Feel like there are days when you’re living on the toilet? Welcome to the world of irritable bowel syndrome (IBS), a chronic disorder that affects your large intestine, triggering symptoms like cramping, abdominal pain, bloating, gas, diarrhea, and/or constipation. It’s the most common GI disorder worldwide, with some studies estimating 10 to 15% of people struggle with it, and it’s more common in folks under age 45. About two-thirds of sufferers are women, probably because gut hormones can be influenced by reproductive hormones, says Gina Sam, MD, director of the Mount Sinai Gastrointestinal Motility Center in NYC. But over the last several years, new treatments and therapies have cropped up to treat this disease. Here’s a look at the strategies, medications, and alternative therapies that can help bring relief.
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Talk to a mental health professional
When the CDC analyzed 2014 data from the National Health Survey, they found that 56.3% of adults with serious psychological distress . While it should go without saying that severe joint pain can cause serious psychological distress, that beliefs about pain control and feelings of helplessness, emotional factors like anxiety and depression, and social support all play important roles in how we experience and adjust to pain. For those with persistent conditions like chronic joint pain, you may find it helpful to consult a pro who can help you develop pain-coping techniques.
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Research shows hypnotherapy is another surprisingly effective IBS treatment—for example, one Swedish study, published in 2012 in The American Journal of Gastroenterology, found that , such as abdominal pain and bloating, in 40% of patients. Even better, the effects seem to last for up to a year. “The key is the hypnotist really focuses on your bowels, evoking images such as your bowel as a brook stream that’s backed up, and you have to work to remove the blockage,” says Douglas Drossman, MD, co-director emeritus at the University of North Carolina at Chapel Hill Center for Functional GI and Motility Disorders. Just make sure you go to a licensed mental health professional—the has a of its therapists.
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Setting a sleep schedule
It’s not enough to get your seven hours of z’s a night; you need to keep a consistent sleep-wake schedule. Nurses with are more likely to experience IBS, according to a University of Michigan study. This isn’t surprising, since all your bodily functions—including those involving your gut—are governed by your biological clock, so throwing it off may trigger symptoms, says Dr. Drossman. If you’re traveling across time zones, consider taking a at bedtime (3 mg is a standard dose), which research suggests may help both regulate your body clock and .
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Ramping up your activity level may not only but also appears to reduce related symptoms, like depression, fatigue, and anxiety, according to a Swedish study. “Exercise raises serotonin levels, which also affect your gut,” explains Dr. Sam. It also increases endorphins, boosting mood and relieving stress. Aim for 3 to 5 hours of moderate to vigorous physical activity such as walking, cycling, or aerobics each week.
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Close to 80% of people with IBS are vitamin D deficient, suggests a 2015 UK study. While experts aren’t clear on exactly how the sunshine vitamin affects your gut, it’s reasonable to ask your doctor to check your vitamin D levels, says Dr. Sam. There’s no current consensus on what blood level of D is enough, but levels under 20 ng/mL are generally considered inadequate. If you’re low, talk to your doc about taking a supplement, about 800 to 1,000 IU daily; you don't want to wind up with one of the 27 health problems linked to low vitamin D.
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IBS sufferers who took the antihistamine ebastine for 12 weeks reported than those taking a placebo, according to a small Belgian study published in 2016 in the journal Gastroenterology. Theoretically, it makes sense, since histamine—which is released when you have an allergic reaction—is also released in your gut, potentially causing inflammation that may worsen IBS symptoms, says Dr. Sam. Ebastine is not available in the United States, but you can talk to your doctor about whether it makes sense for you to try another antihistamine such as Claritin or Zyrtec.
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Peppermint, a natural antispasmodic, relaxes smooth muscles in the intestines, reducing symptoms, says Dr. Sam. There’s solid research behind it: A 2014 meta-analysis, published in the Journal of Clinical Gastroenterology, revealed that can be a safe and effective short-term treatment, improving IBS symptoms and reducing abdominal pain. Use the enteric-coated capsules, which can help you avoid heartburn.
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It could help regardless of whether you’re plugged up or have the runs: not only does fiber get things moving in your digestive tract when you’re constipated, “it also bulks up stool, which helps slow down diarrhea,” explains Dr. Sam. Aim for 25 grams daily (try these high-fiber foods). Since adding in too much too quickly can cause gas and cramping, slowly increase the amount of fiber in your diet—say, add an extra serving of fruits, veggies or beans every two or three days—over a couple weeks.
Low dose antidepressant drugs have been shown to help relieve symptoms of IBS. If you have diarrhea, your doctor may recommend a tricyclic antidepressant such as nortriptyline (Pamelor), which inhibits the activity of nerves in your gut, decreasing pain and that feeling of urgency. If you have constipation, selective serotonin reuptake inhibitors (SSRIs) like Zoloft can help speed up your GI tract.
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Sometimes IBS can be caused or worsened by an overgrowth of bacteria in your intestine, explains Dr. Drossman. The main one doctors prescribe is rifaximin (Xifaxan) which in clinical trials has been found to improve symptoms after a 14-day course of treatment, with relief lasting up to 10 weeks after stopping the treatment. It was approved by the FDA to treat IBS with diarrhea (IBS-D) in May 2015.
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Low FODMAP diet
Some people may find it helpful to follow a , says Dr. Sam. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Research suggests that many IBS sufferers are sensitive to these types of carbohydrates—including fructose (found in fruits and honey), lactose (in dairy), fructans (in wheat, garlic, and onions), galactans (in legumes), and polyols (used as artificial sweeteners and found in stone fruits like apricots, cherries, and nectarines). The diet’s quite complicated, which is why many IBS specialists now have nutritionists in their offices to help you figure out what you can and cannot eat.
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You’ve heard of probiotics before; they’re the “good bacteria” that live in your gut and keep it healthy. It’s thought that some people with IBS have an overgrowth of “bad” bacteria in their GI tract, causing symptoms such as gas and bloating, says Dr. Drossman. Some studies suggest that may help improve IBS symptoms, though more research needs to be done. While there are many different probiotics on the market, one that shows promise is Bifidobacterium infantis, a strain of which is found in the over-the-counter supplement Align. It also can't hurt to load up your diet with more probiotic foods.
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Several studies have found that . “I always give my patients a pep talk about yoga, as well as other relaxation techniques, such as deep breathing,” says Dr. Sam. It doesn’t matter whether it’s Hatha, Vinyasa, Ashtanga, or some other form, as long as it helps wind you down. “Yoga appears to help boost serotonin levels, which soothes your GI tract as well as your brain,” Dr. Sam explains. Poses that may work include corpse pose (lying on back, aka savasana), cat and cow, and child’s pose, as well as these other yoga poses for better digestion.
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FDA-approved in 2015, eluxadoline (Viberzi) helps control IBS-related diarrhea by activating receptors in your nervous system that reduce bowel contractions. “Up until now, the only other prescription drug available to treat diarrhea was alosetron (Lotronex) which was only reserved for very severe cases since it can cause a potentially life-threatening condition called ischemic colitis, which reduces blood flow to the large intestine,” explains Dr. Sam.
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Linzess and Amitiza
If you’re seriously plugged up and lifestyle measures (like eating more fiber, getting plenty of fluids, and increasing physical activity) don’t help, your doctor can prescribe either lubiprostone (Amitiza) or linaclotide (Linzess) to help get things moving. Amitiza works by increasing fluid secretion in your gut; Linzess calms pain-sensitive nerves in your GI tract and speeds up bowel movements.