle, some patients find they need prescription or over-the-counter medications to manage IBS symptoms like bowel movement frequency. Or, once they’ve improved, they want to maintain their long-term symptom remission.

One of the most important IBS symptoms to keep in check is your gut motility, or the speed at which your gut contents move through your digestive tract. Too fast, and you have diarrhea. Too slow, and you have constipation.

Diet and habit changes can do a lot to help maintain your success, but some IBS symptoms aren’t responsive to these efforts. Or, some patients have anatomical problems, like abdominal adhesions or scar tissue, that prevent normal bowel function without outside support.

Here are some of the treatments that research supports. If you think you need additional support beyond diet and lifestyle, speak with your doctor about getting a prescription.

Medication for Bloating

For some IBS patients, bloating is the worst and most frustrating symptom. Some gastroenterologists and gut specialists prescribe antispasmodics such as Bentyl (Reglan) or Levsin (hyoscyamine), or peppermint oil.

Medication for Symptoms of IBS-D

The following medicines may be prescribed to reduce the number of daily bowel movements and improve your stool consistency.

  • Imodium(loperamide) is an over-the-counter medication that slows gut motility by relaxing the smooth muscles of the digestive system.
  • Viberzi (eluxadoline) is a prescription medication for IBS with diarrhea.
  • Lotronex (alosetron) is a prescription medication for women with IBS-D and trouble controlling their bowel movements.
  • Rifaximin (xifaximin) is an FDA-approved antibiotic for the treatment of IBS symptoms of diarrhea, bloating, and SIBO [77 Trusted SourcePubMedGo to source].

Bile Acid Malabsorption (BAM) can be an underlying cause of chronic diarrhea. In bile acid diarrhea, your body has too much bile acid in the intestines, causing watery diarrhea. An elevated level of steatocrit in the stool is a gold-standard test for bile acid diarrhea. Conventional treatment includes bile acid binders such as:

  • Cholestyramine
  • Colestipol
  • Welchol (colesevelam)

Medications for Symptoms of IBS-C and Gut Motility

If you struggle with constipation or slow gut motility, keeping your bowels moving at a normal pace is crucial for reducing recurrences of bacterial overgrowth and IBS symptoms. The following medications or supplements may be used to speed up your gut motility, soften your stool, and reduce the frequency or relapse of symptoms of IBS-C.

Natural Motility Support: The power of natural and herbal motility supports should not be overlooked. MotilPro, which contains high doses of ginger, and Iberogast, which contains an herbal formula to increase motility, have shown promise for many patients. These supplements work on some of the same mechanisms as prescription motility medications but may have fewer side effects.

Over-the-counter laxatives: Glycolax (or Miralax) or magnesium citrate can help keep you regular. Keeping regular is important for reducing the likelihood of small intestinal bacterial overgrowth (SIBO) [78 Trusted SourcePubMedGo to source]. If no other options have led to bowel regularity, medications can help you while you continue to work on solving your underlying causes.

Calcium channel activators: Prescription medications like Trulance (plecanatide) and Amitiza (lubiprostone) activate the calcium channel and act as a laxative.

Serotonin enhancement: For some patients, serotonin metabolism in the digestive tract tissue may be involved with constipation [79 Trusted SourcePubMedGo to source], and some providers prescribe selective serotonin reuptake inhibitors (SSRIs) or low-dose tricyclic antidepressants for constipation [80 Trusted SourcePubMedGo to source]. But these medications carry risks of undesired side effects [81 Trusted SourcePubMedGo to source].

Medications with the most promise and the least amount of side effects include:

  • Low Dose Naltrexone (LDN)
  • Motegrity, Resolor (prucalopride) Prucalopride was recently approved by the FDA for use in the United States.
  • Linzess (linaclotide)

Serum Bovine Immunoglobulins

Immunoglobulins are a relatively new supplement that have been shown to be helpful for patients who have already tried diet changes, gut soothers, probiotics, and antimicrobial treatment without results. Immunoglobulins support the gut immune system by binding to and neutralizing bad bacteria and toxins.

Multiple clinical trials have shown that serum bovine immunoglobulins improve IBS symptoms [82 Trusted SourcePubMedGo to source, 83, 84, 85 Trusted SourcePubMedGo to source, 86, 87 Trusted SourcePubMedGo to source, 88 Trusted SourcePubMedGo to source]. In one exciting study, in patients with IBS or SIBO (or both) who didn’t respond to other treatments, serum bovine immunoglobulins (SBIs) improved symptoms an impressive 75% [89].

It’s important to always start with diet, probiotics, and antimicrobial treatment for IBS. But for patients who don’t respond to these options, SBIs are worth a serious look.

Create Your Customized IBS Treatment Plan for Relief

With the right combination of diet, lifestyle, and medical treatment, you can get your IBS symptoms under control so you can enjoy life again. Adopt a low FODMAP diet, include basic digestive support supplements including probiotics, lifestyle changes, dysbiosis treatment, and medications if necessary to balance your motility for best results.

If you need help creating a plan, see my book Healthy Gut, Healthy You, or reach out to our clinic or our health coach for guidance.

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