Digestive Disorders > IBS

IBS medications: The complete guide

Dr. med. Andre Sommer

Dr. med. Andre Sommer

So far, medications have only played a supporting role in the treatment of irritable bowel syndrome (IBS). The remedies can alleviate irritable bowel symptoms, but cannot combat their causes. Patients and the pharmaceutical industry have therefore been waiting for more effective irritable bowel medications for years. The spectrum of irritable bowel medications includes:

  • Prescription substances,
  • Over-the-counter medications (including probiotics), and
  • Herbal substances (phytotherapeutics)

The selection of the individually suitable preparations for those affected should always be made in consultation with a doctor or pharmacist to avoid possible interactions and side effects. An IBS diagnosis is the necessary prerequisite for taking irritable bowel medication. Drugs can be prescribed or purchased for particular symptoms, which are classified according to the following four main symptoms:

  1. Pain
  2. Diarrhea
  3. Constipation
  4. Bloating and flatulence

Tip

Medications only fight the symptoms of digestive problems, but don't get to the bottom of the cause. What we eat has a huge impact on symptoms such as flatulence, irregular bowel movements and our quality of life. Our digestive health app can help IBS sufferers to achieve their personal health goals.


Which irritable bowel medications help with pain?

Many irritable bowel sufferers have severe pain. Several studies show that pain perception with IBS changes over time. Even small amounts of air in the abdomen can be associated with pain that a healthy person would not perceive as painful. Excessive gas formation (e.g. due to incorrect bacterial colonization) also leads to complaints. Spasms of the intestinal muscles are also perceived as very painful.

Overview of medication for irritable bowel pain with degree of recommendation

Degree of recommendation

(based on German guidelines)

Medication
Recommended Antispasmodics (e.g. Buscopan, Mebeverin)
Possible

Soluble fiber (e.g. macrogol, Indian psyllium)
Tricyclic antidepressants (e.g. amitriptyline)
Selective serotonin reuptake inhibitors (e.g. citalopram)
Probiotics (e.g. E. coli Nissle and bifidobacteria)
Plant-based substances (peppermint or caraway oil)

5-HT3 antagonists in exceptional cases

Not recommended

Peripheral pain reliever (e.g. ibuprofen)
Antibiotics (exception rifaximin in individual cases)
Pregabalin / Gabapentin
Aloe vera
Not recommended

Opiates and opiate agonists (e.g. tramadol)
Pancreatic enzymes

Peppermint and caraway oil to combat IBS pain

Peppermint oil and caraway oil are two herbal substances (phytotherapeutics) that have proven to be antispasmodic and pain-relieving when used for IBS. The oils are also available in capsule form and are taken half an hour before a main meal. There are no known pronounced side effects, but sometimes the smell of the preparation is perceived as annoying when belching.

N-butylscopolamine (buscopan) for cramps

Gastrointestinal cramps usually occur in phases and are a common symptom of IBS. Butylscopolamine lowers the tension of the smooth muscles in the gastrointestinal area. The intestinal muscles are relaxed by inhibiting the muscarinic receptors located there (anticholinergic effect).

N-butyl scopolamine
Application 1–2 coated tablets 3 times a day, maximum 6 coated tablets per day
Side effects The drug is well tolerated and has no serious side effects
Contraindication: do not take with angle-closure glaucoma
Urinary bladder obstruction, e.g. benign prostate enlargement
Fructose intolerance (only with proven intolerance, the drug is harmless within the low-FODMAP diet)
Urinary bladder obstruction, e.g. benign prostate enlargement
Children <6 years, as there is insufficient experience
Interactions Interactions may occur with the simultaneous use of tricyclic antidepressants

Aspirin, Ibuprofen and other analgesics for IBS

No matter how much the pain sufferers experience, the use of classic pain relievers such as ASA (aspirin), paracetamol, ibuprofen etc. is not recommended for IBS. Since the sensation of pain changes with the disease, these substances have no positive effect with prolonged use; on the contrary, they intensify the disturbance of the pain perception. The side effects of pain relievers, such as constipation in opiates, mean they are not recommended for IBS.

Which irritable bowel medications help with diarrhea?

Acute diarrhea, as is common with gastrointestinal infections, mostly differs from the chronic diarrhea that irritable bowel sufferers experience. Therefore, in the case of longer illnesses, causal, holistic therapy for IBS helps to reduce diarrhea. However, there are some medications that can help sufferers in acute phases.

Overview of medication for diarrhea with degree of recommendation

Degree of recommendation

(based on German guidelines)

Medication
Possible

Loperamid
Fiber
Cholestyramine
Probiotics (e.g. E. coli Nissle and bifidobacteria)
Plant-based substances (peppermint or caraway oil)
5-HT3 antagonists in exceptional cases
Antispasmodics, e.g. Buscopan or Buscopan Plus
Not recommended

traditional Chinese medicine / herbal therapy
Antibiotics (exception rifaximin in individual cases)
Aloe vera
Not recommended Racecadotril

Loperamide

Loperamide is a suitable agent for disorders of the motility of the intestinal muscles (motility disorder). The substance acts almost exclusively on receptors in the intestine and reduces the motility of the intestine, which means that the food stays in the intestine longer. As a result, more liquid and electrolytes are absorbed from the food and the watery stool can solidify again. Loperamide should not be consumed for more than two days without consulting a doctor. Adequate hydration should be ensured during intake.

Loperamide
Application Initially 2 tablets and then one tablet after each shaped chair, max. per day
Contraindications Diarrhea with fever and / or bloody stool

Diarrhea related to taking antibiotics

Bacterial inflammation of the intestine due to enteroinvasive pathogens (e.g. Salmonella, Shigella Campylobacter, E. coli variants

Chronic diarrhea

Ulcerative colitis with acute flare-up

Phenylketonuria (aspartame)

Interactions P-glycoprotein inhibitors: Increased plasma levels of loperamide, clinically irrelevant when taken for 2 days

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Which irritable bowel medications help with constipation?

If you do not have a bowel movement for at least two days, this is considered constipation. With constipation, the stool is very hard and usually consists of individual lumps. In society, the tendency to constipation is increasing, as many people increasingly eat low-fiber, processed, and fast-food products. A high-fiber diet with healthy mixed food is recommended. Despite healthy nutrition, constipation with IBS is often due to impaired motility (mobility) of the intestine.

Overview of medications for constipation with degree of recommendation

Degree of recommendation

(based on German guidelines)

Medication
Recommended Dietary fiber (e.g. indian psyllium)
Possible

Macrogol type osmotic laxatives
Lubiprostone (if available)
Probiotics (e.g. E. coli Nissle and bifidobacteria)
Herbal substances (e.g. STW5)
Serotonin reuptake inhibitor
Antispasmodics, e.g. buscopan
Not recommended Domperidone
Antibiotics
Other herbal substances

Medicines that can increase constipation include Amitriptyline, Citalopram, Clozapine, Colestyramin, Dihydrocodeine, Granisetron,Ketoprofen, Nortriptylin, Oxycodone, Piroxicam, and Verapamil.

Which irritable bowel medications help with bloating/abdominal distension?

For some people with IBS, gas, bloated stomach, and a feeling of fullness are the main symptoms. Flatulence is generally classified as normal up to 20 times a day. If it occurs more frequently and is the main symptom, there is often a food intolerance behind it. A bloated abdomen is often a painful symptom of IBS. The first measure that helps many affected people is warmth. The medications presented below can also alleviate the symptoms. Affected people who suffer from incorrect bacterial colonization are treated with an antibiotic that reduces the symptoms or makes them disappear entirely.

Overview of medications for flatulence/feeling of fullness with degree of recommendation

Degree of recommendation

(based on German guidelines)

Medication
Possible

Defoamers (e.g. simeticone)
Probiotics (e.g. E. coli Nissle and bifidobacteria)
Herbal substances
Rifaximin (antibiotic)
Not recommended

Cholinergics / Parasympathomimetics
Analgesics
Tricyclic antidepressants
Not recommended Pancreatic enzymes

Defoamers - simeticone with IBS

Painful gases in the intestine often collect in the form of bubbles and foam. However, the gases cannot be absorbed by the intestinal wall. Simeticone is a defoamer (carminativum) that only works physically in the intestine. It lowers the surface tension of gas bubbles so that they burst and the gas can be absorbed by the intestinal wall.

  • Application: The amount stated on the packaging should be taken with or after meals.
  • Simeticone is also available as chewable tablets with glucose, sucrose, fennel, caraway and peppermint oil

Which irritable bowel medications help build healthy intestinal flora?

Probiotics are equally recommended for irritable bowel symptoms such as diarrhea, constipation, pain, and flatulence.

Healthy intestinal flora is extremely important for intestinal health. The interplay of the different bacteria and microorganisms also has a special impact on our well-being. In many irritable bowel sufferers, the intestinal flora is imbalanced. For example, there are often too many “harmful” bacteria, whereas there are fewer bifidobacteria, which protect our intestinal mucosa and act as a barrier, for example. In this case, the intake of bifidobacteria and E. coli bacteria is recommended. Studies have shown, for example, the E. coli strain Nissle 1917 to be effective.

The preparations are available in pharmacies and are taken once or twice per day as directed. In case of flatulence, which can occur at the beginning of the intake, it can help to start with one dose unit (corresponding to a capsule).

When do antidepressants help with irritable bowel therapy?

Most people associate antidepressants with depression, and it doesn’t immediately appear appropriate to take them with IBS. However, since the intestinal nervous system, like the brain, communicates via signals (transmitters), some researchers have begun referring to “intestinal depression” in IBS.

Changes in transmitters in the intestine could have an impact on pain perception. The tricyclic antidepressant amitriptyline has proven its worth in some people, especially with irritable bowel pain. However, it should not be given to patients with constipation, as amitriptyline itself can cause it as a side effect. For people with constipation, another group of antidepressants is suitable: the serotonin reuptake inhibitors (known as SSRIs).

The listed antidepressants are used for irritable bowel syndrome in lower doses than for depression. They are also suitable for psychological problems that can occur in connection with irritable bowel syndrome.

Do homeopathic medications help with IBS?

In large clinical studies, no increased effectiveness of homeopathic drugs compared to placebo drugs has been confirmed. However, taking homeopathic substances is not harmful. If desired, homeopathic medicines can also be taken for irritable bowel.

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Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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