Medication therapy in irritable bowel syndrome (IBS), is usually directed toward symptom control.
If abdominal pain is very severe, anti cholinergic group of medications (mebeverine hydrochloride) may be helpful. It relieves pain by moderating the smooth muscle contraction of intestine.
Peppermint oil (Colpermin, Mintec) when taken before meal is found to be helpful to minimise bloating and abdominal pain. Also it is better to cut out items like carbonated drinks, vegetables like cauliflower, broccoli and cabbage.
Over- the-counter preparation like loperamide (imodium) is found to be useful to control diarrhoea.
Taking bulk forming fibre supplements such as isphaghula, psyllium (metamucil) or methylcellulose (Citrucel) may help to control constipation.
If constipation is still troublesome, laxatives like senna and lactulose would be helpful.
If the symptoms are not controlled by above simple medications, doctors could try antidepressants to control the symptoms. There are two kinds of anti depressants that are found to be helpful in these cases.
Tricyclic anti depressants: (imipramine, amitryptaline)
Apart from reliving depression, these medications inhibit the activity of neurons that control the intestine. These are particularly useful to control diarrhoea and abdominal pain in irritable bowel syndrome. The main side effects of these medications are dryness of mouth, drowsiness and constipation.
Selective serotonin reuptake inhibitor: (SSRI)
If tricyclic antidepressants are not helpful then the doctor might try this class of antidepressant (fluoxetine, paroxetine).
This medication works by increasing the fluid secretion in the small intestine. This is particularly useful in those patients who have IBS with constipation. It is found to be useful in women, but its effectiveness in males is not yet convincing.
This medication can be prescribed only by doctors enrolled in a special programme as it is not licensed. This medication relaxes the colon and slows the movement of large bowel. It is found to be useful only in women who suffer from IBS with intractable diarrhea.
People suffer from irritable bowel syndrome has excellent prognosis. One study confirmed that 85% of patients were rendered virtually symptom-free in the short term. 68% were still virtually symptom-free 5 years later.
This article is the final part of "Walking with a Doc Series - Irritable bowel syndrome."