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 is reassuring to know that there are some common sense things that you can try to ease your symptoms and help your system to function in a healthier way.
Understand the Problem
If you have been diagnosed with diarrhea predominant irritable bowel syndrome (IBS-D), then you know all too well that your intestines are not working the way that they should. A good place to start in terms of self care is to think about how the system is supposed to be functioning.
Your large intestine is like a long conveyor belt. As stool moves through it, moisture is pulled out. When things are working as they should, this results in a soft, but well-formed stool arriving at the end of the intestine, ready to be evacuated. The aim of a bowel movement is not to empty the bowel, but rather to evacuate this well-formed stool.
Although the number of bowel movements per day varies widely among individuals, a common pattern is to have one or two productive bowel movements daily, with the morning being the most likely time. Unfortunately, this is not the case with IBS-D, as the high frequency of bowel movements results in the passage of loose and watery stools from higher up the tract that has not had a chance to be formed.
As well as being a motility problem, in that the system moves stool too quickly, the symptoms of IBS-D also appear to be the result of visceral hypersensitivity, in that the nerves within your intestines are hyper-reactive to stimulation and pressure.
The goals of a self-care plan would be to do what you can to slow down your intestinal tract and reduce your system's reactivity to triggers.
Tweak Your Eating Habits
Although IBS-D sufferers tend to spend a lot of time worrying about what to eat, it is also important to focus on how to eat. Patients commonly skip meals, thinking that an empty stomach will result in an empty bowel. In this writer's experience, that is a mistake. Again, thinking of the intestines as a conveyor belt, one would want the belt to carry an even, continual load to help it operate more smoothly. Skipping meals raises the risk of overeating, which in itself can strengthen intestinal contractions. You may find that eating small meals throughout the day actually helps reduce the reactivity of your system.
Be Clear about Food Triggers
For many years, medical researchers and IBS patients were at odds over the issue of food as a trigger for IBS symptoms. The medical establishment tended to downplay the role of food as a trigger, while IBS patients were convinced that food was the problem. This gap is slowly being bridged, most notably in the case of research looking into the FODMAP theory. On the other side of the equation, many IBS-D sufferers run the risk of excessively - and unnecessarily - restricting foods for fear of setting off symptoms, which could lead to nutritional deficits.
One approach to identifying your food triggers is to be systematic and scientific through the use of a food diary and elimination diet. Be sure 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.
The other approach is to try the Low-FODMAP diet. It has strong research for its effectiveness in reducing symptoms of IBS-D. Again, your success on the diet will be enhanced if you work with a qualified nutritionist.
For short-term food guidance, see these articles:
Don't Try to Empty
In my experience, many IBS-D sufferers mistakenly think that they will reduce the risk of experiencing diarrhea by making sure that their bowel is empty. The problem with this is that bowels are never truly empty as new stool is constantly being produced. Encouraging the intestines to keep emptying results in evacuating stool that becomes looser and more watery with each bowel movement. Loose and watery stool is hard for the rectum to contain, so a focus on emptying may just make the problem worse. It is much better to try to use strategies to calm your body and delay further movements so that the stool can undergo the process of forming. Think of it as taking care of "tomorrow's stool".
Use Relaxation Exercises to Keep Your System Calm
IBS-D is like a Catch-22 situation. Stress can trigger diarrhea episodes, but diarrhea episodes are stressful! Your body's stress response is at play here. In response to a perceived threat, your body reacts in a variety of ways, one of which is to trigger intestinal movement. It is common for people who have IBS-D to scan their bodies for evidence that their systems will act up. Intestinal movement or noises become a perceived threat that then sets off the unwanted stress response.
What to do? Your best bet is to learn and 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.
- How to Deal with IBS Diarrhea Urgency
- How to Prevent Bathroom Accidents: Dealing with the Fear of Soiling
Thompson, W.G. Gut Reactions Plenum Press: New York 1989.
"Your Digestive System and How It Works" National Digestive Diseases Information Clearinghouse Accessed July 27, 2011.
DISCLAIMER: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.