Irritable bowel syndrome - aftercare

Irritable bowel syndrome (IBS) may be a lifelong condition. You may be suffering from cramping and loose stools, diarrhea, constipation, or some combination of these symptoms.

For some people, IBS symptoms may interfere with work, travel, and attending social events. But taking medicines and making lifestyle changes can help you manage your symptoms.

Changes in your diet may be helpful. However, IBS varies from person to person. So the same changes may not work for everyone.

• Keep track of your symptoms and the foods you are eating. This will help you look for a pattern of foods that may make your symptoms worse.
• Avoid foods that cause symptoms. These may include fatty or fried foods, dairy products, caffeine, sodas, alcohol, chocolate, and grains such as wheat, rye, and barley.
• Eat 4 to 5 smaller meals a day, rather than 3 larger ones.

Increase the fiber in your diet to relieve symptoms of constipation. Fiber is found in whole grain breads and cereals, beans, fruits, and vegetables. Since fiber may cause gas, it is best to add these foods to your diet slowly.

No one drug will work for everyone. Some medicines are prescribed specifically for IBS with diarrhea (IBS-D) or IBS with constipation (IBS-C). Medicines your provider may have you try include:

• Antispasmodic medicines that you take before eating to control colon muscle spasms and abdominal cramping
• Antidiarrheal medicines such as loperamide, eluxadoline and alosetron for IBS-D
• Laxatives, such as lubiprostone, linaclotide, plecanatide, bisacodyl, and other ones bought without a prescription for IBS-C
• Antidepressants (tricyclic and selective serotonin reuptake inhibitor [SSRI] classes) to help relieve pain or discomfort
• Rifaximin, an antibiotic that is not absorbed from your intestines
• Probiotics

It is very important to follow your provider's instructions when using medicines for IBS. Taking different medicines or not taking medicines the way you have been advised can lead to more problems.

Stress may cause your intestines to be more sensitive and contract more. Many things can cause stress, including:

• Not being able to do activities because of your pain
• Changes or problems at work or at home
• A busy schedule
• Spending too much time alone
• Having other medical problems

A first step toward reducing your stress is to figure out what makes you feel stressed.

• Look at the things in your life that cause you the most worry.
• Keep a diary of the experiences and thoughts that seem to be related to your anxiety and see if you can make changes to these situations.
• Reach out to other people.
• Find someone you trust (such as a friend, family member, neighbor, or clergy member) who will listen to you. Often, just talking to someone helps relieve anxiety and stress.

Call your provider if:

• You develop a fever
• You have gastrointestinal bleeding
• You have bad pain that does not go away
• You lose over 5 to 10 pounds (2 to 4.5 kilograms) when you are not trying to lose weight

IBS; Mucus colitis; IBS-D; IBS-C

Ford AC, Talley NJ. Irritable bowel syndrome. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier ; 2021:chap 122.

Mayer EA. Functional gastrointestinal disorders: irritable bowel syndrome, dyspepsia, esophageal chest pain, and heartburn. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier ; 2020:chap 128.

Waller DG. Constipation, diarrhoea and irritable bowel syndrome. In: Waller DG, ed. Medical Pharmacology and Therapeutics. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 35.

Updated by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.