Medication for IBS?

[Frances489]

I am 70 years old. After many investigations, all clear, I was finally diagnosed with IBS in 2012. Since then, I have been taking Mebeverine. I also take 25mg Nortriptyline daily for sleep issues and Fibromyalgia. However, I still suffer from cramping pain and an urgent need to go to the toilet after eating a meal. I can cope with this at home, but it does make me think twice about eating out and visiting places where I'm unsure about toilet facilities. I have had months when things have been reasonably OK, but it has flared up again recently, for no apparent reason.

Is there any other medication I could talk to my GP about, please?

[Dr Neil Galletly]

Hi Frances

It is slightly unusual to develop IBS in your 60s - it can occur but it is important that your doctors are certain this is the correct diagnosis and have ruled out other possible causes for your symptoms. Perhaps you could ask if they have ruled out 'bile acid malabsorption' and 'microscopic colitis'? - these are 2 conditions that often mimic IBS and can cause the symptoms that you describe.

If this is IBS, then you may want to ask your GP if they could refer you to a dietician to discuss the low FODMAP diet (apologies if you have tried this already) and to look for other possible food triggers. Increasing the dose of your nortryptiline may help - nortryptiline can help calm down over-active and over-sensitive nerve endings in IBS and reduce pain and diarrhoea. Don't change the dose without speaking to your GP first!! Using loperamide (Immodium) can help give you confidence about eating out or going out for the day without being 'caught-short' - its not a long-term solution but can be useful in these situations.

Hope this helps!

Neil Galletly

[Frances489]

Thank you very much for your reply. I was interested in what you said about 'bile acid malabsorption' and 'microscopic colitis', as, to the best of my knowledge, neither of these conditions have been ruled out. I also had my gall bladder removed in 2008, which, from what I have read, may be significant. I will go back to my GP and discuss it further with him. Thank you again for your help.