Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a chronic disorder of the colon. For unknown reasons, the colon acts in an abnormal way. It often causes cramps, bloating, abdominal pain, and changes in bowel movements. People with IBS may experience predominately diarrhea, predominately constipation, or a mix of both.
There is no cure for IBS. Treatment is often a combination of steps that may help to manage the symptoms. Options include changes to diet and activity, counseling, a variety of medications, and probiotics. Since symptoms tend to naturally fluctuate, it can take some time to find the best treatment and needs may change over time.
Alternative therapies may be an additional step to help manage symptoms.
- Probiotics —Used to help restore a healthy balance of beneficial bacteria or yeast in the colon. Look for Bifidobacterium bifidum MIMBb75 (adults) and Lactobacillus rhamnosus GG (children). Other strains may be helpful as well. The probiotics used should contain at least one billion colony-forming units per daily dose.A1-A5
- Peppermint (enteric coated)—Appears to reduce muscular spasms in the colon, which helps ease abdominal symptoms.B1-B6
- Note: Peppermint oil is safe when taken as directed, but can be toxic at high or excessive doses
- Hypnotherapy —Involves deep relaxation and focus. Attention may be directed to the gut. It appears to work better in people with IBS that is unresponsive to other treatments.C1-C6
Natural therapies that are possibly effective:
- Yoga —Appears to be more effective in reducing stress and anxiety than easing IBS symptoms in adolescents and young adults.D1-D2
- Relaxation therapy , including mindfulness mediationE1-E5
- Acupuncture —When added to other treatments.F1-F4
- Moxibustion —Adding heat to acupuncture points with or without needles.F1-F4
Herbs or supplement that are possibly effective:
Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.
Herbs and Supplements to Be Used With Caution
Talk to your doctor about all herbs or supplements you are taking. Some may interact with your treatment plan or health conditions.
- Peppermint oil is toxic in high or excessive doses. Take care with how much you use.
- Probiotics should not be taken in people who have:
- A suppressed immune system
- Acute pancreatitis
- TCHM—Toxicities and side effects of TCHM vary depending on the herb and amount used.
- Berberine may be harmful in:
- Pregnant or breastfeeding women
- Herbal combinations—Toxicities and side effects of herbal combinations vary depending on the herb and amount used.
A1. Hungin AP, Mulligan C, Pot B, et al. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice—an evidence-based international guide. Aliment Pharmacol Ther. 2013;38(8):864-886.
A2. Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and symbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(10):1547-1561.
A3. Didari T, Mozaffari S, Nikfar S, Abdollahi M. Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World J Gastroenterol. 2015;21(10):3072-3084.
A4. Guglielmetti S, Mora D, Gschwender M, Popp K. Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life--a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2011;33(10):1123-1132.
A5. Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Aliment Pharmacol Ther. 2011;33(12):1302-1310.
B1. Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. 1997;32(6):765-768.
B2. Cappello G, Spezzaferro M, Grossi L, Manzoli L, Marzio L. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis. 2007;39(6):530-536.
B3. Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008;337:a2313.
B4. Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. 2010;55(5):1385-1390.
B5. Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gasteroenterol. 2014;48(6):505-512.
B6. Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109 Suppl 1:S2-S26.
C1. Simrén M, Ringström G, Björnsson ES, Abrahamsson H. Treatment with hypnotherapy reduces the sensory and motor component of the gastrocolonic response in irritable bowel syndrome. Psychosom Med. 2004;66(2):233-238.
C2. Lindfors P, Unge P, Arvidsson P, et al. Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. Am J Gastroenterol. 2012;107(2):276-285.
C3. Moser G, Trägner S, Gajowniczek EE, et al. Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2013;108(4):602-609.
C4. Lowén MB, Mayer EA, Sjöberg M, et al. Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome. Aliment Pharmacol Ther. 2013;37(12):1184-1197.
C5. Schaefert R, Klose P, Moser G, Häuser W. Efficacy, tolerability, and safety of hypnosis in adult irritable bowel syndrome: systematic review and meta-analysis. Psychosom Med. 2014;76(5):389-398.
C6. Ford AC, Quigley EM, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1350-1365.
D1. Kuttner L, Chambers CT, Hardial J, Israel DM, Jacobson K, Evans K. A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag. 2006;11(4):217-223.
D2. Evans S, Lung KC, Seidman LC, Sternlieb B, Zeltzer LK, Tsao JC. Iyengar yoga for adolescents and young adults with irritable bowel syndrome. J Pediatr Gastroenterol Nutr. 2014;59(2):244-253.
E1. Keefer L, Blanchard EB. The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study. Behav Res Ther. 2001;39(7):801-811.
E2. Boyce PM, Talley NJ, Balaam B, Koloski NA, Truman G. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol. 2003;98(10):2209-2218.
E3. van der Veek PP, van Rood YR, Masclee AA. Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26(6):943-952.
E4. Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011;106(9):1678-1688.
E5. Ford AC, Quigley EM, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1350-1365.
F1. Lembo AJ, Conboy L, Kelley JM, et al. A treatment trial of acupuncture in IBS patients. Am J Gastroenterol. 2009;104(6):1489-1497.
F2. Manheimer E, Cheng K, Wieland LS, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2012;(5):CD005111.
F3. MacPherson H, Tilbrook H, Bland JM, et al. Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterol. 2012;12:150.
F4. Park JW, Lee BH, Lee H. Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis. BMC Complement Altern Med. 2013;13:247.
G1. Mosaffa-Jahromi M, Lankarani KB, Pasalar M, Afsharypuor S, Tamaddon AM. Efficacy and safety of enteric coated capsules of anise oil to treat irritable bowel syndrome. J Ethnopharmacol. 2016;194:937-946.
Traditional Chinese Herbal Medicine
H1. Liu JP, Yang M, Liu YX, Wei M, Grimsgaard S. Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006;(1):CD004116.
H2. Leung WK, Wu JC, Liang SM, et al. Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol. 2006;101(7):1574-1580.
H3. Li Q, Liu F, Hou Z, Luo D. Treatment of constipation-predominant irritable bowel syndrome by focusing on the liver in terms of Traditional Chinese Medicine: a meta-analysis. J Tradit Chin Med. 2013;33(5):562-571.
H4. Li CY, Ain Mohd Tahir N, Li SC. A systematic review of integrated traditional Chinese and Western medicine for managing irritable bowel syndrome. Am J Chin Med. 2015;43(3):385-406.
H5. Bensoussan A, Kellow JE, Bourchier SJ, et al. Efficacy of a Chinese herbal medicine in providing adequate relief of constipation-predominant irritable bowel syndrome: a randomized controlled trial. Clin Gastroenterol Hepatol. 2015;13(11):1946-1954.
H6. Zhu JJ, Liu S, Su XL, et al. Efficacy of Chinese herbal medicine for diarrhea-predominant irritable bowel syndrome: a meta-analysis of randomized, double-blind, placebo-controlled trials. Evid Based Complement Alternat Med. 2016 Jul [Epub ahead of print].
I1. Chen C, Tao C, Liu Z. A randomized clinical trial of berberine hydrochloride in patients with diarrhea-predominant irritable bowel syndrome. Phytother Res. 2015;29(11):1822-1827.
Last reviewed February 2019 by EBSCO NAT Review Board Richard Glickman-Simon, MD Last Updated: 2/22/2019