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IBS-D: Diagnosis and Treatment Options

ibs-d treatment options

Irritable bowel syndrome (IBS) isn’t the same for everyone. While some suffer with constipation, others deal with diarrhea.

Keep reading to learn about irritable bowel syndrome with diarrhea (IBS-D), including its symptoms, diagnosis, and treatment methods.

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Symptoms

IBS-D shares many symptoms with the other types of IBS (IBS-C and IBS-M). These shared symptoms include gas, abdominal pain, and bloating. The primary symptoms unique to IBS-D are diarrhea, loose stools, and sudden urges to have bowel movements. About people with IBS-D have loss of bowel control or soiling. This has a strong, negative impact on daily living.

Diagnosis

Even if you think you have IBS-D, it’s important not to diagnose yourself. Consult with a specialist such as a gastroenterologist. They’ll likely perform a physical exam and get a detailed history of your health. They’ll also ask about any family history of diseases like colon cancer, Celiac disease, or Crohn’s disease.

Doctors may order blood and stool laboratory tests. You may also need a colonoscopy, flexible sigmoidoscopy, and x-rays. These tests help rule out other diseases. For an official IBS-D diagnosis, you must have diarrhea as the primary symptom more than 25 percent of the time. You must also have constipation less than 25 percent of the time.

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Triggers

All types of IBS, including IBS-D, have similar triggers. Stress is a common trigger, although the symptoms are not psychological in nature. Certain foods, such as milk, wheat, and red wine, are more likely to cause reactions. Smoking and caffeine consumption may also trigger IBS symptoms.

Lifestyle Treatments

Managing any type of IBS requires healthy lifestyle habits. This includes reducing stress, getting regular exercise, drinking enough water, and getting adequate sleep.

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For those with IBS-D, dietary changes may be especially helpful. Here are some diet tips:

  • Eliminate gas-producing foods. Some foods are high in gas-producing compounds. These foods include beans, carbonated beverages, raw fruits, and vegetables like cabbage and broccoli. Avoiding these foods may help to reduce painful gas and bloating.
  • Eliminate gluten. Gluten is a protein found in wheat, rye, and barley. A in the journal Gastroenterology found that a gluten-free diet was effective in reducing IBS symptoms. Gluten caused symptoms of “leaky gut” or small bowel permeability. Gluten also increased markers of inflammation.
  • Try a Low-FODMAP Diet. FODMAPs are a type of carbohydrate found in certain foods. The FODMAP acronym stands for Fermentable Oligo-Di-Monosaccharides and Polyols. FODMAP sources include:
    • Fructose (fruits, honey, high-fructose corn syrup)
    • Lactose (milk and dairy products)
    • Fructans (wheat, onion, garlic, and inulin)
    • Galactans (legumes such as beans, soybeans, and lentils)
    • Polyols (stone fruits such as avocados, cherries, and peaches; sugar alcohols such as sorbitol and xylitol)

Reducing your intake of FODMAPs may relieve common IBS symptoms. These symptoms include abdominal pain and cramping, gas, and bloating. However, many of the foods containing FODMAPs are good sources of fiber. You’ll need to take care to get enough fiber from other foods.

Medications

If lifestyle or dietary changes don’t relieve your IBS symptoms, you may want to add medication to your treatment line-up. Here are some suggestions:

  • Antidiarrheal medications. Medications that control diarrhea include an over-the-counter drug called loperamide (Imodium). Prescription medications in a class called bile acid binders can also help. These include colestipol (Colestid), cholestyramine (Prevalite), and colesevelam (Welchol). However, these medications may add to the bloating that is already present in IBS.
  • Anticholinergenic and antispasmodic medications. These medications reduce bowel spasms and associated pain. Examples include dicyclomine (Bentyl) and hyosycamine (Levsin). However, these can lead to constipation and difficulty urinating.
  • Mast cell stabilizers and 5-aminosalicylic acid (5-ASA). About of IBS-D cases occur after a bout with gastroenteritis. These medications are anti-inflammatory agents that may be useful in treating this subset of IBS-D cases.
  • Alosetron (Lotronex). This is the only medication currently approved for IBS-D. It’s only approved for women. The side effects from this medication can be severe, so it’s only available by prescription from doctors enrolled in a special program. It should be used only as a last resort after other treatments have been unsuccessful.

Takeaway

Although IBS-D can be a debilitating and embarrassing condition, there are ways to manage it. Talk to your doctor or gastroenterologist about your symptoms to ensure you get the treatment you need.

Article resources
  • IBS with diarrhea. (2015, February 26). Retrieved from
  • Irritable bowel syndrome (IBS). (2016). Retrieved from
  • Mayo Clinic Staff. (n.d.). Current and future treatments for IBS-D. Retrieved from
  • The low-FODMAP diet. (2014, January). Retrieved from
  • Vazquez-Rogue, M. I., Camilleri, M., Smyrk, T., Murray, J. A., Marietta, E., O’Neill, J., . . . Zinsmeister, A. D. (May 2013). A controlled trial of gluten-free diet in patients with irritable bowel syndrome diarrhea: Effects on bowel frequency and intestinal function. Gastroenterology, 144(5), 903-911. Retrieved from
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