Doctors breakdown Irritable Bowel Syndrome IBS-D vs IBS-C
Author: Erin Thomson
According to the National Institute of Diabetes and Digestive and Kidney Diseases, “irritable bowel syndrome (IBS) is a group of symptoms that occur together, including repeated pain in your abdomen and changes in your bowel movements, which may be diarrhea, constipation, or both. With IBS, you have these symptoms without any visible signs of damage or disease in your digestive tract.”
“IBS-C is primarily constipation and IBS-D is primarily diarrhea,” said Athar Ghannam, MD, Family Medicine resident at McLaren Flint Family Medicine Residency Group Practice. “IBS-C can be intermittent and last for days because stools are hard. The patient will often have the sensation of not feeling empty despite having a bowel movement. This can lead to lots of straining, which perpetuates the cycle of constipation. IBS-D is when a patient is having frequent loose stools. Diarrhea will often occur in the morning and after meals and is also preceded by a sense of extreme urgency followed by a feeling of incomplete emptying. Approximately half of the people with IBS-D also noticed mucus discharge with their diarrhea.”
There is no single diagnostic test for irritable bowel syndrome. Diagnosis involves comparing symptoms to formal sets of diagnostic criteria. There are several different intestinal disorders that have symptoms similar to IBS that can be due to malabsorption, inflammatory bowel disease, celiac disease and colitis which need to be ruled out. Medical history, a physical exam, and select tests are imperative to ruling out other medical conditions. A routine blood test is usually ordered in patients with suspected IBS and sometimes a sigmoidoscopy or colonoscopy is ordered in patients who are over the age of 40. These tests are all used to rule out similar conditions. IBS is a clinical diagnosis and categorized by whichever symptom, constipation or diarrhea, is predominant.
Certain populations are more prone to experiencing IBS. According to the National Institute of Diabetes and Digestive and Kidney Diseases, IBS is known to be the most commonly diagnosed GI condition. It is estimated that 10-20% of people in the general population experience symptoms of IBS. It is about 1.5 times more common in women then in men and often begins in young adulthood.
“The good news is there are a number of treatment options and therapies available for those suffering with IBS,” said Sara Elsayed, MD, board-certified family medicine physician and faculty member at McLaren Flint Family Medicine Residency Group Practice. “Treatment is usually aimed to reduce the pain and symptoms of IBS and often it is necessary to try more than one combination of treatments. The treatment process takes time and begins with monitoring daily symptoms and bowel movements. This helps to identify factors that worsen symptoms such as certain foods or emotional stress.”
Keeping a daily diary to track diet and bowel symptoms is the first step to understanding which symptoms need to be controlled, along with changing your diet to eliminate foods that may aggravate your IBS. Eliminating lactose products and increasing fiber or taking fiber supplements at a low starting dose may also help.
“Psychosocial therapy is also part of the treatment for IBS because stress and anxiety can worsen IBS symptoms,” said Dr. Ghannam. “Some people benefit from formal counseling, with or without antidepressant or anti-anxiety medications. Many patients have also found daily exercise to be helpful in maintaining a sense of well-being which may have a favorable effect on the bowels.”
There are many drugs available to treat symptoms of IBS, but since these drugs do not cure the condition and merely relieve symptoms, they are usually started after conservative methods have failed. Anticholinergic medications such as dicyclomine block stimulation of the GI tract and help reduce severe cramping and irregular contractions of the intestine. These can be taken preventatively before symptoms start. Antidiarrheal drugs such as loperamide can help slow the movement of stool through the digestive tract in patients with IBS-D.
If you are in need of a primary care physician to diagnose and treat your IBS, a list of doctors accepting new patients can be found at mclaren.org/flintappointments