7 Ways to Manage IBS-D Symptoms

Diarrhea-predominant IBS (IBS-D) can wreak havoc on your life, with its unpredictable symptoms of abdominal pain, cramping, urgency, and seemingly continual bowel movements. Since medication options are limited, it may be reassuring to know that there are some common sense ways to ease your symptoms and help your system function in a healthier way. These seven strategies can bring much-needed relief.


Understand the Problem

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There are three major areas of research into the causes of IBS. There appear to be changes in motility, changes in the gut microbiome, and problems with the brain-gut axis.

Motility is the movement of your gut. If motility is a problem, your large intestine is propelling contents forward too quickly. Because of this rapid passage, sufficient amounts of water are not being pulled out of the stool, resulting in stools that are loose and watery. Loose stools seem to trigger the urge for further evacuation—meaning more trips to the bathroom.

Second, a person may have problems with their gut microbiome, which means they may have too many bacteria that are not beneficial to health and/or too few "healthy bacteria."

Third, the brain-gut connection may cause you problems, especially under stress.

The good news is that a home self-care plan can help to slow down your intestinal tract and reduce your system's reactivity to triggers.


Identify Your Food Triggers

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It can be so hard to try to figure out what foods are causing your symptoms. Because many people who have IBS-D run the risk of excessively restricting foods for fear of setting off symptoms, you will need to get a little scientific about the whole thing.

This is not as hard as it sounds. You can simply start to keep a food diary and use an elimination diet to cut out the foods most likely to cause a sensitivity.

You will also want to record other factors (e.g., stress levels and hormonal changes) that might be contributing to any symptom flare-ups, so as to be sure that an individual food is truly problematic for you. If you are struggling with finding foods that you feel are safe to eat, you might want to consider consulting with a qualified nutritionist or dietitian.


Consider the Low-FODMAP Diet

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Research has indicated that a low-FODMAP diet is effective for reducing symptoms of IBS-D. That is because this group of foods can lead to increased water in the colon and increased gas because of fermentation.

The first of 3 phases of this diet require that you eliminate foods that contain certain carbohydrates known as FODMAPs for a period of two to six weeks to see if you feel better.

If you do feel better after limiting FODMAPs, then you will work to gradually re-introduce specific types of FODMAPs to see which ones you tolerate and which ones make your symptoms worse.

The third phase is where you adapt your low-FODMAP plan for long-term use.

Research shows that IBS symptoms are greatly improved for about 75% of people who follow the low-FODMAP diet. Your success on the diet can be greatly enhanced if you work with a qualified dietary professional.


Don't Skip Meals

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Although people with IBS-D tend to spend a lot of time worrying about what to eat, it is also important to focus on eating regularly.

People who have IBS-D commonly skip meals, thinking that an empty stomach will result in an empty bowel. That is a mistake. If you think of the intestines as a conveyor belt, you would want it to operate with a light, continuous load, so as to help it operate more smoothly.

Skipping meals also raises the risk of overeating later, which can increase intestinal contractions. You may find that eating small meals throughout the day actually helps reduce the reactivity of your system.


Keep Your System Calm

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IBS-D can be a vicious cycle. That's because stress can trigger diarrhea episodes, but diarrhea episodes can also cause stress.

Your body's stress response is at play here. In response to a perceived threat, your body reacts in a variety of natural ways, one of which is to trigger intestinal movement.

It is common for people who have IBS-D to scan their bodies for signs that their systems might act up. Intestinal movement or noises can be perceived as a threat, and then that sets off an unwanted stress response.

What can you do? Learn to use relaxation exercises to keep your body as calm as you can. You may also find it helpful to engage in activities that aim to reduce your body's baseline level of anxiety, such as yoga, meditation, and tai chi.

Studies have shown that yoga particularly may improve both the symptoms of pain and also bowel dissatisfaction found in IBS. Researchers are unsure of the mechanism of action, but they suspect that yoga may improve quality of life and sleep, and cause positive changes in the gut microbiome, in addition to calming the effects of the brain-gut axis.


Try Psychotherapy or Hypnotherapy

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Cognitive behavioral therapy (CBT) has been shown to be helpful for IBS. Aimed at modifying specific forms of negative thinking, CBT is believed to help with the frequency of some of the symptoms of IBS-D.

Hypnotherapy has also been shown to be an effective treatment for the symptoms of IBS-D. Specifically, gastrointestinal-focused hypnotherapy appears to help, where patients with IBS receive repeated suggestions about improvement in their GI function while in a hypnotic state.

Some studies have also shown that a modality called psychodynamic interpersonal psychotherapy may be helpful, as well as mindfulness-based stress reduction.

Specialists encourage people to try these important holistic therapies early in their IBS treatment, rather than regard them as a "last-ditch" treatments.


Sip Some Tea

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Black, green, and white teas are all considered to be good beverage options for people with IBS-D because they are low in FODMAPs.

Of the herbal teas, fennel and anise tea may be helpful for people with constipation-type IBS (IBS-C), but not for IBS-D. And chamomile tea is not low in FODMAPs, so it may not be appropriate for IBS sufferers.

Peppermint tea can be soothing for your nerves, and the components found in peppermint can also relax the muscles in your large intestine, resulting in less pain and less spasms.

The American College of Gastroenterology mentions that research shows peppermint to be most helpful when taken taking regularly, not just during symptom flare-ups. Because some people experience heartburn from peppermint, enteric-coated formulations of peppermint oil may be helpful for some people.

6 Sources
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.
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  4. Chey WD, Keefer L, Whelan K, Gibson PR. Behavioral and diet therapies in integrated care for patients with irritable bowel syndromeGastroenterology. 2021;160(1):47-62. doi:10.1053/j.gastro.2020.06.099

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Additional Reading

By Barbara Bolen, PhD
Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.