Have you ever experienced a feeling of urgency or a loose bowel movement? Add on abdominal pain, bloating, and gas and you can start to understand what someone with Irritable Bowel Syndrome-Diarrhea (IBS-D) may experience. Unfortunately, 10-15% of Americans experience some form of IBS (other types include constipation dominant or mixed), with a diagnosis taking, on average, six years (1). If you think you have IBS-D or have been recently diagnosed, read on to find out about the signs and symptoms, along with treatment options.
Diagnosis
IBS-D is a disorder of the gut-brain axis and is a chronic condition. Symptoms include gas, bloating, abdominal pain, urgency, and loose bowel movements. You may not experience all of these symptoms, but in order to get a diagnosis, a gastroenterologist (i.e. GI doctor) will confirm that you’re experiencing abdominal pain and a change in bowel habits at least once per week. While this blog post will focus on IBS-D, there are two other subtypes of IBS: constipation and mixed. The difference between IBS-D and IBS-C is the frequency and consistency of bowel movements. People who have all of the above symptoms as well as diarrhea and constipation are diagnosed with IBS-Mixed (IBS-M).
Could it be something else?
IBS can be difficult to diagnose, as many other gastrointestinal issues mimic each other. Your GI doctor will take a medical and digestive health history, talk about any family history of gastrointestinal disorders and current symptoms. Gastroenterologists rule out other more serious diagnoses before giving you the diagnosis of IBS-D. Some other gastrointestinal disorders that may be ruled out first or can even be in conjunction with IBS are the following:
- Celiac disease: This is an autoimmune condition that may present itself as frequent and/or loose bowel movements. Most doctors will request a simple blood test to rule out Celiac disease. If any of the antibodies in your blood come back positive for Celiac disease, then your doctor will do an endoscopy and biopsy to confirm the diagnosis.
- Inflammatory Bowel Disease (IBD): This is a group of disorders that causes chronic inflammation in your intestines. The umbrella term IBD includes Crohn’s disease, Ulcerative Colitis, and Microscopic colitis. Diagnosis also starts with bloodwork, stool samples, and likely a colonoscopy.
- Small Intestinal Bacterial Overgrowth (SIBO): This is a bacterial overgrowth in your small intestines. It often presents as urgency, loose bowel movements, and severe bloating. Diagnosis is through a positive breath test and is treated with antibiotics.
- Chronic or Functional Constipation: Really bad constipation can actually present itself as diarrhea. This is because the intestine is so full that it creates a blockage, with loose stool creating an overflow effect. The stool retention also creates pain, which may be similar to abdominal pain in IBS-D (3).
Treatment options
- Low FODMAP diet: This is a well-studied diet that eliminates or reduces fermentable carbohydrates that may cause IBS symptoms. The diet uses a three-phase approach: elimination, reintroduction, and personalization. There is also an option to do a Low FODMAP Gentle or Lite, where only frequently consumed high FODMAP foods are swapped out for Low FODMAP alternatives. The Low FODMAP diet is meant to be a short-term diet to identify food triggers, not a long-term solution. The reason for this is that you eliminate or reduce many prebiotic fibers that are important for overall gut health. You can read more about the Low FODMAP diet here.
- Fiber intake: Fiber comes from both food and synthetic sources. High fiber foods include whole grains, legumes, berries, nuts, and greens like, swiss chard. Synthetic (or man-made) fibers are products like Benefiber, Citrucel, or Metamucil. The recent ACG Guidelines for IBS recommend soluble fiber for the management of IBS. Fiber varies based on its viscosity, fermentation, and solubility. Soluble fiber is ideal for both diarrhea and constipation because it adds bulk and softens bowel movements. Psyllium husk is frequently recommended in both the management of diarrhea and constipation. Insoluble fiber increases transit time and has a laxative effect, which is not ideal for someone with diarrhea (2).
- Medications: Loperamide (Imodium) is an over-the-counter option for diarrhea. Unfortunately, it’s not meant to be used long term so this means it’s not a viable option in those with IBS. There are other medication options like rifaximin (an antibiotic) or alosetron. Be sure to talk with your doctor about medication options.
- Supplements: Peppermint oil capsules have been well studied as a safe, short-term option for abdominal pain. Enteric-coated capsules ensure delivery to the small intestine, however, anecdotally many people have found success with peppermint tea. You can read more about peppermint oil and other supplements for IBS here.
- Gut-directed hypnotherapy: this may be a newer treatment option for some people, but it is well studied and is even included in the ACG 2020 IBS Guidelines. Gut-directed hypnotherapy addresses the miscommunication between the gut and the brain. It uses guided imagery, suggestion, and breathing techniques to help manage gut symptoms (4).
IBS-D can feel very overwhelming at first, but there are now so many different treatment options available. Work with your healthcare team to find the best options for you.
References
- “Facts About IBS,” aboutibs.org. International Foundation for Gastrointestinal Disorders, accessed November 20, 2021. https://aboutibs.org/what-is-ibs/facts-about-ibs/
- Lacy, Brian E. PhD, MD, FACG1; Pimentel, Mark MD, FACG2; Brenner, Darren M. MD, FACG3; Chey, William D. MD, FACG4; Keefer, Laurie A. PhD5; Long, Millie D. MDMPH, FACG (GRADE Methodologist)6; Moshiree, Baha MD, MSc, FACG7 ACG Clinical Guideline: Management of Irritable Bowel Syndrome, The American Journal of Gastroenterology: January 2021 – Volume 116 – Issue 1 – p 17-44 doi: 10.14309/ajg.0000000000001036
- Tosto M, D’Andrea P, Salamone I, et al. Functional constipation masked as irritable bowel syndrome. BMC Gastroenterol. 2020;20(1):86. Published 2020 Apr 6. doi:10.1186/s12876-020-01244-9
- Peters, S. L., Muir, J. G., & Gibson, P. R. (2015). Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease. Alimentary pharmacology & therapeutics, 41(11), 1104–1115. https://doi.org/10.1111/apt.13202
