How Do You Know if You Have IBS-D? Symptoms, Diagnosis & Treatments

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Discover the symptoms that set IBS-D (diarrhea-predominant irritable bowel syndrome) apart from other forms of irritable bowel syndrome (IBS). Accurate diagnosis is essential for effective management and treatment strategies. 

While diarrhea is the primary symptom of IBS-D, it’s important to note that cramping, gas, and abdominal pain can also indicate this condition.

The only surefire way to know if you have IBS-D is to get a diagnosis from your healthcare provider. This diagnosis may include a medical history, a family medical history, a physical exam, and ruling out other conditions. (IBS is a clinical condition, meaning there is no simple diagnostic test for it.)

Many of our patients diagnosed with IBS also show positive results for small intestinal bacterial overgrowth (SIBO), due to many similar symptoms that both diagnoses share. 

There isn’t a conventional cure for IBS-D, but there are treatments and lifestyle changes that may resolve symptoms, improve your daily life, and permanently reverse your bowel disorder

I work directly with patients to discover the root cause(s) of their IBS and use the most effective and cutting-edge treatments to reverse those root causes. This begins with understanding the subtype of IBS a patient presents with.

PrimeHealth can help you resolve your IBS. Our gut experts have helped hundreds of people just like you overcome their crippling gut problems using individualized natural and medical treatments that work for your unique situation. Schedule your free consultation today!

Disclaimer: We may receive a small commission from products you purchase via links in this article.

What is IBS-D?

IBS-D is a subtype of IBS that features diarrhea, not constipation, as a primary symptom. 

This functional gastrointestinal disorder is characterized by altered gut motility, abdominal cramping, gas, changes in stool consistency, sometimes mucus in stool, and most notably, frequent diarrhea.

There are 4 subtypes of IBS:

  • IBS-D (diarrhea-predominant IBS)
  • IBS-C (constipation-predominant)
  • IBS-M (mixed, alternating between diarrhea and constipation)
  • IBS-U (undefined, symptoms vary)


Some symptoms occur with both main types of IBS (diarrhea and constipation) and some symptoms are specific to IBS-D, so we separated them into 2 bullet lists.

IBS-D symptoms that overlap with IBS-C:

  • Stomach cramping
  • Bloating
  • Gas
  • Abdominal pain
  • Nausea
  • Fatigue

Symptoms unique to IBS-D:

  • Diarrhea
  • Loose stool
  • White-ish mucus in stool
  • Frequent trips to the bathroom
  • Waking up from sleep to go to the restroom

IBS does not cause unintentional weight loss, blood in stool, low iron levels, or fever. If you experience these symptoms, you should seek medical attention right away because your condition may be more serious than IBS.

Risk Factors

The direct cause of IBS-D is unknown, but there are several potential causes and risk factors that are associated with IBS flare-ups.

Below are the risk factors that may help cause IBS-D symptoms:

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There is no one test for IBS or IBS-D. However, multiple tests can paint an accurate overall picture of your gut health.

We use many of the following diagnostic tools to develop an IBS-D diagnosis:

  • Medical history: Including a current symptom questionnaire
  • Family medical history: Including if you have family who experiences IBS
  • Physical examination: Including listening to your stomach with a stethoscope, feeling your abdomen, or a digital rectal exam
  • Blood tests: To check for celiac disease 
  • Stool tests: To check for the presence of bile acid or  infection 
  • Breath testing: To identify SIBO
  • Colonoscopy or endoscopy: To rule out colon cancer or IBD (inflammatory bowel diseases such as ulcerative colitis)
  • Imaging tests: To rule out gastrointestinal cancer or lesions 

An IBS-D diagnosis is based on the Rome IV diagnostic criteria, a standardized list of symptoms and factors that determine if someone is experiencing IBS-D.

Rome criteria for IBS-D include:

  • Abdominal pain recurring at least 1 day per week for 3 months
  • Abdominal pain that is related to changes in bowel habits or bowel function
  • More than 25% of bowel movements produce loose, watery stool (over a 3-month period)
  • Fewer than 25% of bowel movements produce hard-to-pass lumps (over a 3-month period)

You are more likely to get diagnosed with IBS than IBS-D. Look for a healthcare provider who will do everything in their power to uncover the most specific diagnosis to help you treat the root cause of your condition.

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How to Treat IBS-D

Treating IBS-D depends on your unique situation and the root cause of your IBS. But there are treatment options for all sorts of people, including diet changes, stress relief, supplements, and medication.

What are some IBS-D treatment options? Here are the best IBS-D treatment options that you should discuss with your healthcare provider:

Lifestyle Changes

Lifestyle changes such as regular exercise or avoiding stressful situations can go a long way to reduce IBS flare-ups and improve overall health.

Dietary Changes

Avoid alcohol, caffeine, artificial sweeteners, fried food, and processed foods. Try a low-FODMAP diet and drink plenty of water to resolve IBS-D symptoms. It’s wise to figure out which foods you may be allergic or sensitive to, the most common culprits being lactose and gluten.

Stress Relief

Stress cannot alone cause IBS-D, but it can worsen IBS symptoms. If you find ways to relieve stress (meditation, regular exercise, therapy, etc.), your signs of IBS-D may go away without medication. 

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Natural Supplements

When an imbalance of bad bacteria may be causing IBS-D, probiotic supplements may replace the depleted beneficial bacteria in your gut and resolve symptoms. Peppermint oil may not address the root cause of IBS, but it has been shown to significantly reduce symptoms of IBS.

Fiber supplements can also be beneficial for managing IBS-D, but it’s essential to choose the right ones. Soluble fiber is generally better tolerated for IBS-D. Consider supplements such as psyllium husk (like Metamucil), acacia fiber, or partially hydrolyzed guar gum (PHGG), as they are known to be gentle on the digestive system and can help regulate bowel movements. 

Prescription Medications

Antispasmodic drugs, such as dicyclomine (Bentyl), may be prescribed to help with IBS-D. Rifaximin is the generic form of Xifaxan, an antibiotic approved by the FDA to treat IBS-D. More recently, eluxadoline (Viberzi) was FDA-approved to treat IBS-D. 

Antidepressants may reduce pain or depression, but without treating the root cause. I avoid these treatments, as they’re associated with a large number of side effects and serious withdrawal symptoms.

Prucalopride (Motegrity) may treat SIBO (small intestine bacterial overgrowth) but is primarily for IBS-C. Talk to your doctor about potential side effects.

Over-the-Counter Medications

Loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol) are 2 over-the-counter antidiarrheal medications that doctors may recommend for IBS-D. Imodium should only be taken short-term and is not indicated for chronic conditions like IBS-D.

The most important part of treating IBS-D is identifying and addressing the root cause. If you figure out the underlying cause (through an elimination diet or formal diagnosis), you can target your treatment and save yourself the hassle and cost of ongoing medications.

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What are common triggers for IBS-D?

The most common triggers for IBS-D are gluten, dairy, caffeine, citrus, beans, drinking alcohol, stressful events, and certain carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols).

How does IBS-D affect your life?

IBS-D affects your life in multiple ways, lowering your quality of life and increasing your daily discomfort. Beyond frequent diarrhea, indirect effects of IBS-D may include lower-quality sleep, menstrual changes, sexual dysfunction, and chronic anxiety.

IBS affects up to 55 million people in the United States, according to our best estimates.

Concerned About IBS? Here’s What to Do Next.

If you’re concerned about your irritable bowel syndrome, contact your healthcare provider. Don’t be embarrassed — these medical professionals are trained to talk about bowel conditions with compassion and without judgment.

You may need to change your diet. You may need to alter your lifestyle. But it’s worth it if you can take back control of your health.

If you’re unsatisfied with conventional IBS treatments, consider an integrative doctor. At PrimeHealth, myself and other integrative specialists are ready to look at the big picture of your whole-body health and address the underlying cause of your IBS with natural and medical interventions.

Schedule your free phone consultation with PrimeHealth today! Our IBS experts in Colorado have worked with tons of patients who all have unique situations. We listen, and we involve you in the treatment planning.


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