There’s More Than One Kind of IBS

Healthy Living

April 8, 2021

Your guts are a mess and your bathroom habits are out of whack. Could it be irritable bowel syndrome, aka IBS? Maybe. Lots of people suffer from IBS. And your recent influx of tummy troubles and less-than-pleasant bathroom trips could be signs pointing to an obvious diagnosis.

But not so fast.

IBS isn’t a single condition that affects everyone the same way. Like other health problems, it can manifest differently. Along with stomach pain, you might have diarrhea, constipation or a mix of the two. 

Treatment can help if you do have IBS, but the first step is identifying whether you have it. The next is figuring out which kind you have.

Disclaimer: as always, talk to a doctor if you have any medical concerns or questions. The following is for information only and isn’t meant to diagnose or treat any medical conditions.

Three Types of IBS

Irritable bowel syndrome (IBS) is a gastrointestinal condition. It has to do with how your brain and your stomach interact. Experts think it affects around 12% of Americans.

The three main symptoms of IBS are:

  • Bowel movements that don’t look normal;
  • Changes in how often you use the bathroom; and
  • Recurring stomach discomfort or pain

These are broad symptom categories. Specific problems vary from one patient to the next. Your main trouble could be diarrhea or constipation. It’s also possible to switch between those two issues.

And don’t think intensity necessarily means anything. Like anything else, how you experience your symptoms might differ from how someone else does. You could have mild stomach pain and still have IBS. (That’s why it’s always a good idea to check any symptoms out with a doctor.)

IBS with Diarrhea (IBS-D)

Some people with IBS have recurring diarrhea. This subset of IBS is called IBS-D.

To figure out what type of IBS you have, doctors consider what your bowel movements are like on flare-up days. Normal days don’t count towards your diagnosis.

On symptomatic IBS-D days, more than 25% of your bowel movements are loose or runny. Less than a quarter are hard and dry.

These loose bowel movements can send you to the bathroom again and again. And some of them might even contain mucus.

Researchers are still studying what causes IBS-D, but it seems that the intestine contracts more often than it should. These quick contractions push material through the gut faster than normal. As that material speeds through, your system doesn’t have time to remove much of its water content.

These rapid contractions can also give you stomach pain.

Different things can trigger a flare-up of IBS-D. These include food intolerance or an imbalance of gut bacteria. Stress and mental health disorders can also make symptoms worse. 

And while anyone can have IBS-D, young women tend to experience it more often than others.

IBS with Constipation (IBS-C)

While some people struggle with frequent diarrhea, others don’t go to the bathroom often enough. IBS with constipation is abbreviated as IBS-C.

IBS-C and IBS-D have opposite symptoms. With IBS-C, more than a quarter of your bowel movements on symptomatic days are hard and dry. Less than 25% are loose diarrhea.

If you have IBS-C, you may not have bowel movements very often. For some patients, bathroom trips happen less than three times a week. And while you’re waiting to go again, you might feel full, bloated, gassy or uncomfortable — and it’s not hard to see why.

Once you finally can go again, it may temporarily improve your symptoms. But with IBS-C, you might also feel like you’re not quite, well, done. And there could be a lingering sensation of needing to finish your business, so to speak.

How does IBS-C happen? Again, it’s how your body digests food. In cases of IBS-C, partially digested food moves slowly through the intestine. During this slow trek, your system absorbs extra water. The more water that comes out, the harder and drier your stool becomes.

You may end up with IBS-C because of your hormones or other body chemicals. It’s also possible that your gut bacteria or an infection could cause the problem, as in the case of the diarrhea variant. Or a food sensitivity might be to blame. It could even be down to your genes, too.

Mixed IBS (IBS-M)

Not every case of IBS fits neatly into these two categories. Some people flip flop between constipation and diarrhea. This can be called IBS with mixed bowel habits. It’s also known as IBS-M.

In IBS-M, more than 25% of bowel movements during flare-ups are hard and bulky and more than 25% are loose and watery.

IBS can change over time. You may start with IBS-D or IBS-C but later develop a mixed case. The opposite can happen, too.


Irritable bowel syndrome causes very real symptoms. In other words, it’s not in your head. And if you have any of the symptoms listed above — or any doubts about your gut health — check in with a doctor to see what’s what.

That said, doctors can’t look at someone’s colon to diagnose IBS. There aren’t any visible signs. They’ll usually go by symptoms and patient history to make a diagnosis.

But inflammatory bowel disease (IBD) is an entirely different situation. 

Patients with IBD have inflamed digestive systems. Doctors can see the inflammation during colonoscopies or other scans. Types of IBD include:

  • Celiac disease
  • Crohn’s disease
  • Microscopic colitis
  • Ulcerative colitis

Irritable bowel syndrome is unpleasant and painful, but it’s not usually life-threatening. Unfortunately, inflammatory bowel disease can be more serious. Cancer and perforated bowels are a few of the problems that can develop from IBD.

IBD and IBS share many overlapping symptoms. Also, some patients are affected by both conditions at the same time.

Think you have IBS? Talk to a doctor. Seriously.

We’ve said it before and we’ll emphasize it here: talk to your doctor if you have IBS symptoms. A medical professional can help you find the right diagnosis and treatment.

For one thing, your symptoms might not even point to IBS at all. Maybe there are other reasons you’re having tummy troubles these days. IBS shares symptoms with plenty of other medical issues. Rule those out just to make sure.

For instance, IBS doesn’t usually have symptoms like:

  • Fever
  • Low iron
  • Rectal bleeding
  • Unintended weight loss
  • Upset stomach, including nausea or vomiting
  • Waking up in the night for bowel movements

Also, IBS usually begins before you turn 50. If your symptoms don’t start until later, you might have a different condition. You might end up having IBD instead, for instance. 

Also, parasites or thyroid conditions can cause IBS-like symptoms. You might even find out that you have a food intolerance, even after enjoying foods in those categories for years.

Or you might have a gastrinoma. That’s a tumor in the pancreas or small intestine. Only some gastrinomas are cancerous.

Point being? Get bowel issues checked out, sooner rather than later. Not only could it prevent you from developing other issues down the road, but you may find quicker relief from problematic symptoms.

The right treatment might take time.

Even if your doctor does decide that you have IBS, your treatment might not be straightforward. You may have to go through some trial and error before landing on the plan that works for you.

You’ll probably start by adjusting your eating and drinking habits. Common suggestions include drinking more water and eating high-fiber foods.

Your doctor might also suggest trying a low FODMAP diet. This is a short-term elimination diet for figuring out which foods trigger IBS symptoms, like bloating or diarrhea. For example, some people learn that they should avoid gluten while others find garlic and onions to be particular problems.

Supplements and over-the-counter medications might help alleviate symptoms, but ask about them first before making any assumptions. You may be able to get enough fiber from foods. Or you might need some help in the form of the OTC variety.

Prescription medications may be an option, too. The type will depend on your symptoms. Alosetron and ifaximin are sometimes used to tame diarrhea. Linaclotide and lubiprostone can provide constipation relief. And, weird as it might sound, some antidepressants can also reduce IBS symptoms.

Medical care is especially important for people with IBS-M. It can complicate treatment since both bowel extremes have to be addressed. You don’t want to make one problem worse while fixing the other. With a doctor’s help, you can search for a treatment plan that strikes the right balance. It may take time, but it’s worth the effort.