What Is IBS-D?

Medically Reviewed by Minesh Khatri, MD on March 17, 2024
4 min read

IBS that causes increased diarrhea is often called IBS-D. If you have IBS-D, you have belly pain and other IBS symptoms plus frequent bowel movements. Your stool might be loose, though not always. You also might have sudden urges to use the bathroom.

While there isn’t a cure for IBS-D, there are treatments that can improve the quality of your life and help you feel better.

Researchers don’t know what causes IBS or IBS-D. We do know that women are more likely to have it than men, and it’s more common in adults under 50. If you have a family member with IBS, your odds of getting IBS or IBS-D go up.

With IBS, your colon is more sensitive than normal. It can react to things like stress, bacteria, and even certain foods.

Your brain also plays a role and may respond too much to signals that control your colon. The result: Your intestines squeeze too hard, making food move too quickly through your system. That can cause pain, diarrhea, and other problems like gas.

There isn’t a test that tells you if you have IBS-D (or any kind of IBS). Instead, your doctor will look at your health history and symptoms. If you’ve had abdominal pain and other signs of IBS for at least 3 months, you may have it.

If you have other symptoms, like rectal bleeding, weight loss, or a family history of gastrointestinal cancer, your doctor may want you to have tests to rule out other possibilities.

These can include a blood test to check for celiac disease and a colonoscopy to check for abnormal growths and signs of cancer. (During a colonoscopy, doctors use medication to sedate you, then insert a tube with a tiny camera into your rectum and your large intestine to see if it’s healthy.)

Getting relief from your IBS-D may take some detective work. You’ll probably need to try several strategies and use many different techniques at a time. Make sure your doctor is in the picture. They can work with you to find an effective plan.

Possible treatments include:

Diet changes: Foods and beverages don’t cause IBS-D, but some may trigger your symptoms or make them worse.

Alcohol, drinks with caffeine (like coffee and soda), carbonated drinks, chocolate, sorbitol (an artificial sweetener used in some gums and mints), fried food, and milk products may make IBS-related diarrhea worse.

Fiber can be helpful for people who suffer from IBS with constipation (IBS-C). But if you have IBS-D, too much fiber can make your symptoms worse.

A low FODMAP diet is often a choice. A form of low carb diet, it limits carbs that are "fermentable oligo-, di-, monosaccharides and polyols" and are notoriously hard to digest.

You may need to experiment to figure out which types of whole grains, beans, fruits, and vegetables agree with your gut.

Be sure to drink at least six to eight glasses of water a day because diarrhea can cause dehydration.

Stress relief: The link between stress and IBS is complicated. Stress and related issues like anxiety and depression don’t cause IBS. But they can make symptoms like diarrhea worse. That’s why it’s important to try to find effective ways to manage your mood.

Exercise can help you feel better and improve the way your bowel functions, too. Massage, yoga, hypnotherapy, and forms of talk therapy can help with stress, which may lessen your symptoms.

Over-the-counter medications: Anti-diarrhea medications like loperamide (Imodium) may help. Peppermint oil supplements may reduce cramping.

Some experts believe probiotics (“good” bacteria, which you can get in supplement form or from foods like pickles and sauerkraut) can help relieve IBS symptoms, including diarrhea.

Prescription medications: There are several options your doctor can prescribe.

  • Anticholinergic dicyclomine (Bentyl) slows bowel contractions that lead to diarrhea. Hyoscyamine (Levsin) acts in much the same way.
  • An antidepressant may be an option if your IBS-D causes a lot of pain or if you’re feeling depression or anxiety. Low doses of antidepressants may block pain signals to the brain.
  • Anti-anxiety drugs may work if you feel anxious right before your symptoms come on. Your doctor may suggest medicines like clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) to calm you down.They’re usually only given for a short time since they have a higher risk of addiction.
  • Alosetron hydrochloride (Lotronex) is specifically for women with IBS who are not having success with other treatments. It can help relieve stomach pain and diarrhea, but there are potentially serious side effects.
  • Eluxadoline (Viberzi) may help reduce bowel contractions, belly cramps, and diarrhea. It’s also important to note that this is classified as a Schedule IV controlled substance. This means, among other things, that you’ll have to have a new prescription from your doctor each time you need it.
  • Rifaximin (Xifaxan) is an antibiotic that can decrease bacterial overgrowth and diarrhea. You take it for 2 weeks at a time. The treatment can be repeated up to two times if the symptoms come back.