Irritable bowel syndrome: What helps – and what doesn’t

Photo of a man writing in a diary

There are a lot of treatments for the relief of (IBS) – but there's a lack of good-quality research on them. Because it's not clear what causes IBS, it's difficult to find suitable treatments. Research has suggested that at least some medications and treatments may help.

The main symptoms of are abdominal pain, constipation and diarrhea. Most people only have mild symptoms that they can cope with fairly well without having treatment. Over time, they learn to understand their body's signals. But some people have more severe symptoms that greatly affect their everyday lives, so they look for a treatment to reduce the symptoms.

Which treatments have been tested in good-quality studies?

Although there are all sorts of tips and recommendations out there when it comes to IBS treatment, there's a lack of good research in this area. Generally speaking, it's fair to say that none of the treatments are guaranteed to relieve the symptoms. But research has shown that some treatments can at least help in some people or in the short term. These include the following:

  • Dietary supplements containing peppermint oil or probiotics
  • Certain anti-cramping medications, antidepressants and drugs to relieve constipation
  • Psychological treatments such as cognitive behavioral therapy and hypnosis
  • Physical activities like cycling or doing yoga

But research has also shown that some of these treatments – particularly the medications – can cause side effects.

Based on recent studies, it is still not clear whether , abdominal massage or osteopathy can help in IBS. Research has also not led to any clear conclusions about the effectiveness of in IBS. But studies have proven that homeopathy doesn’t help.

Many other recommended treatments haven't been studied properly so it isn't clear how well they work. These include reflexology massage, enemas and changing what you eat – for instance, more fiber.

What can help?

Studies have suggested that the following substances and medications can help. But the groups of people who took part in the studies aren't suitable for comparison. So it's not possible to say which treatment approach is most likely to work. Overall, 10 to 30 percent of the participants noticed an at least short-term improvement in symptoms. The different treatments have different side effects, though.

Peppermint oil

Peppermint oil is supposed to have a calming effect on the intestine by relaxing the muscles of the intestine. Research has indeed shown that some people benefit from peppermint oil, at least temporarily.

In these studies, peppermint oil was taken in capsules that are resistant to stomach acid. The dose used was between 500 and 800 mg per day. It is not clear whether peppermint solutions or drops help too. 9 out of 100 study participants had mild side effects from the peppermint oil capsules, such as heartburn or acid reflux.


The intestine contains different types of (gut flora) that play an important role in how well it works. These include lactic acid and bifidobacteria. Some people with IBS have abnormal gut flora, so it is thought that probiotics containing these (for instance, in yogurts and drinks) might be able to help.

A number of studies found that probiotics relieved IBS symptoms in some people. But more research is needed to be able to find out which type of helps the most and what dose is most effective. Probiotics are generally well tolerated. They only rarely lead to mild side effects such as flatulence (gas).

Anti-cramping medications

People whose main IBS symptom is cramping often use anti-cramping medications. These medications are meant to relieve the pain by relaxing the muscles of the intestine. Research suggests that four anti-cramping medications may help: butylscopolamine, cimetropium, pinaverium and otilonium. Butylscopolamine is the only one of these that is available in Germany. You can buy it at pharmacies, without a prescription. One study found that this drug relieved IBS symptoms in some people.

Another anti-cramping drug, known as mebeverine, is often prescribed in Germany. But there isn't enough research to be able to say whether it helps.

The possible side effects of anti-cramping medications include a dry mouth, dizziness and blurred vision. About 5 out of 100 people in studies had these types of side effects.

Medications for constipation or diarrhea

Medications for constipation or diarrhea can also be used, depending on which of these problems a person mainly has. But there's hardly any research on their effectiveness in IBS. Many laxatives and anti-diarrhea medications are available in pharmacies without a prescription.

If they don't work, a doctor can prescribe constipation medications containing the drugs prucalopride (Resolor) or linaclotide (Constella). Studies have shown that linaclotide can relieve the symptoms of IBS with constipation. These medications may cause side effects such as headaches, abdominal pain, nausea, dizziness and blood in the stool (poo).

All medications for diarrhea or constipation have the disadvantage that they may just replace one problem with another: Medication for diarrhea may cause constipation if its effect is too strong. Similarly, medication for relieving constipation can lead to diarrhea. In people who have alternating diarrhea and constipation, it's important to make sure that the medications don't make the symptoms even worse.


Antibiotics are sometimes considered as a treatment option for people whose IBS causes diarrhea or flatulence. The best-studied antibiotic is called rifaximin. In Germany, this drug is only approved for treating traveler's diarrhea. Yet doctors can still prescribe it “off-label” after providing full information about that type of use. It is considered to be "off-label use" if the medication is used in a way that hasn't been officially approved by a country's health authorities. When a drug is prescribed off label, insurers will only cover the costs in specific cases.

In studies, rifaximin was shown to relieve IBS symptoms in some people. But it's not clear whether it also has a positive effect in the long term. According to current recommendations, shouldn't be used too often because they can have various side effects, including allergic reactions, nausea and fungal infections. Also, improper use or overuse of can increase the risk of bacteria becoming resistant to antibiotics, and then the drugs won't be as effective in the future. Antibiotics affect the gut flora too ( in the bowels), which can sometimes cause IBS to develop in the first place or make the symptoms worse.


Sometimes IBS is treated with drugs that are normally used to treat depression. These include tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), which you can only get if you have a prescription from a doctor. In Germany, they haven't been approved for the treatment of IBS, so they can only be used off-label.

It is thought that certain antidepressants can relieve pain in IBS. Some may affect the muscles in the digestive tract.

Research has shown that tricyclic antidepressants and SSRIs can help relieve IBS. But they are generally only considered if other treatments haven’t worked.

Antidepressants can have various side effects: In the above-mentioned studies, 15 out of 100 people had side effects like loss of appetite, nausea and decreased sex drive. Some antidepressants can themselves lead to constipation or diarrhea.

Psychological treatments

Because it is thought that psychological stress may contribute to IBS, relaxation and stress management techniques are sometimes used. There is a lack of research on the effectiveness of these approaches. But some studies have suggested that a combination of relaxation techniques and stress management could help.

Other treatment options include psychological approaches like cognitive behavioral therapy. This treatment is mainly considered in people who have very severe symptoms. It aims to help you learn to cope better with the symptoms. There is some that cognitive behavioral therapy can help in IBS.

Avoiding fermentable carbohydrates (the FODMAP diet)

In recent years, IBS has increasingly been associated with foods containing fermentable carbohydrates. These are known as FODMAPs, which stands for "fermentable, oligo-, di-, mono-saccharides and polyols." They are found in many foods, including fructose (a monosaccharide), lactose and starch (oligosaccharides) and sweeteners (sugar alcohols). It is believed that the absorption of FODMAPs in the body can result in more liquid in the intestine, which increases the risk of diarrhea. As these carbohydrates ferment, more gas is produced in the intestine too, causing bloating and wind. The balance of in the intestine is also influenced by diet.

In the low-FODMAP diet, you avoid all foods containing these sugars. But this increases your risk of malnutrition because it is then difficult to get enough vitamins and minerals in your diet. It is also hard to keep up such a strict diet in everyday life.

Research suggests that the low-FODMAP diet might relieve IBS symptoms in some people.

Where is there a lack of good research?

There is no good research on the following treatments and approaches, so it's not known whether they work. They may also have disadvantages and be associated with risks.

Changing your diet

Most people who have IBS find that certain foods improve their symptoms, or make them worse. Unfortunately, there's very little good research on how diet may affect the symptoms – but that's not to say that it plays no role. Different people react very differently to certain types of foods, though.

It usually takes a while to find out what your bowel can and can't handle. It might help to keep a food diary for a few weeks. You can write down what you eat over the course of the day, whether you have any symptoms and, if so, what kind. You can also mention any other factors that might explain the symptoms (such as stress at work). You may gradually start recognizing patterns that help you identify which foods you don't tolerate. You can show your doctor the diary to talk about whether it would be a good idea to stop eating certain foods.

Soluble fibers

People who eat a balanced diet already get enough fiber in their diet. There is no proof that taking fiber supplements helps. There are two different types of fiber supplements:

  • Soluble fiber, which absorbs water in the bowel (e.g. psyllium, also called isphagula)
  • Insoluble fiber, which hardly absorbs any water (e.g. bran)

If you would like to try out fiber: People who have IBS are advised to try eating soluble fiber rather than insoluble fiber, and then see if it helps.


Some people who have IBS try hypnosis-based treatment (hypnotherapy). During a hypnotherapy session, you focus so intensely on a certain idea that you become unaware of the things around you and are more receptive to what your therapist tells you (“suggestions”). In the treatment of IBS, one example of such a suggestion is imagining that you have a healthy, well-functioning bowel. Hypnotherapy may be able to reduce IBS symptoms for several months in some people, but there’s no clear proof here.

Reflexology massage and enemas

Reflexology massage and enemas (a colon cleanse) are also used in the treatment of IBS.

But there's a lack of scientific research on these approaches, so it's not clear whether they're effective. Enemas are associated with risks such as an electrolyte imbalance, infections and injury to the wall of the bowel.

Acosta RD, Cash BD. Clinical effects of colonic cleansing for general health promotion: a systematic review. Am J Gastroenterol 2009; 104(11): 2830-2836; quiz 2837.

Alammar N, Wang L, Saberi B et al. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Altern Med 2019; 19(1): 21.

Altobelli E, Del Negro V, Angeletti PM et al. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients 2017; 9(9): 26.

Amsallem F, Sanchez S, Armoiry X et al. Effectiveness of Non-Pharmacological Interventions for Irritable Bowel Syndrome: A Systematic Review. Evid Based Complement Alternat Med 2021: 4404185.

Connell M, Shin A, James-Stevenson T et al. Systematic review and meta-analysis: Efficacy of patented probiotic, VSL#3, in irritable bowel syndrome. Neurogastroenterol Motil 2018; 30(12): e13427.

Dionne J, Ford AC, Yuan Y et al. A Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPs Diet in Treating Symptoms of Irritable Bowel Syndrome. Am J Gastroenterol 2018; 113(9): 1290-1300.

Ernst E, Posadzki P, Lee MS. Reflexology: an update of a systematic review of randomised clinical trials. Maturitas 2011; 68(2): 116-120.

Ford AC, Harris LA, Lacy BE et al. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther 2018; 48(10): 1044-1060.

Ford AC, Quigley EM, Lacy BE 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; quiz 1366.

Ford AC, Quigley EM, Lacy BE et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol 2014; 109(10): 1547-1561; quiz 1546, 1562.

Ford AC, Vandvik PO. Irritable bowel syndrome: dietary interventions. BMJ Clin Evid 2015: 0410.

Goldenberg JZ, Brignall M, Hamilton M et al. Biofeedback for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2019; (11): CD012530.

Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol 2014; 48(6): 505-512.

Lasa JS, Altamirano MJ, Bracho LF et al. Efficacy and Safety of Intestinal Secretagogues for Chronic Constipation: A Systematic Review and Meta-Analysis. Arq Gastroenterol 2018; 55 (Suppl 1): 2-12.

Layer P, Andresen V, Pehl C et al. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM). AWMF-Registernr.: 021-016. Z Gastroenterol 2021; 59(12): 1323-1415.

Lee HH, Choi YY, Choi MG. The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. J Neurogastroenterol Motil 2014; 20(2): 152-162.

Menees SB, Maneerattannaporn M, Kim HM et al. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2012; 107(1): 28-35; quiz 36.

Moayyedi P, Ford AC, Talley NJ et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut 2010; 59(3): 325-332.

Moayyedi P, Quigley EM, Lacy BE et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109(9): 1367-1374.

National Institute for Health and Care Excellence (NICE). Clinical practice guideline – Irritable bowel syndrome in adults: diagnosis and management. (NICE Clinical Guidelines; No. CG61). 2017.

Nunan D, Cai T, Gardener AD et al. Physical activity for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2022; (6): CD011497.

Peckham EJ, Cooper K, Roberts ER et al. Homeopathy for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2019; (9): CD009710.

Ruepert L, Quartero AO, de Wit NJ et al. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2011; (8): CD003460.

Scaciota AC, Matos D, Rosa MM et al. Interventions for the Treatment of Irritable Bowel Syndrome: A Review of Cochrane Systematic Reviews. Arq Gastroenterol 2021; 58(1): 120-126.

Shah ED, Kim HM, Schoenfeld P. Efficacy and Tolerability of Guanylate Cyclase-C Agonists for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2018; 113(3): 329-338.

Wang J, Yang P, Zhang L et al. A Low-FODMAP Diet Improves the Global Symptoms and Bowel Habits of Adult IBS Patients: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8: 683191.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Updated on February 27, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.