Background: Irritable bowel syndrome (IBS) is a chronic condition. Some patients may benefit from probiotics and rifaximin in diarrhea-predominant IBS (IBS-D). Relaxation therapy has also been tried. 

Aims and Objectives: To assess the efficacy of rifaximin, VSL#3, and relaxation therapy in IBS-D patients. 

Methods: 196 patients with IBS-D were randomly assigned to three groups. Group A, B, and C received rifaximin, VSL#3, and relaxation therapy, respectively. Patients were followed up for six months. 

Results: Relaxation therapy (2.69 ± 0.67) group had significantly improved generalized ill-feeling over VSL# (3.87 ± 0.34) at the end of 6 months. IBS severity score improved in all the groups till the end of the study but relaxation therapy (199.19 ± 30.02) was significantly better than rifaximin (217.21 ± 39.9) and VSL# (250.41 ± 14.78). The subjective global assessment was improved significantly in the relaxation therapy group (2.05 ± 0.9) as compared to rifaximin (3.02 ± 0.85) and VSL#3 (3.84 ± 0.37).

Conclusion: Patients with IBS-D do better with rifaximin and VSL#3 in the short term. Patients respond better to relaxation therapy at the end of 6 months. Relaxation therapy is being a non-pharmacological and cost-effective therapy, could be implemented on a long-term basis.