Digestive Health Irritable Bowel Syndrome IBS With Diarrhea An Overview of Diarrhea Predominant IBS (IBS-D) By Barbara Bolen, PhD Barbara Bolen, PhD Twitter Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome. Learn about our editorial process Updated on June 29, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Jay N. Yepuri, MD, MS Medically reviewed by Jay N. Yepuri, MD, MS Facebook LinkedIn Twitter Jay Yepuri, MD, MS, is board-certified in gastroenterology. He is a partner with Digestive Health Associates of Texas and a medical director at Texas Health Harris Methodist HEB Hospital. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Treatment Diarrhea predominant irritable bowel syndrome (IBS-D) is a subtype of IBS in which a person experiences frequent episodes of diarrhea with accompanying abdominal pain. Like IBS, IBS-D is a functional gastrointestinal disorder (FGD) in that there is no visible disease, inflammation, or injury to account for its symptoms. Estimates suggest that about one-third of people with IBS experience diarrhea as the predominant symptom. Peter Cade / The Image Bank / Getty Images Symptoms of IBS-D As opposed to the other IBS subtypes, people who have IBS-D typically experience: Frequent bowel movements Loose stools Feelings of urgency In addition, people who have IBS-D also have some or all of the following symptoms of IBS: Abdominal pain Gas and bloating A feeling of incomplete evacuation Mucus in the stool According to the Rome IV diagnostic criteria for IBS, symptoms must occur at least once a week, on average, for a period of at least three months. Some people who have IBS may find that they switch from times of having IBS-D to times of experiencing constipation-predominant IBS (IBS-C). Others alternate between constipation and diarrhea on a regular basis, which is a subtype known as IBS-mixed type (IBS-M) or IBS-alternating type (IBS-A). When Your IBS Causes Both Constipation and Diarrhea Causes Although the exact cause of IBS-D remains unknown, researchers are investigating several different possibilities. These include: A dysfunction in the brain-gut connection, with possible neurotransmitter involvement Food sensitivities Gut dysbiosis Idiopathic bile acid malabsorption (I-BAM) Inflammation in the lining of the gut Small intestinal bacterial overgrowth (SIBO) Treatment If you think that you might have IBS-D, please make an appointment with your healthcare provider. There are other serious health conditions that share many of the same symptoms with IBS-D. It is essential to rule these out. If your healthcare provider concludes that you have IBS-D, they will work with you on a treatment plan. They may recommend over-the-counter treatments or prescribe you a medication. Options include: An anti-diarrheal medication, such as Imodium (loperamide) An antidepressant to slow down motility and ease pain An antispasmodic to reduce gut cramping and pain Xifaxan (rifaximin), a targeted antibiotic A bile acid binder such as Prevalite (cholestyramine) A targeted opioid medication such as Viberzi (eluxadoline) Soluble fiber supplements Peppermint oil Probiotics In addition, the American College of Gastroenterology recommends all IBS patients try a low-FODMAP diet to see if it helps ease symptoms. IBS-D symptoms may also benefit from other dietary changes, such as: Eating smaller meals Avoiding high-fat meals Avoiding fried foods Keeping a food diary Identifying and avoiding your IBS trigger foods Last, IBS-D symptoms may be reduced through mind/body approaches, with cognitive-behavioral therapy (CBT) and hypnotherapy having the most research backing their effectiveness for IBS. Was this page helpful? Thanks for your feedback! One of the most challenging aspects of having IBS is trying to figure out what's safe to eat. Our recipe guide makes it easier. Sign up and get yours now! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 1 Source Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036 Additional Reading Saha L. Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine. World Journal of Gastroenterology 2014;20:6759–6773. doi:10.3748/wjg.v20.i22.6759