Irritable Bowel Syndrome (IBS) Medications and Treatments - GoodRx (2024)

Irritable bowel syndrome (IBS) is a gastrointestinal (GI) condition that affects between 7% and 16% of the U.S. population. Although anyone can develop IBS, people younger than 50 years and women are more likely to have IBS.

IBS causes uncomfortable symptoms like abdominal pain, bloating, diarrhea, and constipation. These symptoms can come on suddenly, so many people find that IBS disrupts their daily lives.

There’s no cure for IBS. But there are IBS medications and lifestyle changes that can help people manage their symptoms and get back to their usual routines.

What are the different types of IBS?

There are four subtypes of IBS:

• IBS with constipation (IBS-C): You primarily have hard stools more than a quarter of the time.

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• IBS with diarrhea (IBS-D): You primarily have loose stools more than a quarter of the time.

• Mixed IBS (IBS-M): You have both stools that are extremely loose or solid more than a quarter of the time each — that’s abnormal stools at least half of the time you go.

• Unspecified IBS (IBS-U): You have bowel movements that don’t follow any pattern listed above. This category is less common.

Your healthcare provider may use your history of symptoms, bloodwork, and a physical exam to make the IBS diagnosis. It’s important to know which IBS subtype you have because the treatments can differ.

Which IBS symptoms can you treat with medication?

Treatment for IBS can help you manage abdominal pain and bloating. Treatment can also help relieve constipation and diarrhea by making your stooling pattern more regular. Getting these things under control may help address other IBS symptoms.

Which medications can help relieve and manage IBS symptoms?

There are several types of medications that can help relieve and manage IBS symptoms. Keep in mind that some of these options work better for certain IBS subtypes. Also, people’s experiences with IBS are very different. So treatment options that work well for you may not work well for someone else. You may need to try several different options before finding a combination that works well for you. Here’s a look at different types of medication that may help your IBS symptoms.

Antispasmodic medications

Antispasmodic medications can help relieve abdominal pain from IBS by relaxing the muscles in the intestines. They may also help ease bloating and gas, too.

Antispasmodic medications are more helpful for people with IBS-D, IBS-M, and IBS-U. People with IBS-C may benefit from antispasmodic medication if they continue to have pain even after treatment for constipation.

The most commonly used antispasmodic medications for IBS treatment include:

• Dicyclomine (Bentyl)

• Hyoscyamine (Levsin)

These medications are only available with a prescription. Experts recommend using them on an as-needed basis, when pain flares or when you know you’ll be exposed to something that’s likely to trigger IBS-related pain.

Laxatives and stool softeners

Laxatives are a class of medication that help you pass stool. Laxatives are a treatment option for people with IBS-C, IBS-U, and IBS-M.

There are several types of laxatives and the difference between them has to do with how the medications work on your gut so that it’s easier for you to pass stool. In fact, stool softeners are a type of laxative (emollient laxatives), too. Many types of laxatives are available over the counter (OTC).

Polyethylene glycol (Miralax) is the most commonly used laxative to help with IBS-C. It’s available OTC, causes few side effects, and is inexpensive. In clinical trials, people taking polyethylene glycol had a more normal stooling pattern with less training. They also noted that their stools weren’t as hard. But people didn’t notice any difference in their bloating or abdominal pain.

For women with IBS-C, lubiprostone (Amitiza) is another treatment option. Lubiprostone is a prescription laxative that can regulate stools when polyethylene glycol doesn’t help.

Loperamide

Loperamide (Imodium A-D) is an OTC medication that can ease diarrhea symptoms in people with IBS-D, IBS-M, and IBS-U. Loperamide stops the intestines from contracting, which increases the time between stooling.

In clinical studies, people who took loperamide had fewer, more well-formed stools. But they didn’t have any improvement in their bloating or abdominal pain. You should take the lowest loperamide dose that helps your symptoms. Experts also recommend taking the medication on an as-needed basis instead of a regular schedule to avoid potential side effects.

Tricyclic antidepressants

Tricyclic antidepressants (TCAs) can help relieve abdominal pain from IBS because they have pain-reducing properties and also help regulate how fast food moves through the small intestine. They may be an option for you if antispasmodic medications don’t help relieve your symptoms. The most commonly used TCAs for IBS symptoms are:

• Amitriptyline (Elavil)

• Nortriptyline (Pamelor)

• Desipramine (Norpramin)

• Imipramine (Tofranil)

These medications are only available with a prescription. Experts recommend starting with the lowest dose available and then working your way up until you experience symptom relief. TCAs typically help relieve IBS symptoms at lower doses than needed for depression. It can take 3 to 4 weeks for these medications to start working, so don’t be discouraged if you don’t see results right away.

Drowsiness, dry mouth, and trouble peeing are common TCA side effects. TCAs may not be the best treatment option for older people or those with bladder or prostate problems.

Rifaximin

Rifaximin (Xifaxan) is an antibiotic that may help ease bloating and diarrhea. It’s typically reserved for people who haven’t experienced relief from other treatments. It’s not recommended for people with IBS who experience constipation.

Rifaximin isn’t a long-term treatment option. Most people only take it for 2 weeks at a time.

Are there medications for specific IBS subtypes?

Yes. In addition to the treatment options described above, there are also additional medications that are used to treat people with IBS-D or IBS-C.

IBS-D medications

Additional prescription treatment options for IBS-D include:

• Alosetron (Lotronex): Alosetron (Lotronex) is approved by the FDA to treat women with severe IBS-D who haven’t responded to other treatment options. Alosteron slows down colon movement and decreases secretions. This improves diarrhea and may also help ease abdominal pain.

• Eluxadoline (Viberzi): Eluxadoline (Viberzi) can help with diarrhea symptoms. But it’s only used for severe symptoms when all other treatment options have failed. This is because it can trigger severe acute pancreatitis. If you have a history of liver or biliary conditions or prior history of pancreatitis you shouldn’t take this medication.

IBS-C medications

Additional prescription treatment options for IBS-C include:

• Linaclotide (Linzess): Linaclotide (Linzess) encourages the intestine to release more fluid, which makes stools bulkier, softer, and easier to pass. The medication also encourages intestinal movement, which helps limit constipation. In studies, people taking linaclotide noticed more spontaneous bowel movements and less abdominal pain after taking the medication for 12 weeks. They also experienced less bloating and straining.

• Plecanatide (Trulance): Plecanatide (Trulance) works in the same way as linaclotide. There’s evidence that it works just as well as linaclotide to relieve constipation and abdominal pain.

• Tenapanor (Ibsrela): Tenapanor (Ibsrela) encourages the intestine to move faster and absorb less water, which can reduce constipation. It’s recommended for people with IBS-C who haven’t responded to other therapies.

• Tegaserod: Tegaserod may help relieve constipation and abdominal pain. After being withdrawn from the market, it was approved again for women without a history of cardiovascular disease in 2019.

Are there ways to relieve IBS symptoms naturally?

Yes. In fact, experts recommend starting with natural options before moving to prescription or OTC medications. Experts also recommend continuing treatments, like diet changes, in the long term.

Diet changes

Many people with IBS notice that their symptoms get worse when they eat certain foods. And there’s research to support that certain foods are more likely to trigger IBS symptoms. That’s why experts recommend that everyone with IBS take the time to examine their diet and make certain changes like:

• Following IBS-friendly eating patterns: If you have IBS, experts recommend sticking to a regular meal pattern and avoiding large meals when you do eat.

• Avoiding FODMAPs: FODMAPs are foods that aren’t easily digested and can cause gas and bloating. In a clinical trial, people with IBS who followed a low-FODMAP diet had fewer symptoms after 4 weeks. You won’t have to avoid FODMAPs forever. Experts recommend that people stop eating all FODMAPs for 6 to 8 weeks and then add them back one at a time. This will help you identify which foods trigger your symptoms so you can continue to avoid them while reintroducing foods that don’t trigger your IBS.

• Avoiding gas-producing foods: Some foods make people more gassy. If you have IBS, you should avoid these foods. They include caffeine, alcohol, beans, onions, celery, carrots, raisins, bananas, apricots, prunes, Brussels sprouts, pretzels, and bagels.

• Avoiding lactose: Lactose is the sugar found in milk and many dairy products. If you have lactose intolerance, eliminating lactose from your diet can improve your IBS symptoms. If you don’t have lactose intolerance but you do have IBS, you can try removing lactose from your diet for a few weeks to see if your symptoms improve. If you feel better, talk with your healthcare provider about getting tested for lactose intolerance. It could be that you have lactose intolerance but never knew it. Or it could be that you have a sensitivity to milk proteins.

• Avoiding gluten: Gluten is a protein found in products made from wheat, barley, and rye. There’s some evidence that people with IBS-D can improve their symptoms if they stop eating gluten. Researchers are quick to point out that this doesn’t mean that people with IBS-D have celiac disease. In fact, some researchers believe it’s not the gluten but the fructan (a FODMAP) found in these foods that causes worsening IBS symptoms. When people stop eating foods with gluten, they also stop eating as much fructan, and that might be why their symptoms get better. In either case, you may want to avoid gluten for 4 to 6 weeks to see if your symptoms get better.

Exercise

Regular exercise can also help improve IBS symptoms. In a clinical trial, people with IBS were asked to do moderate exercise for 20 to 60 minutes for 3 to 5 days a week. After 12 weeks, they were asked to report their IBS symptoms. Researchers found that the exercise group had 50% fewer symptoms than a group of people with IBS who didn’t exercise. The exercise group was also three times less likely to report an IBS flare over the 12-week period.

Fiber supplements

Fiber supplements can help with IBS symptoms. But you should only take soluble fiber supplements if you’re living with IBS. Insoluble fiber supplements won’t help IBS symptoms and can actually make them worse.

Psyllium (Metamucil) is a soluble fiber supplement that’s available OTC. It can help improve both constipation and diarrhea from IBS. Experts recommend starting with a low dose (about 3 g to 4 g per day) to avoid side effects like gas and bloating. Your healthcare provider can help you decide when and how to increase your fiber dose. Be sure you’re drinking plenty of fluids with psyllium to help it work and avoid side effects.

Peppermint oil

Peppermint oil can slow down how fast the food moves through the gut and may improve IBS symptoms like gas, bloating, and pain after eating. You can try adding peppermint oil supplements to your IBS treatment plan to see if it helps. But keep in mind that you need to take enteric coated peppermint oil capsules. These are pills that are meant to be swallowed. You shouldn’t drink peppermint oil extract or other liquid forms of peppermint oil. This can lead to serious injury.

Future treatment options for IBS

There’s also future treatment options for IBS on the horizon. Here are some exciting areas of research and new development.

Bile acid binders

Bile acid binders are medications that can help with IBS-D. Excess bile acid can contribute to watery stools and uncontrolled diarrhea. And there seems to be some overlap between IBS-D and excess bile acid. These medications reduce bile acid, which helps manage diarrhea. There aren’t large studies on bile acid binders for IBS. So experts typically recommend them when other treatments haven’t helped.

Aldafermin is another bile acid reducer that’s being investigated for IBS. So far, it seems to improve stool consistency when taken for IBS-D. But it doesn’t seem to reduce abdominal pain or frequency of bowel movements.

Fecal microbiota transplantation (FMT)

Fecal microbiota transplantation (FMT) — or a stool transplant — is a medical procedure in which a small amount of healthy stool is placed in a person’s gastrointestinal tract. The goal of FMT is to stimulate the growth of healthy gut bacteria. It’s not clear how well it works for IBS right now. In some studies, people had improvement of their IBS symptoms but in others, people didn’t notice a difference.

Signs that you need a different treatment for IBS

For many people, IBS symptoms change over time. Symptoms may come and go with periods of no or few symptoms between IBS flares. Sometimes you can also change from one subtype to another. For example, you may have IBS-C that changes to IBS-M over time.

If you start to experience a change in symptoms (diarrhea instead of constipation or vice versa), you should speak with your healthcare provider. You may need to change your treatment regimen. This can be a good opportunity to revisit lifestyle modifications, too.