Irritable Bowel Syndrome and Complementary Health Practices

On this page:

• Key Points
• About Irritable Bowel Syndrome
• Complementary Health Practices for IBS
• What the Science Says
• NCCAM Research on IBS
• If You Are Considering Complementary Health Practices for IBS
• Selected References
• For More Information

As many as one in five Americans have symptoms of irritable bowel syndrome (IBS). Many people with IBS turn to complementary health practices to help relieve their symptoms. This fact sheet provides basic information on IBS and “what the science says” about complementary products and therapies for this condition. If you are considering any of these practices, this information can help you talk to your health care provider.

Top

Key Points

• No complementary health practice has been definitely shown to be helpful for IBS.
• Dietary supplements, including those used for IBS, can cause medical problems if not used correctly, and some may interact with prescription or nonprescription medicines or other dietary supplements.
• Tell all your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Top

About Irritable Bowel Syndrome

IBS is a chronic disorder that interferes with the normal functions of the colon. IBS is characterized by symptoms such as abdominal pain, cramping, bloating, constipation, and diarrhea. IBS often starts between the ages of 20 and 30, but children can also experience symptoms. IBS is twice as common in women as it is in men and can be disabling and seriously affect a person’s quality of life physically, psychologically, socially, and economically. A person with IBS may have other, co-existing chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis (painful bladder syndrome), temporomandibular joint dysfunction, and vulvodynia (chronic vulvar pain). It is not known whether these disorders share a common cause. IBS may also exist with psychiatric conditions such as anxiety and depression.

Researchers have not yet discovered a specific cause of IBS. IBS is often considered a functional disorder. For example, one theory is that the muscles and nerves in the bowel are extra sensitive in people with IBS—muscles may contract too much during or shortly after a meal, or nerves may react when the bowel stretches, causing cramping, diarrhea, or pain. A previous infection in the gastrointestinal tract or an imbalance in serotonin are also possible causes of IBS. Stress, large meals, medicines, certain foods, and alcohol may also be triggers for IBS symptoms.

There is no known cure for IBS, but there are options that can be helpful in controlling the symptoms. Treatments may include:

• Dietary changes (eating smaller meals, avoiding foods that tend to trigger IBS symptoms)
• Medicine (antispasmodics, antidepressants, diarrhea and constipation treatments, and over-the-counter medications such as fiber supplements and laxatives)
• Stress management (including cognitive behavioral therapy, counseling and support, regular exercise, lifestyle changes, and adequate sleep).

Although IBS can be painful, it does not damage the colon or other parts of the digestive system, and it has not been shown to lead to other serious gastrointestinal diseases. Symptoms of IBS are similar to those of other intestinal disorders such as Crohn’s disease and ulcerative colitis; however, they are not related.

Top

Complementary Health Practices for IBS

People with IBS can often control their symptoms by diet, medication, or stress management. However, many people find that their symptoms persist despite these treatments, or the medications they take may cause adverse effects or even worsen symptoms. They may therefore be interested in complementary health practices such as:

• Acupuncture
• Herbal remedies
• Hypnotherapy
• Meditation
• Peppermint oil
• Probiotics
• Reflexology
• Relaxation therapies
• Yoga.

Top

What the Science Says

IBS is challenging to study because its symptoms vary and may disappear for long periods, and because people with IBS tend to respond well to placebos.

This section summarizes research on some of the most popular complementary health practices for IBS. Overall, although there is some emerging evidence suggesting that some of these practices may be helpful for IBS, there have been few large well-designed studies, and most of the studies have had methodological flaws.

• Hypnotherapy (hypnosis), which involves the power of suggestion by a trained hypnotist or hypnotherapist during a deep state of relaxation, is the most widely used mind and body intervention for IBS. Gut-directed hypnotherapy—a specialized form of hypnosis that uses hypnotic induction with progressive relaxation and other techniques, followed by imagery directed toward the gut—is also popular. According to multiple systematic reviews of the research literature, hypnotherapy may be a helpful treatment for managing IBS symptoms. Several studies of hypnotherapy for IBS have shown substantial long-term improvement of gastrointestinal symptoms as well as anxiety, depression, disability, and quality of life.
• Herbal remedies are commonly used for IBS symptoms. Much of the research on these remedies has been done in China. A systematic review of clinical trials for 71 herbal remedies found limited evidence suggesting that some of these herbal remedies might help improve IBS symptoms including abdominal pain, constipation, and diarrhea. However, the review emphasizes that the studies were generally of poor quality.
• Peppermint oil is often used to treat IBS. Results from studies are mixed, but there is some evidence that enteric-coated¹ peppermint oil capsules may be modestly effective in reducing several common symptoms of IBS—especially abdominal pain, bloating, and gas. Non-enteric coated forms of peppermint oil may cause or worsen heartburn symptoms.
• Probiotics—live microorganisms (usually bacteria) that are similar to microorganisms normally found in the human digestive tract—have been associated with an improvement in IBS symptoms compared with placebo. Studies suggest decreases in some patients’ abdominal pain, bloating, and gas. Bifidobacterium and Lactobacillus strains have both been studied for their potential use in preventing and managing IBS symptoms.
• Experimental trials have indicated that acupunctureA family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi and restore and maintain health. has some positive effect on quality of life in people with IBS; however, systematic reviews have concluded that there is no convincing evidence to support the use of acupuncture for the treatment of IBS symptoms.

Evidence for other complementary health practices sometimes tried in treating IBS—including melatonin, meditationA conscious mental process using certain techniques—such as focusing attention or maintaining a specific posture—to suspend the stream of thoughts and relax the body and mind., reflexologyFoot reflexology is a non-invasive complementary modality involving the use of alternating pressure applied to specific locations on the feet, hands, and outer ears that reflexologists believe to be mapped to specific areas of the body. Stimulation to these areas is thought to cause physiological changes in the body through the relaxation process., yogaA practice from Ayurvedic medicine that combines breathing exercises, physical postures, and meditation. It is intended to calm the nervous system and balance the body, mind, and spirit., and herbal remedies such as artichoke—is too limited to draw any conclusions about effectiveness.

¹ Enteric-coating allows the peppermint oil to pass through the stomach unaltered so it can dissolve in the intestines. Note: If coated peppermint oil capsules are taken at the same time as medicines such as antacids, this coating can break down more quickly and increase the risk of heartburn and nausea.

Top

NCCAM Research on IBS

NCCAM-supported research on IBS has looked at the following therapies:

• Acupuncture
• Probiotics for IBS symptoms in children
• Traditional Chinese medicine
• Mindfulness meditation versus support groups
• Supportive patient-provider relations.

NCCAM-funded researchers are also looking at using brain-imaging techniques to study how a placebo might relieve pain in people with IBS.

Top

If You Are Considering Complementary Health Practices for IBS

• Do not replace scientifically proven treatments with health products or therapies that are unproven. Do not use a complementary health practice as a reason to postpone seeing your health care provider about IBS symptoms or any other medical problem.
• Talk with the health care providers you see for IBS. Tell them about the complementary health practice you are considering and ask about its safety, use, and likely effectiveness.
• If you are considering a practitioner-provided complementary therapy such as hypnotherapy or acupuncture, ask a trusted source (such as your health care provider or a nearby hospital) to recommend a practitioner. Find out about the training and experience of any practitioner you are considering. To learn more, see the NCCAM fact sheet Selecting a Complementary Health Practitioner.
• If you are considering taking dietary supplementsA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs., such as herbal remedies, keep in mind that they can act in the same way as drugs. Dietary supplements can cause medical problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements you take. Your health care provider can advise you. If you are pregnant or nursing a child, or if you are considering giving a child a dietary supplement, it is especially important to consult your (or your child’s) health care provider. To learn more, see the NCCAM fact sheet Using Dietary Supplements Wisely.
• Tell all of your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary and alternative medicine, see NCCAM’s Time to Talk campaign.

Top

Selected References

• Hussain Z, Quigley EM. Systematic review: complementary and alternative medicine in the irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2006;23(4):465–471.
• National Institute of Diabetes and Digestive and Kidney Diseases. Irritable Bowel Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases Web site. Accessed at digestive.niddk.nih.gov/ddiseases/pubs/ibs on April 30, 2009.
• National Institute of Diabetes and Digestive and Kidney Diseases. What I Need To Know About Irritable Bowel Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases Web site. Accessed at digestive.niddk.nih.gov/ddiseases/pubs/ibs_ez on April 30, 2009.
• Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Archives of Internal Medicine. 2003;163(3):265–274.
• Videlock EJ, Chang L. Irritable bowel syndrome: current approach to symptoms, evaluation, and treatment. Gastroenterology Clinics of North America. 2007;36(3):665–685.
• Wald A, Rakel D. Behavioral and complementary approaches for the treatment of irritable bowel syndrome. Nutrition in Clinical Practice. 2008;23(3):284–292.

Acupuncture

• Lim B, Manheimer E, Lao L, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2006;(4):CD005111.
• Schneider A, Streitberger K, Joos S. Acupuncture treatment in gastrointestinal diseases: a systematic review. World Journal of Gastroenterology. 2007;13(25):3417–3424.

Herbal Medicines

• Liu J, Yang M, Liu Y, et al. Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2006;(1):CD004116.
• 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.

Hypnotherapy

• Gholamrezaei A, Ardestani SK, Emami MH. Where does hypnotherapy stand in the management of irritable bowel syndrome? A systematic review. Journal of Alternative and Complementary Medicine. 2006;12(6):517–527.
• Webb AN, Kukuruzovic RH, Catto-Smith AG, et al. Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2007;(4):CD005110.
• Whitehead WE. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. International Journal of Clinical and Experimental Hypnosis. 2006;54(1):7–20.
• Whorwell P. Hypnotherapy for irritable bowel syndrome: the response of colonic and noncolonic symptoms. Journal of Psychosomatic Research. 2008;64(6):621–623.
• Wilson S, Maddison T, Roberts L, et al. Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2006;24(5):769–780.

Mind and Body Medicine

• 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.

Peppermint Oil

• Charrois TL, Hrudey J, Gardiner P, et al. Peppermint oil. Pediatrics in Review. 2006;27(7):e49–51.
• Kligler B, Chaudhary S. Peppermint oil. American Family Physician. 2007;75(7):1027–1030.

Probiotics

• McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World Journal of Gastroenterology. 2008;14(17):2650–2661.
• Nikfar S, Rahimi R, Rahimi F, et al. Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized, controlled trials. Diseases of the Colon & Rectum. 2008;51(12):1775–1780.
• Wilhelm SM, Brubaker CM, Varcak EA, et al. Effectiveness of probiotics in the treatment of irritable bowel syndrome. Pharmacotherapy. 2008;28(4):496–505.

Top