DEAR MAYO CLINIC: Can irritable bowel syndrome be managed without medication, or is it typical that someone with this condition will need medication to control symptoms?

ANSWER: Medications can be used to treat irritable bowel syndrome, but not everyone who has this disorder needs medication. For some people, particularly those with mild symptoms, lifestyle adjustments, such as diet modification, stress management, and regular exercise, are enough to control symptoms. For moderate to severe symptoms, a combination of lifestyle changes and medication may be necessary to manage irritable bowel syndrome.

Irritable bowel syndrome affects the large and sometimes small intestines. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food through the digestive tract. When you have irritable bowel syndrome, those contractions may be stronger or more noticeable than normal. That can lead to abdominal cramping and pain as food, gas, or stool passes through the intestines. Irritable bowel syndrome also is associated with bowel irregularity, such as diarrhea or constipation. Other symptoms can include gas and bloating.

In those diagnosed with irritable bowel syndrome, it’s important to be aware that some abdominal issues are not associated with this disorder and could signal another underlying problem. In particular, these symptoms require prompt medical attention: blood in the stool, unexplained or rapid weight loss, unrelenting or severe abdominal pain, unexplained vomiting, significant pain with or difficulty swallowing, or an abdominal mass or lump.

Irritable bowel syndrome is a chronic condition, and symptoms tend to come and go over time. There’s no cure, but symptoms often can be eased with diet, lifestyle, and stress management.

More than 60% of people who have irritable bowel syndrome say their symptoms are connected to food in some way. However, because symptoms vary significantly from one person to another, it’s difficult to give specific dietary advice that works for everyone with this disorder.

In general, though, eating high-fiber foods and drinking plenty of fluids are beneficial for many people with irritable bowel syndrome. Avoid foods and beverages that contribute to gas and bloating, including carbonated and alcoholic beverages; caffeine; raw fruit; and vegetables such as cabbage, broccoli, and cauliflower. Reducing or eliminating gluten may ease diarrhea that’s related to irritable bowel syndrome.

Research has shown that certain carbohydrates known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can lead to abdominal pain, bloating, and gas in people with irritable bowel syndrome. These are found in certain fruits and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk, cheese, and yogurt; and artificial sweeteners.

Following a diet low in FODMAPs can ease symptoms of irritable bowel syndrome. But because so many foods contain these compounds, it can be difficult for patients to create such a diet on their own. Finding a dietitian familiar with irritable bowel syndrome can help. A dietitian can review a patient’s symptoms and dietary needs, discuss recommended dietary changes, and develop an individualized food plan to ease symptoms.

Stress also affects irritable bowel syndrome, with episodes of higher stress associated with an increase in symptoms. Using stress reduction techniques and participating in activities that relieve stress, such as yoga and meditation, may decrease stress-related flare-ups. Working with a therapist or counselor experienced in stress management, mindfulness, and behavior modification also may help those with irritable bowel syndrome better control stress and ease symptoms.

Regular exercise is recommended for people who have irritable bowel syndrome. Daily physical activity relieves stress, stimulates normal contractions of the intestines, and promotes overall wellness.

If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your healthcare provider about medication options. A wide variety of prescription and nonprescription medications are available to treat irritable bowel syndrome.

— Dr. Robert Kraichely, Gastroenterology, Mayo Clinic, Rochester, MN