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The Best IBS Treatments, According to Gastroenterologists

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Irritable bowel syndrome, or IBS, is a tricky condition. For starters, symptoms vary between each patient and can even shift over time. IBS — “a disorder of how your brain and gut interact with each other,” according to Dr. Johanna Iturrino-Moreda, a gastroenterologist at Beth Israel Deaconess Medical Center — typically presents with constipation or diarrhea or, in some cases, both, as well as bloating, gas, and abdominal pain. There’s also no clear cause for IBS, though Iturrinio-Moreda says it’s “sometimes triggered by a stressful life event, a gastrointestinal infection, frequent antibiotic use, small intestinal bacterial overgrowth, or even food intolerances and sensitivities.”

All of this can make IBS difficult to diagnose, but that doesn’t mean it’s not happening. “IBS is a real disease, and patients should not be embarrassed to talk about it. It’s not in their head, they’re not imagining it, and there is real help out there to take care of it,” says Dr. Lawrence Brandt, a gastroenterologist at the Montefiore Medical Center. And once your doctor has diagnosed you with IBS, you can move forward with creating an appropriate treatment plan — which can include changing your diet and going on a low FODMAP diet to limit sugars that aren’t well-absorbed by the gut, or taking over-the-counter or prescription medication. But if you’re still looking for additional assistance, these over-the-counter remedies may ease some of the day-to-day symptoms (though it’s always good to check with your doctor if you have more serious concerns).

For gas, bloating, and abdominal pain

Gas, bloating, and abdominal pain are common symptoms IBS patients experience, whether IBS presents as constipation (known as IBS-C) or diarrhea (IBS-D). Simethicone, the active ingredient in Gas-X, helps with bloating experienced by both groups of patients because it “breaks up big bubbles of gas into smaller bubbles of gas,” says Brandt. And when the bubbles are broken up, they’re “more evenly distributed and don’t distend the bowels as much.” The smaller bubbles of gas also may be easier to pass, which can, in turn, give you relief.

Four out of five gastroenterologists we spoke with recommend taking peppermint oil as a way to reduce abdominal pain, bloating, and gas. “Peppermint oil acts as an antispasmodic and may reduce cramps and urgency,” explains Iturrino-Moreda. IBGard slowly releases peppermint oil into the digestive tract, relaxing the bowel and relieving any discomfort you may be experiencing. And unlike Gas-X, it can be taken either as a source of relief or as an everyday preventative medication, before you experience any gassiness. That’s because the medication is designed to normalize the lining of the gut in an effort to regulate digestion and absorption of nutrients. But ask your doctor which might work best for you.

Brandt also recommends Iberogast, which has a mixture of different plants — including peppermint and chamomile — that help relieve abdominal discomfort. “It changes the motility of your GI tract and relaxes the smooth muscle in your intestine,” he explains. If you have a spasm, it will relax it, similar to how plain peppermint oil works within the digestive tract. The choice to take this instead of IBGard just depends on personal preference. “Certain people respond to one rather than the other. So try one and if it doesn’t work, try another one,” he says.

For both diarrhea and constipation

Each gastroenterologist we interviewed recommends upping your fiber intake if your IBS presents with diarrhea, because fiber can help thicken and form the stool, according to Iturrino-Moreda. Somewhat counterintuitively though, fiber can also help those with IBS with constipation. That’s because stool that’s been bulked up with fiber is also softer than normal, which is helpful for constipated patients and easier to pass. That’s why Dr. Felice Schnoll-Sussman, a gastroenterologist at Weill Cornell Medicine and NewYork-Presbyterian calls it a “miracle supplement.”

But Schnoll-Sussman warns that timing your intake is very important because “sometimes when you give extra fiber to patients, they can bloat.” So she also recommends that patients see a nutritionist to dial in exactly how much fiber to take and when. If you want to give it a try, Metamucil is a popular fiber supplement, and it specifically contains psyllium fiber, which Brandt says “will bring water into the stool and make the stool less hard to pass.”

For diarrhea

When stool enters the large intestine, it’s liquid, and as it’s moving through the intestinal tract, water is absorbed and the stool solidifies. If you experience diarrhea, the stool is moving too quickly, and it doesn’t have time to properly solidify, which is the case for IBS with diarrhea (IBS-D) patients. Unlike those with IBS-C, who want to loosen and soften the stool so that it’s easier to pass a bowel movement, IBS-D patients want to bulk up the stool and slow down the process. “Taking an anti-diarrheal product, such as loperamide, decreases transit in the gut; therefore, you’re increasing water absorption and improving stool form,” says Iturrino-Moreda. Imodium is a common over-the-counter anti-diarrheal used to slow down the stool, and it’s recommended by gastroenterologists because it’s a multi-symptom relief pill. Not only does it tackle diarrhea with the loperamide, but it also relieves any gas and bloating with the simethicone, which is also found in Gas-X.

For constipation

Though laxatives have a bad reputation, they can be very helpful for IBS-C patients. And though Scholl-Sussman recommends a different laxative for each patient, depending on their specific case and symptoms, she considers Miralax as a reliable over-the-counter option. Miralax is a non-stimulant laxative, which means that instead of stimulating the nerves in the walls of the large intestines and causing intestinal contractions to eliminate stool, it increases the amount of water in the stool, preventing it from solidifying too much. Your bowel movement becomes “softer, more fluid, and overall much easier to pass,” according to Brandt. One word of warning: While this may be an over-the-counter treatment, Schnoll-Sussman still recommends consulting with your doctor about taking a laxative if you have IBS-C because, “there’s a hierarchy of how you try to give individuals treatments, even laxatives. You are constantly balancing your treatments,” and your doctor may have other recommendations in mind to start.

Because constipation can actually mean different things to different people, Schnoll-Sussman advises patients to be very direct and accurate with what they mean when they say they feel “constipated.” She asks, “Does constipation mean they’re moving their bowels once a day, but they still feel constipated and not fully evacuated? Or are they someone who is moving their bowels once every seven days and really not evacuating at all?” That’s an important distinction for patients to make for their doctors because it could impact how your doctor approaches your treatments. So while a laxative can cause a bowel movement, which may be ideal for those who aren’t passing stool regularly, a stool softener makes it more comfortable for you to pass stool if it’s too hard and painful. The doctors we spoke with specifically recommended a stimulant-free stool softener (which will specifically be noted on the box) for the same reasons a stimulant-free laxative is preferred — to prevent spasms — and Dulcolax is a popular option for that reason.

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The Best IBS Treatments, According to Gastroenterologists