An official website of the United States governmentIrritable Bowel Syndrome and Complementary Health Approaches
Irritable bowel syndrome (IBS) is challenging to study because of its varied, nonspecific symptoms, episodic nature, and the lack of confirmatory diagnostic testing. Although there is emerging evidence suggesting that some complementary health practices may be used for treating IBS, most of the studies have methodological flaws. Systematic reviews evaluating complementary modalities for IBS symptoms have concluded that few large, well-designed studies exist, and further research is required to determine whether complementary or integrative health practices are effective for treating IBS.
This issue of the digest summarizes the current research on commonly used complementary health approaches for managing symptoms of IBS.
What the Science Says:
Irritable Bowel Syndrome and Complementary Health Approaches
Modality and Summary of Current Research
There is limited evidence that suggests some probiotics may improve symptoms of IBS; however, benefits have not been conclusively demonstrated, and not all probiotics have the same effects. Clinical guidelines issued in 2021 by the American College of Gastroenterology recommend against the use of probiotics for the treatment of global IBS symptoms. (The recommendation is conditional, with “very low level of evidence.”)
Prebiotics are specialized plant fibers that beneficially nourish the good bacteria already in the large bowel or colon. They are a nondigestible food ingredient, are not affected by heat, cold, acid, or time, and provide a wide range of health benefits. There has been increasing interest in prebiotics because they may reduce the risk for certain conditions and help improve health. However, the quality of evidence examining the effect of prebiotics in IBS is poor and more well-designed, long-term clinical trials are needed to support health claims.
Some studies have suggested benefit of gut-directed hypnotherapy for IBS symptoms, including gastrointestinal symptoms, anxiety, depression, disability, and health-related quality of life. Significant relief from pain-related functional gastrointestinal pain disorders in children has been reported after hypnotherapy compared with standard care or waitlist approaches. Clinical guidelines issued in 2021 by the American College of Gastroenterology recommend that gut-directed psychotherapies, such as gut-directed hypnotherapy, be used to treat global IBS symptoms. (The recommendation is conditional, with “very low quality of evidence.”)
There is some evidence that enteric-coated peppermint oil capsules may be modestly efficacious, in the short term, in reducing several common symptoms of IBS, in particular abdominal pain, bloating, and gas. Long-term efficacy has not been established. Clinical guidelines issued in 2021 by the American College of Gastroenterology recommend the use of peppermint to provide relief of global IBS symptoms. (The recommendation is conditional, with “low quality of evidence.”)
There is limited evidence to suggest some herbal remedies improve IBS symptoms. However, much of the data available is based on studies with inadequate methodology and small sample populations.
In sham-controlled, randomized trials, acupuncture was found to be no better than placebo for IBS symptom severity or health-related quality of life. In other studies, acupuncture appeared to provide greater benefits than two antispasmodic drugs, although the studies could not rule out that these benefits may have been due to patient preferences or expectations of improvement.
A small amount of evidence suggests that yoga and other types of exercise may be helpful for symptoms of IBS.
There is little research on the benefits of meditation and mindfulness for improving health in people with IBS, and the results are not conclusive.
There is little research on the use of relaxation therapy for IBS and the results are not conclusive.
Clinical Guidelines
- ACG Clinical Guideline: Management of Irritable Bowel Syndrome (American Journal of Gastroenterology)
Scientific Literature
Information for Your Patients
NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.
The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.
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