Antispasmodics in Crohn’s disease and ulcerative colitis

Antispasmodics suppress muscle spasms, helping to reduce stomach pain, cramping and bloating. They are sometimes used in IBD to relieve symptoms. Find out more...


What are antispasmodic medicines?

Antispasmodic medicines are a type of symptomatic medicine, which suppress muscle spasms. They are used to help ease symptoms such as functional abdominal pain, cramping and bloating you may have as a result of a wide range of conditions, including inflammatory bowel disease (IBD). They can also help to reduce the movement (motility) of your gut.

Commonly used to treat the symptoms of irritable bowel syndrome (IBS), antispasmodics help to relax intestinal muscles of your gut. Food is able to move along your digestive system because the muscles contract and relax in a regular pattern throughout the length of your gut. This happens because your body produces chemical messages that tell the muscles to work. The chemical messenger (neurotransmitter) is acetylcholine and part of its job is to contract smooth muscles. Sometimes these contractions can happen too often, or be too strong, causing pain and other symptoms.

Symptomatic medicines do not treat the underlying cause of symptoms, and so should not be a replacement for your IBD treatment.

Why might I use antispasmodic medicines in IBD?

People who have IBD, such as Crohn's disease or ulcerative colitis, may be advised to take antispasmodic medicines to help to ease pain, discomfort and symptoms whilst other medicines take effect, or if they have symptoms that are not responding to other IBD medicines. 

In addition some patients with IBD continue to have pain and symptoms despite there being little or no evidence of active inflammation - “Many IBD patients experience non‐specific functional symptoms such as bloating, wind and altered bowel habit, even when the IBD is apparently quiescent”1. It is becoming more widely recognised that if you have IBD, you can also have IBS, however diagnosing IBS can be difficult because many of the symptoms are similar to those of IBD. Antispasmodics can be used to ease symptoms in these circumstances.

What types of antispasmodics are there?

There are two main types of antispasmodics, antimuscarinics (also called anticholinergics) and smooth muscle relaxants.

Antimuscarinics

As mentioned earlier, your body sends chemical messages to your gut, telling the muscles to contract. Antimuscarinics block the action of the chemical messenger (neurotransmitter) acetylcholine, reducing the strength of muscle contractions, spasms and cramps. This also reduces gut motility. Examples include:

  • Dicyclomine (Bentyl)
  • Hyoscyamine
  • Hyoscine butylbromide (Buscopan)
  • Atropine
  • Propantheline

Smooth muscle relaxants

Smooth muscle relaxants work directly on the smooth muscle wall of the gut, helping it to relax and relieving pain associated with contractions, cramps and spasms. Examples include:

  • Mebeverine (Colofac, Duspamen and Duspatalin)
  • Alverine citrate (Spasmonal)
  • Peppermint oil

Smooth muscle relaxants tend to have fewer side effects so will often be suggested first. Some people seem to respond better to one type of antispasmodic than to another, so if one type does not work for you, it may be worth trying another.

When should I take antispasmodics for inflammatory bowel disease?

Some types of antispasmodics are available over-the-counter without a prescription. However, you should always speak to your IBD team before taking one of these medicines, in case it is not suitable for you, or might interact with other medicines you are taking. It is also important to ensure that by taking them you aren’t masking symptoms that indicate increased disease activity.

If you are prescribed antispasmodics, your IBD team or doctor will tell you how to take the medicine. You can also read the patient information leaflet that comes with them. You may be encouraged to take antispasmodics at specific times of day, in relation to when your symptoms occur. 

It is generally recommended that you only take antispasmodics when necessary, stopping if the symptoms settle down.

What side effects could I have with antispasmodics?

Most people who take antispasmodics will not have any serious side effects. Generally smooth muscle relaxant antispasmodics will have fewer, milder side effects than antimuscarinics. This is because antimuscarinics block the chemical messenger acetylcholine, which has other roles within the body, including dilating blood vessels, increasing bodily secretions and slowing your heart rate.  

You can read the accompanying patient information leaflet for medicine-specific side effects and cautions.

Some common side effects include:

  • Heartburn
  • Constipation
  • Dry mouth
  • Difficulty urinating
  • Dizziness
  • Drowsiness
  • Headache
  • Nausea
  • Mild skin rashes
  • Palpitations and tachycardia
  • Blurred vision

Most people can take antispasmodics safely, however there are a few exceptions. This will be listed in the patient information leaflets, and includes:

  • If you have, or might have a bowel obstruction
  • If you already have gut motility issues
  • If you have myasthenia gravis, a condition that causes muscle weakness
Funding to help in the production of this article was received from PredictSURE IBD, however they had no input into its content.

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