Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a wide variety of presentations that may include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits. Symptom-based criteria and a limited medical evaluation are used for diagnosis. The heterogeneity of IBS presenting symptoms, together with the pathophysiology of the disorder, is unclear, making treatment challenging. Treatment strategies are focused on specific symptoms, potential underlying disorders in stress responsiveness, and predisposing psychological features. Although only two medications, tegaserod for constipation-predominant IBS and alosetron for diarrhea-predominant IBS, are specifically indicated, a wide variety of treatment options are available and are discussed in this review.