Irritable bowel syndrome: Are there treatments you can count on to help?

Irritable bowel syndrome will improve for many people without medication. But fibre supplements, anti-cramping medicines and anti-depressives offer a small chance of effective symptom relief.

Abdominal pain is the main problem, but it comes with constipation and/or diarrhoea as well. If people have been having this combination of problems on and off for a year, without doctors being able to identify any other cause, it is called irritable bowel syndrome (IBS). It is also sometimes called irritable colon, spastic colon, mucus colitis, spastic colitis or nervous stomach.

IBS is very common, but it has often been trivialised. People with the condition were sometimes dismissed as just being overly sensitive about their bowels. However it is now a medically-accepted syndrome when it meets specific criteria. Click here to read about these criteria.

The causes of IBS are not known. There are many theories. The possible causes range from dietary triggers through to problems with the functioning of the bowel's muscle action and psychological factors such as stress. You can learn more about IBS in our Fact Sheet (URL: index.278.195.en.html).

The list of strategies and treatments that people with IBS try is just as long. Some change their diets or try to reduce stress in their work and private lives. Many buy bulking treatments like fibre supplements or anti-cramping medications (anti-spasmodics). Complementary therapies include products such as peppermint oil. In some countries, antidepressants are used for IBS. Some types of antidepressants can have an effect on the bowel, as well as psychological effects. Antidepressants are not licensed for this use in Germany, for example. Antidepressants can have serious adverse effects.

To try and shed some light on what medications and bulking products can do, researchers from the Cochrane Collaboration analysed the results of trials in which such products were tested in people with IBS.

At first glance the amount of available information looks good. The researchers found 11 trials on bulking treatments, 24 trials on anti-spasmodics and six trials on antidepressants. But many of the trials were quite small. There were also other questions about the way the quality of these trials. This led the Cochrane researchers to be very cautious in their conclusions.

The results of the trials are somewhat disappointing. There is no conclusive evidence that any of these three types of products can be counted on to relieve the typical symptoms of most people with IBS.

The researchers found weak evidence that at least some anti-spasmodic drugs can relieve abdominal pain and the overall symptoms reported by some patients. The trials so far do not suggest that any of these medical products is particularly effective. Bulking products and antidepressants did not perform a great deal better than anti-spasmodics.

Because of this, the researchers were not confident about the potential benefit for all patients with IBS from these products. One of the basic problems of medications for bowel problems is their adverse effects. For example, a medication against diarrhoea might cause constipation - or make existing constipation worse. People with IBS can have both these conditions. And medications for constipation could lead to diarrhoea. That kind of adverse effect could mean that one problem is simply exchanged for another. The researchers did not report on how often these and other adverse effects occur.