I was diagnosed with IBS and feel like that basically means no one knows what’s going on. I’ve seen people recommend things like abdominal massages online. Would that help?
The biggest misconception I see about irritable bowel syndrome as a gastroenterologist is that people think we don’t know what the actual underlying problem is. The second biggest misconception is that we don’t have effective ways to treat it.
A recent analysis of over 130 popular TikTok videos on irritable bowel syndrome, or IBS, found that only about 20 percent were made by health care providers. The most popular suggested interventions included chamomile tea, caffeine avoidance, probiotic supplements and abdominal massage. The #hotgirlswithIBS movement, a hashtag that racked up over 100 million views on TikTok alone, did something genuinely valuable: It got people talking openly about a condition many find too embarrassing to discuss. I am fully here for it.
But here’s the problem: The conversation quickly filled up with remedies that have little to no scientific backing. These remedies will not be found anywhere in the guidelines advised by the academic gastroenterological societies. IBS is a disorder with well-studied molecular and cellular changes in the gut – and the suggestion that chamomile tea is the best and only remedy we have leaves me gobsmacked.
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I find it frustrating because I know the reason many people turn to these suggestions is because they hear from others – often their own physicians – that there isn’t anything we can do about IBS. That belief flies in the face of decades of rigorous medical research and clinical trials, yet it remains pervasive. People want help with their symptoms, and science-backed answers can be surprisingly hard to find.
If you’ve been told there is no real treatment for IBS, I have some good news for you: We have many treatment options that work and we have the data to back them up. Misinformation around IBS is something I am personally passionate about and determined to correct. It’s IBS Awareness Month, and it’s high time to set the record straight.
What is IBS and what is it doing to my body?
We know quite a lot, actually. Studies of the enteric nervous system, the approximately 500 million nerve cells in our guts, have led to the discovery of numerous real, measurable abnormalities in the gut in people who have IBS. The key reason there is so much misinformation about IBS is that standard clinical tests like colonoscopies or routine bloodwork come back “normal,” which leads both patients and doctors to wrongly conclude that nothing is actually wrong.
But remember this: Normal tests do not mean a normal gut. Much of the enteric nervous system lives in the deep muscle layers of the bowel wall, which cannot be assessed by a colonoscopy. For instance, we know that the nerves in the gut fire at a lower threshold than they should, making ordinary sensations like from gas or food feel genuinely painful. Special cells called mast cells can create microscopic inflammation around the gut lining, which leads to pain and changes how the nerves function. There are also disruptions in the microbiome and in how the gut contracts, with some people skewing toward diarrhea and others toward constipation (and many oscillating between the two).
Just because your colonoscopy is negative, it does not mean “it’s all in your head.” Many people are told that their IBS is due to stress, which misses the point. While stress certainly can aggravate symptoms in the gut, problems in the gut itself aggravate stress and can be the very source of the anxiety and depression that are common in IBS.
What actually helps IBS
The hallmark of IBS is pain or discomfort, stemming from those hypersensitive nerves in the gut. Effective treatments target the cells involved in pain signaling and how quickly – or slowly – your gut moves.
As a starting point, there is good data to try soluble fiber, such as psyllium husk, as a first-line therapy in IBS. A large meta-analysis found soluble fiber meaningfully improved IBS symptoms, though insoluble fiber (think wheat bran) actually made things worse for some patients.
The type matters as does hydration: When you take a soluble fiber supplement, it’s critical to ramp up slowly and mix it with plenty of water (at least a 10-ounce cup per teaspoon). In some cases of IBS, a short-term trial of a diet called the low FODMAP diet, which excludes certain fermentable carbohydrates, can be considered, but here’s the part I’ve seen people get wrong: It should be limited, meaning you should only exclude those foods that trigger symptoms. The point is to identify a few food triggers, avoid just those, and then vary your diet as much as possible – not to restrict everything on the list indefinitely.
Peppermint, which has antispasmodic properties on the gut, has also been surprisingly well-studied in randomized controlled trials. It’s not a magic bullet by any means, but peppermint is recommended by the American College of Gastroenterology and has better evidence for mild IBS symptoms than what many people on TikTok are recommending. You can try it as a tea, although enteric-coated peppermint oil capsules have the strongest data. Exercise and minimizing ultra-processed foods can also help support gut function.
What didn’t make the list? The American Gastroenterological Association does not recommend probiotics for IBS – and the American College of Gastroenterology explicitly advises against them. The evidence simply doesn’t support probiotics for IBS, despite their enormous popularity and marketing to the contrary. There’s weak but vaguely positive data on abdominal massage for constipation (certainly not enough to be formally recommended by the academic societies). While it’s probably harmless, if an abdominal massage isn’t moving the needle profoundly, it’s time to try something with better data.
The next step is often medication, and there are several FDA-approved prescription options. Here are some examples by type:
· For IBS with predominant constipation: The ACG and AGA both recommend prescription agents called chloride channel activators (lubiprostone) and guanylate cyclase-C activators (such as linaclotide or plecanatide). These work directly on the gut lining to increase fluid secretion and speed up the colon. They have been shown in multiple randomized controlled trials to improve abdominal pain, bloating and bowel frequency.
· For IBS with predominant diarrhea: Rifaximin – a minimally absorbed antibiotic – may be recommended or bile salt sequestrants like colestipol, which help reduce irritation. Tricyclic antidepressants such as nortriptyline are also recommended for patients with diarrhea and abdominal pain, even in patients without depression. They work by directly modulating the gut’s nerve signaling, not necessarily by treating mood.
If you’ve never heard of these prescription medications, have a chat with a gastroenterologist and see what options may be right for you. No one needs to suffer in the dark.
What I want my patients to know
Many third-party companies promise they can identify the cause of your gut health woes through expensive kits like at-home microbiome tests. Be warned: These are not clinically validated, and I’ve seen patients waste hundreds of dollars in search of answers with companies that prey on desperation. You deserve better than that. IBS is real, common (affecting 15 percent of Americans), and it is treatable. Instead, find a gastroenterologist who specializes in IBS and can give you evidence-backed options. Bring this column to your next appointment.