Manage IBS without special drugs
By the faculty of Harvard Medical School for The Harvard Medical School Adviser

Q: I was taking the drug Zelnorm for irritable bowel syndrome until it was taken off the market recently. What else can I do to help manage my symptoms?

A: Irritable bowel syndrome, or IBS, is a very frustrating condition with no known cause or cure. The most common symptom is pain or discomfort in the abdomen. Some people have frequent bowel movements, with loose, watery stools. Others have constipation, and some people alternate between the two extremes. Bloating and gas are also frequent complaints. IBS doesn't cause permanent damage, but it can make daily life uncomfortable.

Earlier this year, the Food and Drug Administration asked the company that makes tegaserod maleate (Zelnorm) to remove the drug from the market. It had been approved to treat constipation caused by IBS. Compared to a placebo (dummy pill), Zelnorm appears to slightly increase the risk for heart attack and stroke. It's the second IBS drug to be recalled. Alosetron hydrochloride (Lotronex), whi ch was approved in 2000 to treat diarrhea caused by IBS, was pulled off the market after just nine months because studies linked it to serious bowel-related problems.

Fortunately, there are many other things you can try to manage IBS symptoms. Diet is the place to start. Some people find that certain foods make their symptoms worse (see sidebar and below for more information).

For people mainly troubled by constipation, bran and fiber supplements help move waste through the intestines. However, they can cause gas and bloating, so start slowly and add small amounts to your diet gradually. Be sure to drink plenty of fluids. Many clinicians think that laxatives are safe and effective when used judiciously. But laxatives with stimulant properties (Dulcolax, Senokot, Ex-Lax, others) may cause some cramping. Laxative herbal teas can also help. Start with a weak brew, and then increase the strength until it works for you.

If diarrhea is an issue, an over-the-counter antidiarrhea drug, Imodium, can help. The prescription drug diphenoxylate (Lomotil) may also be useful. Fatty foods, coffee and alcohol can trigger cramps and diarrhea. So can chewing gum and drinks containing sorbitol or the sugar fructose. Fructose is found naturally in honey and certain fruits, and it's added as a sweetener to many food products.

For gas and bloating, simethicone-based products (Gas-X, Maalox, Mylanta, Phazyme, others), charcoal, and a product known as Beano aren't very effective. Prescription drugs aren't much help either. The best approach is to avoid the foods that tend to trigger these symptoms. Some common offenders are beans, pretzels and bagels, milk products, carbonated beverages, bananas, apples and other raw fruits, and vegetables such as cabbage, cauliflower and broccoli. Try eliminating these foods one at a time to find out which ones give you trouble. It's also important to rule out lactose intolerance as a cause of symptoms; just avoid all dairy products for a few days to see whether your problems improve.

Medications such as dicyclomine (Bentyl) and hyoscyamine (Anaspaz, Cystospaz, Levsin, others) -- help relieve pain by reducing bowel spasms. Low doses of certain antidepressants, such as amitriptyline (Elavil) and nortriptyline (Aventyl, Pamelor), taken at bedtime, may alleviate abdominal pain. (These drugs should be used only for diarrhearelated IBS, because they can cause constipation.) The effects of other antidepressants on IBS symptoms haven't been studied extensively. A heating pad may ease abdominal pain, and caffeine-free herbal tea such as chamomile can be soothing. Some people have found that peppermint oil helps reduce spasms.

You might also consider trying probiotics, which are live bacteria taken in capsule or powder form or in yogurt. They help with intestinal problems by restoring bacterial balance in the intestine and possibly by affecting the immune system. Anecdotal reports and several small studies suggest that probiotics can improve IBS symptoms. For more information and news about probiotics, visit www.usprobiotics.org.

IBS is a common problem that still lacks a solution. More research is needed to find the basic causes and best treatments. Still, there are things you can do to help yourself. It may take trial and error, but if you work with your doctor, you should be able to construct a program that will provide some relief.

Copyright 2007 the President and Fellows of Harvard College. Developed by Harvard Health Publications (www.health.harvard.edu). Distributed by UFS. Submit q ue havardadviser@hms.harva rd.edu.