Treatment of irritable bowel syndrome (IBS)
There is currently no cure for irritable bowel syndrome (IBS). Treatment aims to relieve symptoms and improve the patient’s quality of life.
Options include dietary and lifestyle changes, as well as medication. The treatment approach is tailored to each individual, taking into account the severity of symptoms, their impact on daily life and the patient’s preferences.
Decision-making should be shared between the healthcare professional and the patient. A clear understanding of the condition and realistic expectations about treatment can help to achieve better outcomes.
Non-pharmacological treatment
Regular physical activity. Moderate-intensity aerobic exercise, such as brisk walking, gentle jogging, moderate cycling, swimming or attending exercise classes, may help improve gastrointestinal symptoms in people with IBS. Regular physical activity can also help regulate bowel movements, reduce stress and improve overall wellbeing, all of which may influence symptom severity.
Diet. Making changes to eating habits can also be beneficial. The following measures may help to manage symptoms:
- Eating slowly and chewing food thoroughly.
- Avoiding heavy meals.
- Having five or six smaller meals throughout the day.
- Reducing the intake of ultra-processed foods and sweeteners.
- Choosing low-fat cooking methods.
- Limiting alcohol and caffeine intake.
Soluble fibre may help improve gastrointestinal symptoms. However, some people may experience a temporary worsening of symptoms when they first increase their fibre intake.
Low-FODMAP Diet
The low-FODMAP diet —an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols— is currently the dietary strategy with the strongest scientific evidence for improving symptoms of IBS.
The short-chain carbohydrates included in this group are poorly absorbed in the small intestine. Once they reach the large intestine, they are fermented by the gut microbiota and may trigger gastrointestinal symptoms in susceptible individuals.
These carbohydrates are found in a variety of everyday foods, including:
- Wheat, onions, garlic and asparagus (which are rich in certain oligosaccharides).
- Pulses such as lentils and chickpeas (which contain galacto–oligosaccharides).
- Milk and some fresh dairy products (which contain lactose).
- Fruits such as apples, pears and mangoes, as well as honey (which can contain excess fructose).
- Sweeteners such as sorbitol and mannitol, which are found in some chewing gums and sweets, as well as in fruits such as plums and peaches (polyols).
The dietary approach involves temporarily reducing foods that are high in FODMAPs to help relieve symptoms. The restrictive phase should generally be limited to no more than 8 weeks, as prolonged restriction may alter the balance of the gut microbiota. This imbalance of the gut microbiota is known as dysbiosis. It means that the different types of bacteria in the gut are no longer present in their usual proportions, which may affect digestive health.
For this reason, the low-FODMAP diet should always be followed under the supervision of a qualified nutrition professional. This can help prevent nutritional deficiencies and ensure that foods are reintroduced appropriately.
Pharmacological treatment
Pharmacological treatment for irritable bowel syndrome (IBS) aims to relieve the symptoms that are most predominant in each individual and should always be prescribed and monitored by a healthcare professional.
When diarrhoea is the main symptom, antidiarrhoeal medicines such as loperamide are safe and effective for reducing the frequency of bowel movements and improving stool consistency.
When constipation is the predominant symptom, osmotic laxatives have been shown to increase the number of complete bowel movements and make stools easier to pass.
When abdominal pain is the main concern, antispasmodic medicines may be used to relax the muscles of the intestine. Peppermint oil preparations may also be used and may help reduce abdominal discomfort.
If dietary measures and initial treatments are not enough to relieve symptoms, second-line treatments may be considered, including:
- Rifaximin, a non-absorbable antibiotic indicated for IBS with diarrhoea (IBS-D).
- Linaclotide, indicated for IBS with constipation (IBS-C).
IBS is one of the disorders of gut–brain interaction (DGBI), in which the way the nervous system processes signals from the digestive system is altered. This may result in normal sensations being perceived as painful. For this reason, the use of neuromodulators may be considered in some cases. These medicines help regulate communication between the gut and the brain.
Examples include amitriptyline, fluoxetine, citalopram and duloxetine. When used to treat IBS, these medicines are prescribed at lower doses than those typically used in psychiatry. Their purpose is to reduce sensitivity to abdominal pain and improve digestive symptoms, rather than to treat a mental health condition.
Psychological support
As part of a comprehensive approach, psychological therapies may play an important role for some patients. Therapies such as cognitive behavioural therapy (CBT), stress-management techniques and hypnotherapy have been shown to help reduce gastrointestinal symptoms and may also benefit psychological symptoms that can coexist with IBS.
Substantiated information by:
Published: 25 September 2026
Updated: 25 September 2026
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