Diarrhea Predominant Irritable Bowel Syndrome (IBS-D)

Last Updated: February 20, 2023

Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS that leads to abdominal pain, gas, bloating, and frequent, urgent diarrhea. The exact causes are unknown, but research suggests that multiple factors — such as the gut-brain axis, abnormal muscular contractions, gut microbes, and genetics — could play a role in the disease. IBS-D can be managed with dietary modifications, psychotherapy, supplements, and prescription medications.

Diarrhea Predominant Irritable Bowel Syndrome (IBS-D) falls under theGut Healthcategory.

What is IBS-D?

IBS-D is a subtype of IBS characterized by abdominal pain, gas, bloating, and frequent, urgent diarrhea. Approximately 29% of IBS sufferers have IBS-D, and women are more commonly affected than men.[1]

What are the main signs and symptoms of IBS-D?

IBS-D shares most symptoms — including abdominal pain, bloating, and gas — with the other IBS subtypes, but in IBS-D, diarrhea is the predominant bowel habit. People with IBS-D also report more abdominal pain compared to the other subtypes.[2]

Symptoms often subside after a bowel movement, but will sometimes worsen after certain triggers such as caffeine, psychological stress, and foods high in certain fermentable carbohydrates (e.g., beans and wheat products; see Low-Fodmap Diet).[3]

How is IBS-D diagnosed?

There is no test to diagnose IBS-D, so doctors often use blood and stool tests to rule out other diseases before reaching an IBS-D diagnosis. Rome IV criteria can be used to diagnose IBS-D based on the proportion of bowel movements rated as diarrhea compared to those rated as normal.[4] Symptoms need to occur at least once per week for at least three months to be considered IBS.[3]

What are some of the main medical treatments for IBS-D?

Medications for IBS-D broadly include antidiarrheals, antispasmodics, and antidepressants. They work by reducing or normalizing intestinal motility (organized contractions of the digestive tract) and water content in the bowel. In some cases, antibiotics are prescribed to treat an underlying infection or small intestinal bacterial overgrowth (SIBO).[3]

Have any supplements been studied for IBS-D?

Few supplements have been studied for IBS-D specifically, but enteric-coated peppermint oil can reduce abdominal pain and certain probiotic strains are effective for multi-symptom relief.[5][6]

In a 16-week placebo controlled trial (including an 8-week double-blind phase followed by an 8-week open label phase), polymethylsiloxane polyhydrate — an over-the-counter intestinal absorbent — improved abdominal pain, stool consistency, and the frequency and urgency of bowel movements in IBS-D.[2]

How could diet affect IBS-D?

Certain foods and substances, including caffeine, sugar alcohols, and some types of dietary fiber, can worsen IBS-D symptoms by increasing gut motility or retaining fluid in the intestines. These factors explain, in part, why a low-FODMAP diet is recommended for people with IBS-D.

In a 12-week randomized controlled trial, researchers compared a low-FODMAP diet to one that replaced cereal grains (like wheat) with Tritordeum (a hybrid of durum wheat and wild barley), and found that both diets were equally effective at reducing IBS-D symptoms.[7]

Traditional dietary advice — such as avoiding trigger foods, limiting alcohol, and eating smaller, more frequent meals — is also effective (though the low-FODMAP diet is slightly more effective.)[8][3]

Are there any other treatments for IBS-D?

Moxibustion — which involves heating different areas of the body with burning mugwort leaves — was found in one meta-analysis to be superior to medication for improving bloating and bowel movement frequency in IBS-D, but with a high risk of bias due to the lack of blinding in nearly all studies.[9] Tong Xie Yao Fang, a traditional Chinese medicine formula, was also reported to be superior to conventional treatment in another meta-analysis that also cited a high risk of bias due to the lack of blinding and randomization.[10] Shugan Jianpi Zhixie (an ingredient of Tong Xie Yao Fang) was more effective than placebo according to one meta-analysis that only included randomized, double-blind, placebo-controlled trials, but it wasn’t compared to conventional treatment.[11]

What causes IBS-D?

Though the cause of IBS-D is still unknown, research suggests that multiple factors — such as the gut-brain axis, abnormal muscular contractions, gut microbes, hormones and genetics — could play a role in the disease.

IBS is twice as common in women compared to men, which could be explained, in part, by hormonal changes during the menstrual cycle.[12] Other evidence suggests that some women with IBS-D carry a gene mutation that affects their gut-derived serotonin receptors, which could lead to abnormal motility.[1][3]

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  1. ^Fritz N, Berens S, Dong Y, Martínez C, Schmitteckert S, Houghton LA, Goebel-Stengel M, Wahl V, Kabisch M, Götze D, D'Amato M, Zheng T, Röth R, Mönnikes H, Tesarz J, Engel F, Gauss A, Raithel M, Andresen V, Keller J, Frieling T, Pehl C, Stein-Thöringer C, Clarke G, Kennedy PJ, Cryan JF, Dinan TG, Quigley EMM, Spiller R, Beltrán C, Madrid AM, Torres V, Mayer EA, Sayuk G, Gazouli M, Karamanolis G, Bustamante M, Estivil X, Rabionet R, Hoffmann P, Nöthen MM, Heilmann-Heimbach S, Schmidt B, Franke A, Lieb W, Herzog W, Boeckxstaens G, Wouters MM, Simrén M, Rappold GA, Vicario M, Santos J, Schaefert R, Lorenzo-Bermejo J, Niesler BThe serotonin receptor 3E variant is a risk factor for female IBS-D.J Mol Med (Berl).(2022-Nov)
  2. ^Howell CA, Kemppinen A, Allgar V, Dodd M, Knowles CH, McLaughlin J, Pandya P, Whorwell P, Markaryan E, Yiannakou YDouble-blinded randomised placebo controlled trial of enterosgel (polymethylsiloxane polyhydrate) for the treatment of IBS with diarrhoea (IBS-D).Gut.(2022-Dec)
  3. ^Irritable Bowel Syndrome: NIDDK; Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; cited Feb 2023
  4. ^Max J Schmulson, Douglas A DrossmanWhat Is New in Rome IVJ Neurogastroenterol Motil.(2017 Apr 30)
  5. ^Alammar N, Wang L, Saberi B, Nanavati J, Holtmann G, Shinohara RT, Mullin GEThe impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical dataBMC Complement Altern Med.(2019 Jan 17)
  6. ^Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi PSystematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndromeAliment Pharmacol Ther.(2018 Nov)
  7. ^Russo F, Riezzo G, Orlando A, Linsalata M, D'Attoma B, Prospero L, Ignazzi A, Giannelli GA Comparison of the Low-FODMAPs Diet and a Tritordeum-Based Diet on the Gastrointestinal Symptom Profile of Patients Suffering from Irritable Bowel Syndrome-Diarrhea Variant (IBS-D): A Randomized Controlled Trial.Nutrients.(2022-Apr-08)
  8. ^Mohammad Javad Zahedi, Vahideh Behrouz, Maryam AzimiLow fermentable oligo-di-mono-saccharides and polyols diet versus general dietary advice in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled trialJ Gastroenterol Hepatol.(2018 Jun)
  9. ^Tang B, Zhang J, Yang Z, Lu Y, Xu Q, Chen X, Lin JMoxibustion for Diarrhea-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Evid Based Complement Alternat Med.(2016)
  10. ^Dai YK, Li DY, Zhang YZ, Huang MX, Zhou YL, Ye JT, Wang Q, Hu LEfficacy and safety of Modified Tongxie Yaofang in diarrhea-predominant irritable bowel syndrome management: A meta-analysis of randomized, positive medicine-controlled trials.PLoS One.(2018)
  11. ^Xiao Y, Liu Y, Huang S, Sun X, Tang Y, Cheng J, Wang T, Li F, Kuang Y, Luo R, Zhao XThe efficacy of Shugan Jianpi Zhixie therapy for diarrhea-predominant irritable bowel syndrome: a meta-analysis of randomized, double-blind, placebo-controlled trials.PLoS One.(2015)
  12. ^Adeyemo MA, Spiegel BM, Chang LMeta-analysis: do irritable bowel syndrome symptoms vary between men and women?Aliment Pharmacol Ther.(2010-Sep)
  13. ^Yang J, Deng Y, Chu H, Cong Y, Zhao J, Pohl D, Misselwitz B, Fried M, Dai N, Fox MPrevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome.Clin Gastroenterol Hepatol.(2013-Mar)
  14. ^Gry I Skodje, Vikas K Sarna, Ingunn H Minelle, Kjersti L Rolfsen, Jane G Muir, Peter R Gibson, Marit B Veierød, Christine Henriksen, Knut E A LundinFructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten SensitivityGastroenterology.(2018 Feb)
  15. ^Fedewa A, Rao SSDietary fructose intolerance, fructan intolerance and FODMAPs.Curr Gastroenterol Rep.(2014-Jan)
Examine Database References
  1. Immunity - Yalçin SS, Yurdakök K, Tezcan I, Tuncer MEffect of glutamine supplementation on lymphocyte subsets in children with acute diarrheaTurk J Pediatr.(2010 May-Jun)
  2. Quality of Life - Mohammad Javad Zahedi, Vahideh Behrouz, Maryam AzimiLow fermentable oligo-di-mono-saccharides and polyols diet versus general dietary advice in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled trialJ Gastroenterol Hepatol.(2018 Jun)
  3. Irritable Bowel Syndrome Symptoms - Yawen Zhang, Lijun Feng, Xin Wang, Mark Fox, Liang Luo, Lijun Du, Binrui Chen, Xiaoli Chen, Huiqin He, Shuwen Zhu, Zhefang Hu, Shujie Chen, Yanqin Long, Yubin Zhu, Li Xu, Yanyong Deng, Benjamin Misselwitz, Brian M Lang, Bahtiyar Yilmaz, John J Kim, Chung Owyang, Ning DaiLow fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomesAm J Clin Nutr.(2021 Jun 1)