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19th July 2023

Management

FBDs should be managed with a biopsychosocial approach involving a multidisciplinary team to deliver holistic care that is patient-specific with the aim of ameliorating symptoms and improving quality of life. Patients should be informed of an FBD diagnosis early with a thorough explanation that FBDs are chronic, often relapsing conditions and are, therefore, incurable and hard to treat. Management strategies, therefore, do not have curative intent and instead focus on improving symptom control and reducing their impact on the sufferer’s daily life, as shown in table 6.
BIOLOGICAL (MEDICAL) 
SYMPTOM TREATMENT
Abdominal pain 1st line: Antispasmodics – peppermint oil, hyoscine, mebeverine

2nd line: Antidepressants – Tricyclic antidepressants, selective serotonin reuptake inhibitors
Constipation 1st line: Osmotic laxatives (macrogols – Movicol, Laxido)

2nd line: Prucalopride – 4 week trial in women with FBD who have failed treatment with 2 other laxatives

2nd line: Linaclotide – 3 month trial in patients with >1 year of constipation and no symptomatic improvement with maximum tolerated doses of previous laxatives
Diarrhoea 1st line: Loperamide

2nd line: Ondansetron
PSYCHOLOGICAL
THERAPY Cognitive Behavioural Therapy

Gut-directed hypnotherapy

Dynamic psychotherapy
SOCIAL (LIFESTYLE)
LIFESTYLE CHANGES Increased relaxation – optimising sleep hygiene, practising mindfulness

Regular physical activity (20 to 30 minutes 3-5 times per week)
DIETARY CHANGES Increase:

  • Water – 8 cups per day
  • Oat and linseeds (if prone to bloating), soluble bran (if prone to constipation)

Reduce:

  • Insoluble bran, high-fibre foods, resistant starches and aloe vera
  • Fresh fruit to 3 portions daily
  • Caffeine and alcohol
  • Sorbitol (artificial sweetener) if prone to diarrhoea
  • Other trigger foods identified through symptom tracking with a food diary

Other advice:

  • Small regular meals
  • 4 week trial of probiotics
  • Refer to dieticians to consider initiating a LOW FODMAP diet

Table 6: Management of FBDs

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