Irritable Bowel Syndrome: In Depth
What Is IBS?
IBS is a chronic disorder that affects the large intestine and causes symptoms such as abdominal pain, cramping, constipation, and diarrhea.
More about IBS
As many as one in five Americans have symptoms of IBS. The cause of IBS isn’t well understood but stress, large meals, certain foods, and alcohol may trigger symptoms in people with this disorder.
For more information on IBS, see the National Digestive Diseases Information Clearinghouse Web page on IBS at niddk.nih.gov/health-information/digestive-diseases.
What the Science Says About the Effectiveness of Complementary Health Approaches for IBS
Some evidence is emerging that a few complementary health approaches may be helpful for IBS. However, the research is limited so we don’t know for sure.
Mind and Body Practices for IBS
- For easing the severity of IBS, actual acupuncture wasn’t better than simulated acupuncture, a 2012 systematic review reported.
- A 2009 clinical trial included in the review found that of the 230 participants with IBS, those who received either actual or simulated acupuncture did better than those who received no acupuncture.
- Hypnotherapy (hypnosis). Researchers are studying gut-directed hypnotherapy (GDH), which focuses on improving bowel symptoms. Several IBS studies have found an association between hypnotherapy and long-term improvement in gastrointestinal symptoms, anxiety, depression, disability, and quality of life. The American College of Gastroenterology stated in a 2014 paper that there is some evidence that hypnosis helps with IBS symptoms, but the research is very uncertain.
More on hypnotherapy
- Just more than half of study participants who had 10 GDH sessions over 12 weeks felt better, compared with 25 percent of participants not assigned to undergo GDH, a 2013 study of 90 adults with IBS showed. The benefits lasted for at least 15 months. The non-GDH group had the same number of sessions of supportive talks with a physician who was trained in diseases related to stress and other factors.
- A research review suggested that children with IBS who underwent GDH had greater reductions in abdominal pain than children who received standard treatment. This was true whether the children underwent GDH with a therapist or listened to an audio recording. However, the result may not be reliable, as the researchers found only three small studies that met their standards.
- Many children and adolescents with mild IBS symptoms who get only reassurance from their health care provider improve over time.
- Mindfulness meditation training. Some studies suggest that mindfulness training helps people with IBS, but there’s not enough evidence to draw firm conclusions.
- The American College of Gastroenterology stated in a 2014 paper that the few studies that have looked at mindfulness meditation training for IBS found no significant effects. But the authors noted that given the limited number of studies, they can’t be sure it doesn’t help. A 2013 review that included these and other studies concluded that mindfulness training improved IBS-associated pain and quality of life but not depression or anxiety. The amount of improvement was small.
More on mindfulness
- A 2011 NCCIH-supported clinical trial (which was in the 2013 review) of 75 women with IBS showed that mindfulness training may decrease the severity of IBS symptoms, including psychological distress, compared to attending a support group. The benefits lasted for at least 3 months after the training ended.
- Yoga. In a small 2014 NCCIH-supported study, young adults (18 to 26 years old) reported generally feeling better and having less pain, constipation, and nausea after completing a series of yoga classes, compared with a waitlist control group. They were still feeling better at the study’s 2-month followup.
- There’s too little evidence to draw conclusions about the effectiveness of meditation, relaxation training, and reflexology for IBS.
More about placebo effects
In a 2008 clinical trial on placebos, 262 adults with IBS were given simulated acupuncture, simulated acupuncture with added positive attention from the health practitioners, or no intervention. None of the groups received actual acupuncture. The group that received the added positive attention improved the most, and the simulated acupuncture group fared better than the group who received no intervention.
Normally, researchers tell study participants that they’ll receive either a placebo or the treatment being tested, but they won’t know which they received until after the study. However, in a 2010 study, funded in part by NCCIH, researchers told 40 people with IBS that they were getting a placebo and that placebos have been shown to help people. The other 40 received no intervention. Members of both groups had teh same amount of patient-practitioner interaction. People given the placebo showed greater improvement than those given no treatment.
About Dietary Supplements for IBS
A variety of dietary supplements, many of which are Chinese herbs and herb combinations, have been investigated for IBS, but we can’t draw any conclusions about them because of the poor quality of many of the studies.
- Chinese herbs. In a 2008 systematic review, a combination of Chinese herbs was associated with improved IBS symptoms, but extracts of three single herbs had no beneficial effects.
- Peppermint oil. Peppermint oil capsules may be modestly helpful in reducing several common symptoms of IBS, including abdominal pain and bloating. It’s superior to placebo in improving IBS symptoms, the American College of Gastroenterology stated in a 2014 paper.
- Probiotics. Generally, probiotics improve IBS symptoms, bloating, and flatulence, the American College of Gastroenterology stated in a 2014 paper. However, it noted that the quality of existing studies is limited. It’s not possible to draw firm conclusions about specific probiotics for IBS in part because studies have used different species, strains, preparations, and doses.
More on probiotics
- IBS patients given probiotics did no better than those who got a placebo, a 2013 clinical trial of 131 patients found. The group received either the placebo or probiotics for 6 months.
- In a 2012 review, 34 of 42 studies of probiotics for IBS symptoms found greater improvement in people taking probiotics than a placebo. However, the difference in improvement between the probiotic and placebo groups varied a lot among the studies.
- A 2011 review of studies on a strain of probiotic bacteria showed associations between taking probiotics and a decrease in symptoms in children with IBS.
More To Consider
- Unproven products or practices should not be used to replace conventional treatments for IBS or as a reason to postpone seeing a health care provider about IBS symptoms or any other health problem.
- If you’re considering a practitioner-provided complementary practice such as hypnotherapy or acupuncture, ask a trusted source (such as the health care provider who treats your IBS or a nearby hospital) to recommend a practitioner. Find out about the training and experience of any practitioner you’re considering. For information about selecting a complementary health practitioner go to nccih.nih.gov/health/tips/selecting and nccih.nih.gov/health/howtofind.htm.
- Keep in mind that dietary supplements may interact with medications or other supplements and may contain ingredients not listed on the label. Your health care provider can advise you. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, it’s especially important to consult your (or your child’s) health care provider.
- Tell all of your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
For More Information
- Brandt LJ, Chey WD, Foxx-Orenstein AE, et al. An evidence-based systematic review on the management of irritable bowel syndrome. American Journal of Gastroenterology. 2009;104(Suppl 1):S1-S35.
- Clarke G, Cryan JF, Dinan TG, et al. Review article: probiotics for the treatment of irritable bowel syndrome—focus on lactic acid bacteria. Alimentary Pharmacology and Therapeutics. 2012;35(4):403–413.
- Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. American Journal Gastroenterology. 2014;109(suppl 1):S2-S26.
- 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. American Journal of Gastroenterology. 2011;106(9):1678–1688.
- Kaptchuk TJ, Friedlander E, Kelley JM, et al. Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS One. 2010;5(12):e15591.
- Kearney DJ, Brown-Chang J. Complementary and alternative medicine for IBS in adults: mind-body interventions. Nature Clinical Practice. Gastroenterology & Hepatology. 2008;5(11):624–636.
- Lembo AJ, Conboy L, Kelley JM, et al. A treatment trial of acupuncture in IBS patients. American Journal of Gastroenterology. 2009;104(6):1489–1497.
- Manheimer E, Cheng K, Wieland LS, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2012;(5):CD005111. Accessed at www.cochranelibrary.com on January 27, 2015.
- 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. American Journal of Gastroenterology. 2013;108(4):602–609.
- National Institute of Diabetes and Digestive and Kidney Diseases. Irritable Bowel Syndrome. National Digestive Diseases Information Clearinghouse Web site. Accessed at https://www.niddk.nih.gov/health-information/digestive-diseases on January 27, 2015.
- Pimentel M, Chang C. Inflammation and microflora. American Journal of Gastroenterology. 2011;40(1):69–85.
- Rahimi R, Abdollahi M. Herbal medicines for the management of irritable bowel syndrome: a comprehensive review. World Journal of Gastroenterology. 2012;18(7):589–600.
- Ruepert L, Quartero AO, de Wit NJ, et al. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2011;(8):CD003460. Accessed at www.cochranelibrary.com on January 27, 2015.
- Rutten JM, Reitsma JB, Vlieger AM, et al. Gut-directed hypnotherapy for functional abdominal pain or irritable bowel syndrome in children: a systematic review. Archives of Disease in Childhood. 2013;98(4):252–257.
All Other References
- Chey WD, Maneerattaporn M, Saad R. Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome. Gut and Liver. 2011;5(3):253–266.
- Enck P, Junne F, Klosterhalfen S, et al. Therapy options in irritable bowel syndrome. European Journal of Gastroenterology & Hepatology. 2010;22(12):1402–1411.
- Michelfelder AJ, Lee KC, Bading EM. Integrative medicine and gastrointestinal disease. Primary Care. 2010;37(2):255–267.
- Wald A, Rakel D. Behavioral and complementary approaches for the treatment of irritable bowel syndrome. Nutrition in Clinical Practice. 2008;23(3):284–292.
- Wu JC. Complementary and alternative medicine modalities for the treatment of irritable bowel syndrome: facts or myths? Gastroenterology & Hepatology. 2010;6(11):705–711.
- Yoon SL, Grundmann O, Koepp L, et al. Management of irritable bowel syndrome (IBS) in adults: conventional and complementary/alternative approaches. Alternative Medicine Review. 2011;16(2):134–151.
- Shi J, Tong Y, Shen JG, et al. Effectiveness and safety of herbal medicines in the treatment of irritable bowel syndrome: a systematic review. World Journal of Gastroenterology. 2008;14(3):454–462.
Mind and Body Practices
- Lahmann C, Röhricht F, Sauer N, et al. Functional relaxation as complementary therapy in irritable bowel syndrome: a randomized, controlled clinical trial. Journal of Alternative and Complementary Medicine. 2010;16(1):47–52.
- Lakhan SE, Schofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS One. 2013;26;8(8):e71834.
- 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. American Journal of Gastroenterology. 2012;107(2):276–285.
- Vlieger AM, Rutten JM, Govers AM, et al. Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome. American Journal of Gastroenterology. 2012;107(4):627–631.
- Ford AC, Talley NJ, Spiegel BM, et al. Effect of fiber, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008;337:a2313.
- Kligler B, Chaudhary S. Peppermint oil. American Family Physician. 2007;75(7):1027–1030.
- Merat S, Khalili S, Mostajabi P, et al. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Digestive Diseases and Sciences. 2010;55(5):1385–1390.
- Kaptchuk TJ, Kelley JM, Conboy LA, et al. Components of placebo effect: randomized controlled trial in patients with irritable bowel syndrome. BMJ. 2008;336(7651):999–1003.
- Francavilla R, Miniello V, Magistà AM, et al. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 2010;126(6):e1445-e1452.
- Guandalini S, Magazzù G, Chiaro A, et al. VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study. Journal of Pediatric Gastroenterology and Nutrition. 2010;51(1):24–30.
- Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Alimentary Pharmacology and Therapeutics. 2011;33(12):1302–1310.
- Hun L. Original research: Bacillus coagulans significantly improved abdominal pain and bloating in patients with IBS. Postgraduate Medicine. 2009;121(2):119–124.
- Kligler B, Cohrssen A. Probiotics. American Family Physician. 2008;78(9):1073–1078.
- McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World Journal of Gastroenterology. 2008;14(17):2650–2661.
NCCIH thanks the following people for their technical expertise and review of the update of this publication: Wendy Weber, N.D., Ph.D., M.P.H., John (Jack) Killen, Jr., M.D., and David Shurtleff, Ph.D., NCCIH.
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