Diarrhea Predominant Irritable Bowel Syndrome (IBS-D)
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.
Last Updated:March 27, 2025
IBS-D (diarrhea-predominant IBS) is a subtype of irritable bowel syndrome that is characterized by symptoms such as abdominal pain, gas, bloating, and frequent, urgent diarrhea. It affects approximately 29% of people with IBS, and the prevalence is higher in women.
The main signs and symptoms of IBS-D (diarrhea-predominant IBS) include abdominal pain, bloating, gas, and diarrhea as the predominant bowel habit, and abdominal pain is more pronounced than in other IBS subtypes. Symptoms may improve after a bowel movement but can worsen due to triggers like caffeine, psychological stress, and certain high-FODMAP foods.
IBS-D (diarrhea-predominant IBS) is diagnosed by ruling out other diseases through blood and stool tests because there is no specific test for IBS-D. The Rome IV criteria can be applied, which require symptoms to occur at least once per week for 3 months, with a focus on the proportion of diarrhea compared to normal bowel movements.
The main medical treatments for IBS-D (diarrhea-predominant IBS) include antidiarrheals, antispasmodics, and antidepressants, which help normalize intestinal motility and water content in the bowel. Antibiotics may also be prescribed for underlying infections or small intestinal bacterial overgrowth (SIBO).
Few supplements have been studied for IBS-D (diarrhea-predominant IBS), but enteric-coated peppermint oil can alleviate abdominal pain, and certain probiotic strains provide multisymptom relief. Additionally, a 16-week trial showed that polymethylsiloxane polyhydrate improved abdominal pain, stool consistency, and bowel movement frequency and urgency in people with IBS-D.
Diet can significantly affect symptoms of IBS-D (diarrhea-predominant IBS) because certain foods like caffeine, sugar alcohols, and specific dietary fibers may increase gut motility or fluid retention. A low-FODMAP diet is often recommended and has been shown to be effective, alongside traditional dietary advice such as avoiding trigger foods and eating smaller meals.
Moxibustion has been found to be more effective than medication for improving symptoms of IBS-D (diarrhea-predominant IBS), although studies show a high risk of bias. Additionally, the Traditional Chinese Medicine formula Tong Xie Yao Fang and its ingredient Shugan Jianpi Zhixie have also shown superior effects compared to conventional treatments, but have similar concerns related to study quality.
The cause of IBS-D (diarrhea-predominant IBS) remains unknown, but research indicates that factors such as the gut-brain axis, abnormal muscular contractions, gut microbes, hormones, and genetics may contribute to the condition. Additionally, hormonal changes in women and specific gene mutations that affect serotonin receptors may also play a role.
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