IBS With Diarrhea (IBS-D)

What Is IBS With Diarrhea (IBS-D)?

If you have IBS-D, you feel the belly pain that’s common with irritable bowel syndrome (IBS), and you have to go to the bathroom a lot. The “D” stands for diarrhea.

Some people with IBS have the opposite problem, constipation. That's IBS-C. And some have both, at different times, which is another type of IBS.

There is a wide range of things you can try to help tame your symptoms. It may take some time to hit upon what works best for you, but it can get better.

Causes

Doctors aren't sure what causes IBS, but some of the things that can affect it are:

Bacterial infection . You can get IBS after having a serious infection in your stomach or intestines, like salmonella or campylobacter, which you usually get from tainted food or water.

Digestive system problems. Normally, your intestines gently contract, or squeeze and relax, to move food from your stomach through your bowels. But sudden, strong squeezing can cause pain.

Food sensitivity. Certain foods trigger symptoms in many people with IBS. That makes doctors wonder if there's a link between food sensitivities or allergies and IBS.

Foods that often trigger these problems include:

  • Dairy products
  • Beans and peas, or legumes
  • Broccoli, cauliflower, Brussels sprouts, and cabbage, also called cruciferous vegetables

These foods increase gas, which can cause cramps.

Sensitive intestines. People with IBS may be more sensitive to normal movement in the intestines. So when intestines stretch from gas or stools, they feel pain.

There are other theories about what plays a part in IBS. These include:

  • Faulty messages that run from the brain to the gut
  • Too many bacteria in the small intestine
  • High levels of certain chemicals and hormones in the body
  • Your genes

Stress and anxiety. People who are stressed or depressed are more likely to have IBS. These feelings probably make symptoms worse, instead of causing them, but the exact connection isn't clear.

Symptoms

The main symptoms you would notice are belly pain and diarrhea. People with IBS-D have loose or watery stools at least one-fourth of the time they have a bowel movement.

You may also have:

  • Excess gas
  • Sudden urges to go to the bathroom, especially after eating
  • A need to go to the bathroom often
  • Nausea
  • A feeling of not being able to empty your bowels
  • Losing control of your bowels

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Getting a Diagnosis

Your doctor will do a physical exam and will probably give you a routine blood test to rule out any other problems. He may also ask you questions, such as:

  • What symptoms are you having?
  • When did this start?
  • Have you noticed anything that seems to affect your symptoms?
  • Do any particular foods make it worse?
  • Does stress seem to affect how bad it gets?
  • How is it affecting your life?
  • Does anyone else in your family have similar problems?

Because there is no one test for IBS, your doctor may also recommend several tests that together can help him rule out other diagnoses:

Stool test. You collect a stool sample so it can be sent to a lab to look for parasites, blood, or other problems. Your doctor may also do a rectal exam, looking for similar issues. For this, he'll put a gloved finger in your behind.

Lower GI series. This is a special X-ray of your large intestine. You usually follow a clear-liquid diet for a few days beforehand and take laxatives or an enema the night before. At the hospital or medical office, a flexible tube is inserted in your behind. Through this tube, a chalky liquid called barium, called a “contrast,” fills your lower intestine, to make it show up better on the X-ray. Afterward, most of the liquid is drained out through the tube. Your bowel movements may look white for a day or two afterward. You also may feel some cramping or bloating.

Flexible sigmoidoscopy or colonoscopy. These tests are similar to a lower GI and are used to look at the rectum and colon. After prepping with a clear-liquid diet and enemas, a flexible tube is placed in the rectum to look for problems. Instead of carrying barium, this tube has a tiny camera with a light on the end. It lets the doctor see inside the bottom end of your lower intestine, the part higher up, or both.

Your doctor will check that you don't have other conditions, such as ulcerative colitis, Crohn's disease, and celiac disease, which have symptoms similar to IBS.

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Questions for Your Doctor

Managing your IBS-D starts with understanding as much about it as possible. Ask your doctor questions like these:

  • How did you make the diagnosis?
  • What treatment do you recommend?
  • What kind of results can I expect, and when?
  • Are there things other than medicine that might help?
  • Should I work with a dietitian, and can you recommend one?
  • How often do I need to follow up with you?
  • Should I see a specialist?

Treatment

Your doctor may suggest medicine to ease belly pain or help control diarrhea, including:

Anticholinergic drugs. Medications like dicyclomine (Bentyl) and hyoscyamine (Levsin) stop severe cramping and the colon contractions that can lead to pain and diarrhea.

Antidepressants . Low doses of some tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) can help ease belly pain. TCAs include Amitriptyline, imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor). SSRIs include citalopram (Celexa), fluoxetine (Prozac, Sarafem), or paroxetine.

Antidiarrheal drugs. Temporary use of diphenoxylate with atropine (Lomotil) or loperamide (Imodium) can slow down stool as it moves through your digestive tract. Talk with your doctor before taking any nonprescription medicines, though.

Anti-anxiety drugs. If anxiety makes your symptoms worse, your doctor may suggest anti-anxiety drugs like clonazepam (Klonopin), diazepam (Valium), or lorazepam (Ativan).

Talk therapy. If stress and anxiety are triggers, your doctor may suggest counseling or cognitive behavioral therapy, which focuses on new ways of thinking and acting to solve specific problems.

Taking Care of Yourself

You can take action to work on your symptoms. Let your doctor know what you're trying and how it's going.

Changes in diet. If you know certain foods trigger your symptoms, avoid them. If you're not sure what foods are to blame, work with your doctor. Try cutting back on dairy products, beans, some vegetables, and other foods that cause gas. Drinks with alcohol, caffeine, and artificial sweeteners also trigger symptoms in some people.

Probiotics . These "good" bacteria live in your gut. They can sometimes help IBS symptoms. You can find them in some foods, such as yogurt, but you also can take them as supplements. Ask your doctor if using them would help your treatment.

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Exercise . Being active every day can help ease stress and anxiety, and make you feel better overall. Some people say that eases their symptoms.

Some people with IBS feel unsure about going out, because they don't know when their IBS is going to flare up. It may help to connect with other people who have IBS in a support group, and to let people you're close to know what's going on with you. Therapy may also help you find ways to keep up with your life, in spite of having IBS-D.

What to Expect

Figuring out the treatment plan that works for you can take some time and experimentation. You can learn a lot about your triggers, which helps you control your symptoms.

You may also find that some of the mind-body approaches help, both with the symptoms themselves and with feeling more confident day to day.

Getting Support

There are online support groups. For more information on IBS with diarrhea, go to the web site of the International Foundation for Functional Gastrointestinal Disorders.

WebMD Medical Reference Reviewed by David T. Derrer, MD on January 06, 2016

Sources

SOURCES:

International Foundation for Functional Gastrointestinal Disorders: "IBS with Diarrhea."

Medscape: "Irritable Bowel Syndrome."

National Digestive Diseases Information Clearinghouse: "Irritable Bowel Syndrome."

UpToDate: "Patient information: Irritable bowel syndrome (Beyond the Basics)."

WomensHealth.gov: "Irritable bowel syndrome (IBS) fact sheet."

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