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Understanding the 4 Types of Irritable Bowel Syndrome

IBS symptoms

If you have irritable bowel syndrome (IBS), you’re not alone. Some 10 to 15 percent of the adult population is thought to suffer from IBS, although many of them are not diagnosed, according to the American College of Gastroenterology.

However, not everyone has the exact same signs and symptoms. That's because there are actually four different types of IBS:

  • IBS-C (constipation)
  • IBS-D (diarrhea)
  • IBS-M (mixed, meaning you experience both constipation and diarrhea)
  • IBS-U (unclassified).

Although there's some overlap in the symptoms and treatments for each IBS type, there also are some distinguishing factors for each one.

Here’s what you should know about each type of IBS.

    IBS-C: Irritable bowel syndrome with constipation

    If you have IBS-C, you often have trouble having a bowel movement. According to the American Society for Gastrointestinal Endoscopy, IBS-C is associated with the following symptoms:

    • Infrequent bowel movements
    • Straining when you have to make a bowel movement
    • Hard or lumpy stools
    • Feeling as if you don’t completely empty your bowel
    • Needing to sometimes change your body position to complete a bowel movement

    As with other types of IBS, you will also experience stomach pain, bloating and discomfort.

      IBS-D: Irritable bowel syndrome with diarrhea

      If you have IBS-D, you have the opposite problem as someone with IBS-C. Instead of having trouble making a bowel movement, you find you need to run to the bathroom fairly frequently. According to an article published in the journal Gastroenterology in 2016, common symptoms of IBS-D include:

      • Sudden urges to pass a bowel movement
      • Loose stools
      • Frequent bowel movements
      • Nausea

      Stomach discomfort, bloating and gas are also common symptoms associated with IBS-D, according to the International Foundation for Gastrointestinal Disorders.

        IBS-M: Irritable bowel syndrome of mixed type

        If you have IBS-M (also called IBS of alternating type), you may experience both constipation and diarrhea, at different times. Frequent symptoms generally include:

        • Infrequent bowel movements
        • Straining when you have to make a bowel movement
        • Hard or lumpy stools

        Then, at other times, your symptoms may include ones that are usually part of IBS-D, such as:

        • A sudden urge to pass a bowel movement
        • Loose stools
        • Frequent bowel movements
        • Nausea

        Like with other types of IBS, abdominal discomfort, gas and bloating also are part of IBS-M.

          IBS-U: Irritable bowel syndrome unclassified

          If you have IBS-U, it’s hard to place your IBS into a specific category. IBS-U is associated with:

          • Bloating
          • Cramping
          • Gas
          • Mucus in the stool
          • Stomach pain

          However, you probably don’t have the same irregularities in your bowel habits as someone with IBS-C, IBS-D or IBS-M, according to the International Foundation for Gastrointestinal Disorders.

            Getting a diagnosis

            An accurate diagnosis of your condition is the first step toward treatment that can help improve your quality of life and reduce your symptoms. And, though symptoms vary some among the different types of IBS, the way they are diagnosed is basically the same.

            As part of the diagnosis process, your doctor will ask about your symptoms and will give you a physical exam. In addition to pain in your abdomen, other symptoms that a doctor may ask about include:

            • Pain that gets better or worse after bowel movements
            • Changes in how often you have bowel movements
            • Changes in the way your stools look

            If you have two or more of the above symptoms, your doctor may diagnose IBS. Your doctor also will consider how long you’ve had symptoms. If you’ve had your IBS-related symptoms at least once a week for three months or your symptoms started at least six months earlier, you may be diagnosed with IBS. Your doctor may also want to order some other tests, including blood work or a colonoscopy. These additional tests help to rule out other gastrointestinal disorders, such as Crohn’s disease, which is a type of inflammatory bowel disorder.

              Treating your inflammatory bowel syndrome

              Although some treatment options are beneficial for most people with IBS, other treatments will work best in people experiencing a specific symptom. Treatments include the following:

              • Medication. Some people with IBS notice symptoms improve with medication, although the type of medication prescribed will be depend on your type of IBS. For instance, in someone with IBS-D, anti-diarrheal drugs may be considered, whereas in someone with IBS-C, laxatives could be a possible treatment. According to the American College of Gastroenterology, the types of medications used to treat IBS include anti-diarrheal drugs, laxatives, antibiotics, eluxadoline (a drug that helps those with IBS-D) and drugs that work on the serotonin receptors in the gut or spinal cord.
              • Food and diet changes. Paying close attention to the foods you eat sometimes helps people realize that certain foods may trigger their IBS. A type of diet called a low-FODMAP diet helps some people with IBS because foods containing FODMAPs may be harder to digest. FODMAP is an acronym that stands for "fermentable oligosaccharides, disaccharides, monosaccharides and polyols" — fermentable short-chain carbohydrates. Examples of foods that contain FODMAPs include certain fruits, large amounts of fruit juice, dairy products, certain types of vegetables, honey and products with sweeteners ending in “-ol” such as mannitol or xylitol. A FODMAP diet can be hard to follow, so it’s best to follow the plan with help from a registered dietitian.

              Additionally, according to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), some people with IBS may find that their body has a hard time digesting gluten, which is a protein found in wheat, barley and rye. Doctors also may recommend eating more fiber if you have constipation-predominant IBS. Fiber can make your stools softer.
              Other general lifestyle changes that may help your IBS include getting enough sleep, managing stress and getting regular exercise.

              There are other treatments that may work for IBS, but they need further study, according to the American College of Gastroenterology. These include the use of probiotics, which is a type of “good” bacteria for the gut, peppermint oil and acupuncture.

                Frequently asked questions

                • Who gets IBS? Although anyone can get IBS, it's more common in women. In fact, women are twice as likely to develop it as are men. It’s also more common in people younger than 50, according to the NIDDK. Other factors that make you more likely to have IBS include having a family member with IBS, having stressful life events and having a bad infection in your gastrointestinal tract.
                • When should I see a doctor for IBS? If you have constipation or diarrhea that returns regularly and that also causes stomach discomfort or bloating, you should see a doctor. You may have IBS or another gastrointestinal disorder. It can be treated.
                • What causes IBS? It’s not entirely clear what causes IBS, according to the NIDDK. Experts know that IBS is connected to the way your brain interacts with your gut. However, the specific cause is different for different people, just like people may have different types of IBS. Problems that may be related to IBS include bacterial infections in your gastrointestinal tract, mental disorders like depression or anxiety, early physical or sexual abuse, small intestinal bacterial overgrowth and problems tolerating certain types of food. Genes also may play a role in your chance of developing IBS.
                • Is Crohn’s disease a type of IBS? It’s not. Crohn’s falls under the umbrella of inflammatory bowel disease. Crohn’s disease is an inflammation of the gastrointestinal tract, usually in the small intestine, according to the International Foundation for Gastrointestinal Disorders.
                • Is ulcerative colitis a type of IBS? No. Much like Crohn’s disease, ulcerative colitis also is a type of inflammatory bowel disease. Ulcerative colitis causes ulcers, or sores, in the lining of the large intestine.

                Article references

                1. American College of Gastroenterology. IBS FAQs. https://gi.org/topics/irritable-bowel-syndrome/#tabs3
                2. American Society for Gastrointestinal Endoscopy. Understanding IBS with constipation. https://www.asge.org/home/for-patients/patient-information/understanding-irritable-bowel-syndrome-with-constipation-ibs-c
                3. Lacy BE, et al. Bowel Disorders. Gastroenterology. May 2016. https://www.gastrojournal.org/article/S0016-5085(16)00222-5/abstract
                4. International Foundation for Gastrointestinal Disorders. IBS with diarrhea. https://www.aboutibs.org/ibs-with-diarrhea.html
                5. National Institute for Diabetes and Digestive and Kidney Diseases. Diagnosis of irritable bowel syndrome. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/diagnosis
                6. International Foundation for Gastrointestinal Disorders. Inflammatory bowel disease. https://www.iffgd.org/other-disorders/inflammatory-bowel-disease.html