Abdominal pain in irritable bowel syndrome
Although controlled trials have not shown significant benefit, antispasmodic drugs may help to control abdominal pain and, occasionally, diarrhoea in patients with irritable bowel syndrome (IBS). These drugs may prove useful if symptoms are particularly intrusive over a short period. Consider:
1peppermint oil (0.2 mL/capsule) 1 to 2 capsules orally, up to 3 times daily half an hour before food if required peppermint oil peppermint oil peppermint oil
OR
2hyoscine butylbromide 20 mg orally, up to 4 times daily if required hyoscine butylbromide hyoscine butylbromide hyoscine butylbromide
OR
2mebeverine 135 mg orally, up to 3 times daily if required. mebeverine mebeverine mebeverine
The herbal preparation Iberogast (also known as STW5) is well tolerated and may relieve mild IBS-associated abdominal pain. Analgesics are generally ineffective for abdominal pain in IBS. Do not use opioids because of the risk of dependence and narcotic bowel syndrome.
If pain is severe and refractory to the treatments above, address the patient’s psychological health (see Psychological therapies), and consider trialling a low-dose tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI) Lacy, 2021—see Neuromodulation using antidepressant drugs in irritable bowel syndrome for dosage. Referral to a specialist pain team may be indicated.