SELF | Understanding the Different Types of IBS

For context, your brain sends electrical signals that control actions throughout your body, including digestion. When your brain and gut have trouble interacting, your gut can become more sensitive to food, causing abdominal pain and bloating. Or your colon muscles could contract more slowly or quickly, leading to constipation or diarrhea, the NIDDK explains. For some people, certain foods, medications, or even stress can trigger IBS symptoms, according to the Cleveland Clinic.

IBS should not be confused with inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, separate conditions that can cause similar symptoms, such as diarrhea and abdominal pain. With IBD, your immune system mistakenly reacts to normal gut bacteria as a threat and attacks various parts of your gastrointestinal tract, leading to chronic inflammation². Without treatment, IBD can permanently damage your intestines or colon, whereas IBS does not cause long-term damage to your digestive tract.

With that distinction made, here are the types of IBS to be aware of:

 

As the name suggests, IBS with constipation (IBS-C) is classified as having infrequent and typically hard stools, otherwise known as constipation. Roughly 30% of people with IBS have this form of the condition, according to a 2017 paper published in the International Journal of General Medicine³.

Constipation happens when your colon contracts slowly, so food stays in your digestive tract for longer periods of time and loses water (which typically makes it looser and easier to pass), according to the Cleveland Clinic. IBS-C specifically means your stools are hard or lumpy more than 25% of the time on days when you have what you’d consider abnormal bowel movements. What’s more, you would have watery or loose stool less than 25% of the time on those days, per the NIDDK.

But there are also other ways you can experience constipation, like by having less than three bowel movements a week, straining to go to the bathroom, and feeling like you’ve never really gotten everything out (if you know what we mean). Other IBS-C symptoms include gas, bloating, and stomach pain.

A lot of people get constipated from time to time, but that’s different from constantly struggling to go to the bathroom or always having very hard stool. It’s not clear why, but people assigned female at birth are more likely to develop IBS-C than people assigned male at birth⁴.

IBS with diarrhea (IBS-D) develops when your digestive system works faster than what is considered normal, resulting in liquid-y stools that are very loose, otherwise known as diarrhea. IBS-D is the most common type of irritable bowel syndrome, making up about 40% of reported cases⁵. Further, people assigned male at birth are more likely to have IBS-D than people assigned female at birth⁴.

IBS-D symptoms involve having loose stool more than 25% of the time on days when you notice changes in your bowel movements. You’d also have hard stool less than 25% of the time on those days, Shaham Mumtaz, M.D., a gastroenterologist at Northwestern Medicine Central DuPage Hospital, tells SELF.

Excessive gas, bloating, and stomach pains that are so uncomfortable you have trouble sleeping are also common. That’s why IBS-D can really impact your quality of life and lead to stress and anxiety around social events. For example, going on a date can be even more nerve-wracking if you’re worried about heading to the bathroom every few minutes.

For some, IBS symptoms may include both constipation and diarrhea (lucky you). This is known as IBS with mixed bowel movements (IBS-M), meaning you can get constipated or have diarrhea because your bowels speed up or slow down at different times. According to the NIDDK, you’ll deal with constipation or diarrhea more than 25% of the time on days when you have abnormal bowel movements.

So, with IBS-M, you might be constipated in the morning and then unexpectedly have diarrhea in the afternoon. Understandably, this can make it really difficult to follow any sort of schedule and cause anxiety about when you’ll have access to a bathroom. As with the other types of IBS, you could have really uncomfortable stomach pain, bloating, and gas that can interfere with your daily activities, like going to the gym or concentrating on work. Research suggests people of both sexes assigned at birth are equally as likely to have IBS-M⁴.

Unlike other types of IBS that don’t have one specific cause, post-infectious IBS develops after a person has a gastrointestinal illness, such as food poisoning or a stomach bug, which is often caused by eating food contaminated with bacteria like salmonella or viral infections like norovirus, according to the Centers for Disease Control and Prevention (CDC).

So, for example, you may get sick with food poisoning and feel terrible with initial symptoms like diarrhea, vomiting, and stomach cramping. Then, your illness might ease up so you’re no longer vomiting, but you could still have diarrhea and severe stomach cramps that don’t seem to be getting better, according to the Cleveland Clinic. About 46% of people with post-infectious IBS have both diarrhea and constipation, meaning they also technically have IBS-M—but it’s crucial to point out that their IBS is categorized as post-infectious IBS because it was clearly triggered by an infection. A large number of people with post-infectious IBS (about 40%) only have diarrhea, and 15% are mostly constipated^6. All of those common symptoms we’ve mentioned, like gas and bloating, can happen with this type of IBS too.

Post-infectious IBS generally doesn’t last forever, but there’s no set timeline for how long you may have symptoms—it could be weeks, months, or even years. It’s not clear why some people develop post-infectious IBS or why symptoms clear up more quickly in some people. However, research shows that people assigned female at birth, older individuals, and people with a bacterial infection (rather than a viral one) are more likely to develop post-infectious IBS. People whose diarrhea symptoms last longer, who have really frequent cramps, and who have bloody stool when they’re sick with a bacterial infection may also be more likely to develop post-infectious IBS, according to the Mayo Clinic.

Your IBS treatment depends on your specific symptoms and triggers. “For some, these symptoms are related to diet,” Dr. Mumtaz says. “For others, stress and anxiety may play a role, and medicines or psychotherapy may be the most effective treatment.” It can be extremely difficult to pinpoint what sets off your IBS symptoms on your own, which is why seeing a gastroenterologist or a registered dietitian specializing in G.I .disorders can be really helpful.

According to the Cleveland Clinic, many people start their treatment plan with some common IBS lifestyle changes, such as:

• Exercise: Numerous studies⁷ show that moderate aerobic exercise (like biking or speed walking) may help improve all types of IBS, although it’s not entirely clear why and there is no recommended amount to specifically relieve symptoms. But if your IBS is related to stress, then exercising may help you manage some of the tension and anxiety associated with it. Exercise also normalizes contractions in your large intestine, which can help relieve constipation. Most adults should aim to get 150 minutes of moderate aerobic activity a week, according to the CDC.
• Not smoking: Anecdotally, some people say smoking makes their IBS diarrhea worse, according to NYU Langone. Experts theorize that nicotine may stimulate your colon and lead to diarrhea. On the flip side, some research indicates that smoking may slow colon contractions in some people, causing constipation.
• Stress management: As we mentioned, stress can make IBS worse for some people. It’s impossible to eliminate stress (we get it), but doing your best to unwind as possible can help you feel better (in more ways than one). Working with a therapist, picking up a new hobby, or even taking a few minutes every day to practice mindfulness can be good places to start.
• Diet changes: What you eat affects your bowel movements, and certain foods may trigger your IBS symptoms. For example, if you have IBS-C, it may help to eat more fiber-rich foods, like oatmeal, fruits, and vegetables. Doctors recommend keeping a food journal so you can track everything you eat daily, in addition to any IBS symptoms that occur after eating⁸. Before you make any drastic changes to your diet, though, be sure to talk to your doctor about the best way to do so safely.

Sometimes, your doctor may recommend trying certain medications too. “There are medications specific to IBS-D and IBS-C that can be used when it seems like the underlying issue is related to the bowel not moving at the appropriate pace,” Dr. Mumtaz says.

If you are chronically constipated and lifestyle changes don’t fully help, your doctor may consider the following medications:

• Over-the-counter medications: These come in many forms, such as stool softeners that make bowel movements easier to pass. Laxatives can also stimulate your bowels, soften your stool, or do both. It’s important to talk to your doctor before using these to make sure they will help your situation and that you’re taking them safely. In some cases, using laxatives can interfere with your electrolyte balance or how your body absorbs nutrients, according to the Mayo Clinic.
• Lubiprostone: This prescription medication (taken as a pill) increases the amount of fluid in your bowel, so stool can pass through more easily. It can also help prevent stomach pain and bloating, according to the U.S. National Library of Medicine (NLM).
• Linaclotide: This is another prescription drug that increases fluids in your bowels and comes in a pill form.

If you struggle with diarrhea, there are medications that can help normalize your bowel movements:

• Loperamide: Known by the name brand Imodium, this medication (available in pill and liquid form) slows down your bowel movements, helping to prevent diarrhea, according to the NLM. When taking OTC medications, it’s important to use them as directed and to talk to your doctor if you want to use them long-term.
• Diphenoxylate is a prescription medication (available via pill or liquid) that slows down movement in your colon, allowing for firmer, more regular stools to pass, according to the NLM.
• Antispasmodic medications (available via pill or liquid) are given to slow down how quickly your stool travels⁹. These drugs include hyoscyamine and dicyclomine.

There isn’t just one recommended treatment plan for people with IBS-M or post-infectious IBS. Your doctor will work with you to make sure your G.I. woes are actually due to IBS and not another condition (so they may perform additional blood or stool tests) and recommend treatments based on the specific diagnosis^10. Since symptoms vary from day to day for those with IBS-M and post-infectious IBS, your doctor may prescribe a mix of medications from the IBS-C and IBS-D categories, depending on your symptoms.

Bottom line: Every person experiences IBS differently. But there’s no need to suffer in silence. With the growing wealth of knowledge in this field, Dr. Mumtaz stresses that working closely with a gastroenterologist can help relieve your symptoms and get you on your way to living a healthier and happier life (in and out of the bathroom).

Sources:

1. StatPearls, Irritable Bowel Syndrome
2. StatPearls, Inflammatory Bowel Disease
3. International Journal of General Medicine, Diagnosis and Treatment of Irritable Bowel Syndrome With Predominant Constipation in the Primary-Care Setting: Focus on linaclotide
4. Journal of Neurogastroenterology & Motility, Sex-Gender Differences in Irritable Bowel Syndrome
5. Canadian Medical Association Journal, An Approach to the Care of Patients With Irritable Bowel Syndrome
6. Middle East Journal of Digestive Diseases, Post-Infectious Irritable Bowel Syndrome: A Narrative Review
7. PLOS One, Physical Activity in Relation to Irritable Bowel Syndrome Among Iranian Adults
8. Quality of Life Research, Psychometric Assessment of the IBS-D Daily Symptom Diary, and Symptom Event Log
9. ScienceDirect, Antispasmodic
10. UNC Center for Functional GI & Motility Disorders, Post Infectious Irritable Bowel Syndrome