IBS-D: Causes, Symptoms, And Treatment

IBS-D stands for irritable bowel syndrome with diarrhea. This is in contrast with IBS-C, which is irritable bowel syndrome with constipation.

IBS-D  can be a debilitating condition and make it quite difficult to get on with everyday life, especially if you keep needing to use the toilet. There are ways to manage IBS-D, and your doctor will be able to prescribe a treatment plan that is suited to you and your symptoms.

What causes IBS-D?

IBS is considered a syndrome, which means it can have multiple clinical manifestations. There are a number of theories about why and how IBS develops, but despite intensive research, the causes are not yet clear.

Some of the possible causes¹ of IBS-D include:

• Intense contractions in the gut — your bowel is working harder than it needs to, resulting in painful cramps and changing bowel habits.

• Heightened sensitivity of the nerves in your digestive system — normal amounts of gas or movement are perceived as excessive and painful.

• Severe gastrointestinal infection

• Stress and anxiety

• Changes to the microbes in your gut

People with IBS-D tend to suffer periodic "episodes" of pain, gas, and diarrhea.

Symptoms can be triggered by:

• Certain foods, most often wheat, dairy products (which contain lactose), legumes (such as beans), cruciferous vegetables (such as broccoli, cauliflower, brussels sprouts, and cabbage), and certain fruits (such as apples, pears, mangoes, and cherries)

• Stress and anxiety

IBS is more common in the following groups of people:

• People under the age of 50

• Women

• Those who have a family history of IBS

• People with anxiety, depression, or a history of abuse

What are the symptoms of IBS-D?

Symptoms of IBS-D are variable. People who suffer from IBS-D may still experience episodes of constipation. A diagnosis depends on which symptom is dominant.

Symptoms² of IBS-D include:

• Abdominal pain that is typically worse or better after a bowel movement

• Changes in frequency of bowel movements

• Changes in stool appearance

Most people experience these kinds of symptoms occasionally. When you "eat something that disagrees with you" and experience the symptoms listed above, this means your bowel is irritated.

If you experience symptoms at least once a week for three months, you will likely be diagnosed with IBS. To be diagnosed with IBS-D specifically, you would have to experience diarrhea more often than constipation. You should talk to your doctor if you have these symptoms regularly.

Several intestinal conditions can present with symptoms similar to IBS, such as inflammatory bowel disease, celiac disease, and microscopic colitis. A combination of medical history, physical examination, and tests will help differentiate between IBS and these other conditions. You may also be tested for lactose intolerance and overgrowth in bacteria.

Additional tests may be necessary for patients who first develop symptoms of IBS over the age of 50 or those who have a family history of inflammatory bowel disease or colorectal cancer.

You should also talk to your doctor if you have any of the following symptoms:

• Unexplained weight loss

• Diarrhea at night

• Rectal bleeding

• Progressive abdominal pain

• Unexplained vomiting

• Difficulty swallowing

These symptoms might indicate a more serious condition, such as cancer. In this case, your doctor may recommend a colonoscopy to rule it out.

Treatment

There is no "cure" for IBS-D. However, treatment can bring symptoms under control and restore your quality of life. IBS may go into remission in some cases, but it is likely to come back if you experience increased stress or get an infection.

Treatment recommendations depend on the type and severity of your symptoms.

Mild IBS-D treatments

• Keeping a food diary so you can track and avoid foods that trigger IBS-D symptoms

• Eating more fiber

• Drinking plenty of fluids

• Exercising regularly

• Avoiding carbonated and alcoholic beverages

• Cutting out or reducing your intake of lactose and gluten

Your doctor will likely refer you to a nutritionist who will be able to help you make diet changes. In some cases, a nutritionist might recommend that you follow the FODMAP diet for a few weeks. The FODMAP diet is an elimination diet where you remove foods that are known to cause problems (such as dairy, certain grains, vegetables, and fruits) then slowly reintroduce them.

Always talk to your doctor before making significant changes to your diet. Eliminating foods without assistance might worsen your symptoms or cause you to experience new issues, especially if you cut out important food groups.

Moderate to severe IBS-D treatments

Therapy

Stress is a major cause of IBS-D flare-ups, so your doctor might refer you to a counselor who can help you manage or reduce your stress levels through cognitive behavioral therapy. Your doctor may also recommend hypnotherapy or relaxation training to help you moderate your symptoms.

Antidepressants

If you have depression and your doctor believes this is affecting your IBS, you may be prescribed tricyclic antidepressants. If you don't have depression, your doctor may put you on a low dose to help rebalance your gut neurological activity and reduce pain.

Other medications

• Anti-diarrheal medications (Imodium A-D, or a prescription bile acid binder such as cholestyramine, colestipol, or colesevelam)

• Anticholinergic medications (to relieve pain during bouts of diarrhea)

• Pain medications

• Alosetron³ (typically prescribed for severe cases of IBS-D in women who have not responded to other treatment)

• Eluxadoline (reduces muscle contractions and fluid secretion in the intestine)

• Rifaximin (helps decrease bacterial overgrowth)

The last three medications often have significant side effects and are therefore only prescribed in certain circumstances.

For the majority of people with IBS-D, lifestyle changes can bring your condition under control and allow you to return to normal without being constantly aware of the location of your nearest toilet!

The lowdown

IBS-D is a type of irritable bowel syndrome where the individual typically experiences diarrhea as the main symptom.

Certain groups of people are more likely to experience IBS-D, including women, people under 50, and those with depression. Exactly what causes IBS-D is unclear, although it is typically triggered by periods of increased stress and the consumption of a specific food group, like wheat, dairy, or legumes.

Symptoms of IBS-D to watch out for include abdominal pain relating to passing stool, stool that changes in appearance, and changing bowel habits. If you experience other symptoms, like nighttime diarrhea or rectal bleeding, see your doctor as soon as possible to rule out a more serious issue.

There are various treatment plans for IBS-D, including dietary changes. More serious cases may be treated with medication or therapy. Luckily, most people can manage IBS-D by making lifestyle changes, like upping their water and fiber intake, exercising more, and avoiding problematic foods.