IBS-D: What You Can Do For Your Patients

MARCH 10, 2018
As a pharmacist, I try to provide the best possible care I can for my patients. When asked a question that I may not be too familiar with or may not know that much about, I take down the patients information so that I can look into the question and provide a well-informed answer, rather than just saying 'I don’t know.' Last week, I had a patient approach me about what they thought to be Irritable Bowel Syndrome with Diarrhea (IBS-D). This condition was just a small portion of my academic curriculum and is not as commonly seen, compared to conditions like diabetes or hypertension, which I feel very confident about. Rather than just going off of the little information I remembered about the condition, I decided to dive deep, to give the patient the best possible answer that I could. 

I was already familiar with the symptoms of IBS-D, and when the patient told me about what they had been experiencing, it seemed to hit right on the money with what their extensive WebMD search had found: individuals with IBS-D may experience diarrhea, gas, bloating, and abdominal pain. I could have just simply told the patient to go see their doctor to get the proper diagnosis, and in the meantime use an over-the-counter diarrhea regimen, such as Pepto-Bismol or Loperamide, but that is not the kind of pharmacist I am. I like to provide the patient with information and lead them to use non-pharmacological remedies, as well to improve quality of life and relieve symptoms without always relying on pharmaceuticals.

Below you can read about some of the things I discovered about IBS-D, which is information I will continue to share with my patients to ensure I deliver the best treatment possible. Instead of providing your patients with a short answer and directing them to the correct aisle, maybe next time you can also provide them with tips and things to avoid when struggling with conditions, such as IBS-D.

Things You Should Avoid If You Have IBS-D
  • Dairy Products
  • Whole Grains
  • Processed foods, anywhere from hot dogs to chips
  • Chocolate
  • Caffeine
  • Fried Food
  • Large portions
  • Chewing Gum
  • Alcoholic beverages
  • Eating Quickly
If your patients avoid these triggers, then they should have fewer episodes and less of a need to rely on medications. In fact, lifestyle modifications play a big role in managing IBS-D and can improve the patient’s quality of life significantly. There are tips you should also inform your patients about, as nonpharmacological treatment is just as important as pharmacological methods. For instance, although drinking water is very healthy and recommended, people with IBS-D should not drink water while they are consuming food and should separate drinking by at least an hour before or after meals. Patients with the condition should also not eat very large meals and should only eat small portions throughout the day, as it is less irritating for their stomach.

The condition can also be exacerbated by stress and other environmental factors, so remedies such as yoga, therapy, and meditation can really help decrease the episodes of IBS-D in many individuals. Things like work, school, financial problems, and just stress in general, can play a big role and truly worsen an individual’s IBS-D, so it is important to tell the patient to find something that really helps them to relax in order for them to reduce stress, as many people are unaware that stress even plays a factor. Exercising helps tremendously, not only with the stress, but reduces IBS-D incidences significantly.

As far as the pharmacotherapy side, the patient will still need to go to his/her doctor in order to get the proper diagnosis, as sometimes these symptoms are caused by other factors or conditions, but in the meantime can use short-term therapy such as the medications I briefly mentioned above like Loperamide. Studies have shown the probiotics can also be integrated into a patient’s daily regimen as they provide the patient with good bacteria that will live in the gut. Some evidence has indicated that intestinal disturbances are sometimes caused because of the lack of bacteria within the gut. Studies have concluded that after several weeks of taking a Probiotic daily, patients with IBS-D have had fewer incidences and a greater quality of life. So with that being said, next time instead of guiding your patients directly to the Pepto-Bismol you might want to mention a probiotic as a recommendation as it can truly make a difference.

Works Cited
American Gastroenterological Association, Bharucha AE, Dorn SD et al. Gastroenterology. 2013; 211-217.
Aragon G, Graham DB, Borum M, Doman DB. Probiotic therapy for irritable bowel syndrome. Gastroenterol Hepatol (NY) 2010;6:39–44. [] []

Shelby Leheny, Pharm D, B.S
Shelby Leheny received her Doctor of Pharmacy Degree from Lake Erie College of Osteopathic Medicine (LECOM) and her Bachelor's of Science degree at the University of Pittsburgh. She is a pharmacist at CVS.
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