Understanding and Managing IBS Pain
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“IBS is multifactorial in nature,” says Dr. Riehl. “Things that can contribute to IBS include diet, stress, and changes to your gut microbiome. It’s not a one-stop shop to get improvements in your IBS.”
Here are five strategies that experts recommend for managing IBS symptoms:
1. Try a Low-FODMAP Diet
Knowing exactly how to follow a low-FODMAP diet can be tricky because it eliminates so many foods that may be staples for you.
“It’s so effective that it can lead to food anxiety where patients will only eat five things that they know are safe, so it’s best to work with a dietitian who specializes in IBS to broaden what you can eat,” says Riehl.
If you don’t have a dietitian on your healthcare team, check out My Nutrition Health, a site created by gastrointestinal specialists at the University of Michigan and Cedars-Sinai in Los Angeles that’s entirely dedicated to the ins and outs of the low-FODMAP diet.
2. Get Moving
Whatever exercise you like to do is what you should do, advises Riehl. When you run, bike, swim, or simply go for a walk, you lower your levels of cortisol — your stress hormone — and you boost mood-enhancing endorphins. That combination works wonders on the tummy and helps relieve IBS symptoms.
“Exercise and activity improve the messages that go from the brain to the gut and the gut to the brain,” says Dr. Lacy.
3. Get a Good Night’s Sleep
“Exercise also helps you sleep better, and sleep plays a huge role in gut behavior and digestive functioning,” Lacy says.
“Taking measures to improve sleep can have a profound impact on feeling happier and improving digestion,” says Lacy.
4. Over-the-Counter Treatments
While your doctor may want you to take prescription medicines to relieve the pain associated with diarrhea, bloating, or constipation, plenty of over-the-counter treatments are effective as well, says Lacy.
Lacy often tells his patients to drink peppermint tea or take peppermint oil capsules before eating. “It’s cheap, safe, easy, and not addictive,” he says. “Menthol or peppermint acts on smooth muscle, so there’s biologic plausibility that it works to aid digestion.”
For constipation, Lacy recommends soluble fiber like psyllium (Metamucil). Bran, on the other hand, does not help. He also recommends laxatives with few side effects, such as Miralax.
For diarrhea, Lacy often steers his patients to loperamide (Imodium).
5. Talk It Out in Psychotherapy
Since IBS is a disorder in how the brain and the gut communicate with each other, it’s important to learn tips and tricks that foster relaxation and improved digestion.
“There are a lot of interventions, like cognitive behavioral therapy and gut-directed hypnosis, that are extremely beneficial,” says Riehl. She adds that psychotherapy can help patients learn strategies to calm their body down before the bowels rev up anxiety. “The tools you learn can prevent symptoms from happening.”
Treatment focuses on providing patients with tools to improve coping, resilience, and stress management. Additionally, brain-gut therapies are evidence-based treatments that target abdominal pain and are recommended in the ACG guidelines.
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