Many gastroenterologists recommend trying dietary manipulation before resorting to bulking agents. The most effective drugs for relieving the abdominal pain of IBS are the anti-spasmodics, which work by reducing the spasm of the muscles in the intestinal tract. They work by damping the transmission of nerve signals to the bowel wall, blocking the action of acetylcholine and relaxing the intestinal wall muscles. Their use is associated with a high incidence of cholinergic side-effects such as dry mouth and blurred vision. They are contra-indicated in glaucoma, prostate hypertrophy and intestinal obstruction.
Dose titration is recommended in the elderly.
Kolanticon are indicated for IBS or gastro-intestinal spasm and have OTC licences. Patients should be warned to use these products only on an 'as necessary' basis to avoid dependence. Peppermint oil also has a carminative action to relieve pain caused by bloating but may cause heartburn. OTC products include Colpermin and Mintec. Most patients respond to a careful explanation of their symptoms and the importance of self-help, which involves encouraging them to eat more healthily.