You asked for it – so here we go! Here’s our medication series on IBS meds for pain and discomfort. We will cover some over-the-counter and prescription medications frequently used in IBS!
As a reminder – your doctor or pharmacist is the only person that can provide individual medication advice. The purpose of these posts is to inform and educate, and most importantly – de-stigmatize!
What makes IBS different than ‘just’ constipation or diarrhea?
The pain!
Pain and discomfort is the predominant feature of IBS and can be really distressing.
Peppermint for IBS Pain and Discomfort
One of my non-pharmacological go-to’s is peppermint oil. It’s quite well researched in the grand scheme of herbal options to help manage IBS!
In fact, a 2014 meta-analysis looked at the role of peppermint oil versus a placebo for managing GI symptoms. It encompassed 9 studies and over 700 patients and found that peppermint oil significantly reduced abdominal pain and global improvement of IBS symptoms (which included quality of life, satisfaction with bowel habits, distention, and pain).
🍃Why? 🍃
Peppermint relaxes the smooth muscles of the gut, helping to reduce pain and discomfort. However it can worsen reflux by way of this same mechanism too, so something to be aware of when choosing the right peppermint product for you!
Peppermint comes in many forms – such as tea, liquid, or capsules.
Iberogast for IBS Pain and Discomfort
Today we’re discussing iberogast, because I get asked about it A LOT.
Iberogast is another over-the-counter herbal!
While not quite as thoroughly researched as peppermint oil itself, Iberogast is a mix of peppermint and a slew of other herbals.
It has evidence to support its use in both IBS and functional dyspepsia, in particular, reducing total symptom scores, improving abdominal pain, and in some small studies, helping to improve gastric emptying.
Similar to peppermint, side effects are uncommon but can include worsening symptoms and nausea, most commonly.
The one thing I find challenging from a practical perspective is, with Iberogast is the actual administration of it. You have to take 20 drops in a small amount of liquid, which requires a lot of intention and planning and makes it harder to take consistently. As such it’s not one I use or see used as frequently in practice.
Have you trialed Iberogast for IBS or functional dyspepsia? Did you find benefit? I’d love to know!
Neuromodulators for IBS Pain and Discomfort
Neuromodulators are often a highly stigmatized medication!
I am super passionate about reducing the stigma around neuromodulators.
Why?
Because they can often provide significant benefit to patients and – because SCIENCE over stigma!
Neuromodulators are traditionally known as anti-depressants or anti-anxiety medications. So when patients get suggested them, many times they think ‘great – this is proof, my doctor thinks my digestive issues are all in my head’.
Part of de-stigmatizing neuromodulators is understanding how they effect your gut – not your brain!
Did you know, mood hormones like serotonin and norepinephrine don’t just impact our brain, but our gut motility? In fact, 50-80% of our serotonin is found in our guts!
In functional gut disorders, small doses of neuromodulators, which ‘modulate’ serotonin and norepinephrine can target these hormones in the gut to change how quickly or slowly your gut moves, and perception of pain!
So, in using them, we can flip thinking of their use in anxiety and depression, and instead, think of them like meds that target the hormones that reside in our gut.
While they may not be the best fit for all patients, they can be very effective in the right patients.
Antispasmodics for IBS Pain and Discomfort
Like peppermint oil, antispasmodics help to relax the smooth muscles in the gut, relieving pain and discomfort.
It includes medications like:
- buscopan
- dicyclomine
- mebeverine
A lot of times I see them prescribed ‘as needed’ in IBS, and they can absolutely be taken that way.
However! Most of the research looking at antispasmodics in IBS have looked at regular use. ie. taking it 3x per day pre-meal. Often times, this regular pattern of dosing is required to really see ‘does this medication work for you?’
Many times I see patients that tell me the medication did not work for them. When I probe a bit deeper, they were often taking it after symptom onset as needed (which can be helpful), but weren’t necessarily given instructions or strategies to also try it at regular intervals, as explored in the IBS research!
Pro tip: Ask your prescribing physician how a medication works, and how to take it can make the world of a difference between something working well for you, and something not working so well.
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