I have IBS and in the last few years it has been misery and pain. I flat out refuse to do another endoscopy or colonoscopy because it took six months after the endoscopy for my system to be close to regular and a full year after the lower end scoping (imagine never having even five days with-o diarrhea AND constipation that alternate for an 6 mos to an entire YEAR even with medicine, yuck!). It has been awful. Even a bad flu can give months of problems.
There ARE things that can help. I strongly suggest he add fiber to his diet. He wants psyllium fiber because it does not ferment in the system like other types. He can get it in a capsule or tablet at the store and it will help regardless of what the IBS is doing. It will absorb the excess fluid of diarrhea and it will add bulk and ease the constipation. He MUST drink a full 8 oz glass of liquid with each tablet, preferably water or juice but anything at hand will help.
One thing that has helped me through the years is to keep cereal like frosted mini wheats on hand. I eat them dry, always have, and it managed mine for 15 years without any other medications needed. They are a great snack, crunchy, slightly sweet but not too, and filling. Granola also helps, as do other cereals. I have even done snack mix using unfrostedmini wheats and chexs etc... and the spices from chex mix or even taco seasoning to help a friend who craved salty snacks but could not handle the grease from chips. I used a small amount of olive oil to mix with the seasonings. He said it helped a lot and was a way to get the fiber he needed and avoid snacks that caused problems. Maybe a care package of some high fiber treats from mom (NOT marked high fiber, lol) would help. He should also try the various fiber bars that are available now. Fiber is one of the best ways to help with this.
There ARE medications that help. One that might be good is donnatol. My mom used to give it to me as a kid when I got sick and my doctor gave it to me a few years ago. It is a mix of 4 medications and can be helpful. Another rx medication is levbid, generic name hyoscyamine (sp?), and it is very helpful. It relaxes the smooth muscles in the gut, but you have to take it only as directed because it can cause blurred vision if you take more than rx'd or are very sensitive. It relaxes the smooth muscles in your eyes and temporarily can blur your vision. It is actually very safe, in fact they rx'd it for colic for J when she was a baby.
Tell him to avoid immodium like the PLAGUE. It is one of the WORST things you can do for IBS. It will only make things worse. It provides a temporary stop to the release, but it will build up pressure in the gut, causing cramping, and the waste will only get hard and then liquid waste will end up passing around the overly solid stool. My reg doctor and both my gastro doctor and my mom's gastro doctor ALL say taht immodium should be taken off the market because it makes the entire situation much much worse and it draws it out. If there is infection and you take immodium, you get much worse. If you have IBS it adds to the spasms that cause the pain and it can keep your body from being able to try to help heal itself.
One thing that helps but few people think of it is to take mucinex. It is an expectorant and people with IBS generally have a lot of mucus in their waste. It can get thick and cause problems but mucinex does end up making it less sticky and problematic.
If he drinks water, have him think of the source. Even for coffee and brushing his teeth, suggest he use distilled water or a brita type filter pitcher. He should NOT NOT NOT use the type of filter that attaches to the faucet. Those filters are fine until they get clogged. Once they are clogged they then start sending out the stuff they filtered into your water and you get a double or triple dose until you change the filter. The pitcher filters are easier to keep track of how much water goes through them. You don't really know how much water you use through each faucet so you don't know when to change the filter on the faucet mounted systems. If he buys water, he needs distilled water, which is purified more than just bottled water. Bottled water can be tap water from anywhere so you don't know what or how much of the minerals etc... are in the water. someone here suggested that to me, I think it was IC or maybe TM, and it was very helpful.
I hope some of this helps. It is no fun to endure this. There really isn't much the ER will or can do for diarrhea other than to give you some antispasmodics and really they don't use them much. been there done that a couple of times a year for the last 2-3 years after I get a flu bug of any kind.
Does he have indigestion with it? Nasty tasting burps, cramps, etc???? If so, I have recommendations for that also. First of all, he needs to start taking lansoprozole or omeprazole (prevacid or prilosec respectively). They are OTC and under $20 for 3 courses of medications with 14 days in each course. The directions say to talk to the doctor, but every doctor I have ever had says you can take it for long term with no problems unless your other medications interact. I have taken one or the other for many, many years, and so has Jess. These will shut down the acid producing pumps in the system so there is less acid to bother him. Gas X (simethicone) is also very safe, effective and inexpensive. Two bottles of 72 gelcaps are about $7 here. Charco caps, capsules of activated charcoal that you take with lots of water, absorb problems like acid etc..., is not absorbed by your body, and is incredibly helpful, esp if you have the sour or sulphur burps that taste so awful. If you don't drink enough liquid, you may burp charcoal powder, which can be a tad disconcerting but generally won't be a problem. You will also have black waste for a few days after you take it, but only because the charcoal is coming out of you and it is black. He may want to consider taking acidophilus tablets as an imbalance of the bacteria in the gut can cause or contribute hugely to these problems. Price doesn't make them better, so look for active cultures and store it in the fridge after you open it.
An rx medication for problems in the stomach, esp ulcers and irritation/cramping, that is amazing is carafate. Generic is sucralfate and most places only have the tablets in generic, not the liquid. The liquid isn't made by many generic medication companies, but the tablets are easy to find and most pharmacies have it on hand. Sucralfate is also taken with a full glass of liquid and it forms a protective barrier over the lining of the stomach so that food, acid, etc.... doesn't hurt. It has been a miracle for me. You do take it before or after food and other medications because otherwise it won't coat the stomach well. It doesn't react iwth many medications, and the body doesn't absorb much of it. It can keep medications from absorbing properly, so taking it as directed before or after other medications is important.
I hope one or more of these things helps. I have battled this since I was 14 or so and have tried lots of things for it. Anxiety truly does make it vastly worse, and medications truly can make a big difference as can diet (esp fiber). If he hates whole grain bread, brown rice, etc...., the fiber bars really do help and so do the other things i suggested. I can give you easy recipes for snack mix (sweet or spicy/salty), granola and other high fiber things that don't taste like health food. I know he stresses you out, but a care package of some of these might help him find some sources that he likes and make him feel better/more loved with-o you having to directly talk to him. Of course I know he is well loved by you, but in his anxiety he likely forgets.
Let me know if you want recipes, ideas, etc...