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IBS-C vs. IBS-D: What's the Difference?

If you have IBS then you may be familiar with the terms IBS-C and IBS-D. IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D) each have different symptoms and are important to understand when learning how to manage IBS. Knowing the difference between IBS-C symptoms and IBS-D symptoms as well as how treatment differs between the two diagnoses can help to ensure you’re on the right path to managing your IBS.

What is IBS-C?

Irritable bowel syndrome can present with a range of symptoms including abdominal pain, bloating, excessive gas, constipation, or diarrhea. IBS-C symptoms include the symptoms of IBS as well as constipation. This is known as constipation-predominant IBS.

Constipation with or without IBS is defined as having less than three bowel movements per week. One way IBS-C is diagnosed is by referencing the Bristol stool chart to determine the type and frequency of stool passed by a person with IBS. MONASH University, a leading institution providing education on IBS and the Low FODMAP diet, defines IBS-C as having greater than 25% of bowel movements with Bristol stool types 1 or 2 and less than 25% of bowel movements with Bristol stool types 6 or 7. (See Bristol stool chart below)

What is IBS-D?

IBS-D is like IBS-C except the predominant symptom of IBS-D is diarrhea. Diarrhea-predominant IBS is defined by MONASH University as having frequent bowel movements throughout the day where less than 25% are Bristol stool types 1 or 2 and more than 25% are Bristol stool types 6 or 7. As with IBS-C, people who experience diarrhea-predominant IBS also experience other IBS symptoms such as excessive gas, abdominal pain, and bloating.

How does treatment differ between IBS-C and IBS-D?

Understanding the type of IBS you’re experiencing will help with finding a treatment that works best for you. Constipation and diarrhea require different approaches to managing symptoms. These varied approaches will often contradict one another since the two symptoms of IBS have the opposite effect on bowel habits. For example, IBS-C treatment will focus on strategies to speed movement of the bowels whereas IBS-D treatment emphasizes strategies to slow movement. If you’re experiencing IBS-D then you will want to steer clear of the treatment strategies used to relieve IBS-C symptoms and vice versa. Failing to do so many exacerbate symptoms and is an important reason why receiving the proper diagnosis is necessary for IBS management.

Treating IBS-C

Constipation-predominant IBS treatment requires an individualized approach, but there are a few starting points for treatment:

  1. Stay hydrated.

Optimal hydration is paramount for gut health, especially for those experiencing constipation. Drinking plenty of fluids throughout the day aids in digestion and the passage of stool through the gastrointestinal tract. Drinking water and other unsweetened beverages will contribute to daily hydration needs. Eating fruits and vegetables as well as other foods with high water content, like soups, will also contribute to daily hydration needs.

2. Incorporate daily movement.

Staying active may provide a benefit when managing constipation. Some research shows that moderate to vigorous physical activity is associated with a reduction in constipation while other research shows mixed results. Despite the inconclusive evidence, staying physically active has a plethora of other health benefits and may help to provide a mood boost. Even if it doesn’t help your constipation, it’s still worth adding to your daily routine.

3. Meet the recommended daily fiber intake.

Fiber plays a role in gut motility (movement of stool through the gastrointestinal tract) as well as helping to create bulk in the stool. Meeting your daily fiber intake can ease constipation symptoms and is especially true if incorporating soluble fiber sources which help to pull water into the GI tract. Ensure you’re staying hydrated as well to prevent the extra fiber intake from exacerbating constipation.

4. Take laxatives if prescribed.

Laxatives are sometimes necessary for the treatment of IBS-C. MONASH University recommends taking non-fermentable osmotic laxatives to treat IBS-C versus fermentable osmotic laxatives. For example, magnesium sulfate may be a better choice than prune juice. Talk with your doctor or dietitian before starting a laxative regimen.

5. Talk to your doctor or dietitian about medications and/or supplements.

Some medications such as those used for pain management may worsen constipation. Other supplements such as iron supplements can also contribute to constipation. Sharing your medication and supplement dosages with your doctor and/or dietitian is necessary for identifying a treatment strategy for IBS-C.

Treating IBS-D

Like IBS-C, diarrhea-predominant IBS treatment also requires an individualized approach. Consider these starting points:

1. Add fiber via foods or supplements.

Making diet adjustments to manage IBS can sometimes result in inadvertently reducing fiber in the diet. This can be problematic, especially if you’re struggling with IBS-D. Fiber is important for creating bulk in the stool, something those with IBS-D lack. Increasing fiber intake slowly will help to reduce other symptoms such as bloating that can often occur with high fiber doses.

2. Consider probiotics.

Research shows that probiotics may play a role in improving IBS symptoms. Probiotics are the good bacteria that live in the gastrointestinal tract. Research suggests that individuals experiencing dysbiosis, an imbalance of bacteria in the GI tract, may be more likely to experience IBS. Some probiotic strains may be more beneficial for IBS-D versus IBS-C, so it’s important to discuss with a dietitian or doctor before taking probiotics.

3. Reduce osmotically active FODMAP food sources.

Some foods are high in osmotically active FODMAPs that may exacerbate IBS-D symptoms. These include foods high in fructose and polyols. Fructose sources include fruits such as apples, mango, and watermelon, fruit juices, and sweeteners such as honey and high fructose corn syrup. Polyols include sorbitol, mannitol, and lactose. These are found in a variety of foods including stone fruits, mushrooms, cauliflower, and dairy products. For some, limiting the intake of these foods may improve IBS-D symptoms, but it’s important to work with a dietitian to ensure you’re not eliminating foods unnecessarily.

4. Talk to your doctor and/or dietitian about medications

As with IBS-C, some medications can influence bowel motility. Be transparent about the medications and supplements you take daily so that your doctor and/or dietitian can decide on the best treatment route if you’re experiencing IBS-D.

Managing Your IBS-C or IBS-D Symptoms

IBS-C and IBS-D can present with very different symptoms, so receiving a proper diagnosis is paramount to successful symptom management. Making diet changes, ensuring adequate hydration, staying physically active, and discussing medications with a health professional are all key considerations for IBS treatment. If you’re ready to work with a registered dietitian on managing your symptoms, schedule a discovery call today. The sooner you start, the quicker you’ll be on a path to finding relief.


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