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note that lactulose is not recommended as it may worsen bloating [14] [18] For abdominal pain : Antispasmodics (mebeverine, peppermint oil) taken before meals For global symptoms : Tricyclic antidepressants at low doses, with selective serotonin reuptake inhibitors (SSRIs) considered if TCAs are ineffective or not tolerated Psychological therapies have robust evidence in IBS management, including cognitive behavioural therapy (CBT), gut-directed hypnotherapy, and mindfulness-based interventions