Irritable Bowel Syndrome with Diarrhea

In a previous page on this site irritable bowel syndrome with constipation or IBS – C as the dominant symptom was described. Many patients have the syndrome with both diarrhea and constipation and some only with diarrhea. IBS is a very common complaint causing loss of work and high costs.

Both forms of IBS are a common cause for anorectal complaints. Both can result in the formation of hemorrhoids and anal fissures.

People with IBS are often suffering from anxiety and stress that may reflect an oversensitive communication between the central nervous system and the bowel. It sometimes can follow severe gastrointestinal infections.

The diagnosis of irritable bowel syndrome is based principally on the patient's history since there are no specific tests available. Patients with irritable bowel syndrome with the dominant symptom of diarrhea or IBS – D often complain of bloating and cramps, having more than 3 to 4 loose stools per day for more than four weeks, a sense of urgency and then incomplete evacuation and the passage of mucus with flatus.

Patients with lactose intolerance may also have diarrhea, bloating and cramps after eating foods containing lactose. Many other foods can be responsible for gas and bloat and diarrhea and these can be sequentially eliminated. Increasing the fiber in the diet can bulk the stools for a more solid consistency.

A first-line of treatment may be Kaopectate or Pepto-Bismol.

Over-the-counter medications may be effective. Anti-spasmodics including Bentyl or Levsin may be helpful. Antidepressants when appropriate have been prescribed. Lomotiland Imodium helps slow the passage of the stool through the bowel. Anti-anxiety medication may be indicated.

Some suggest that patients with IBS may have an alteration in the gastrointestinal flora. Specifically, findings suggest that patients with IBS have excessive bacteria in the small bowel, referred to as bacterial overgrowth. Therefore there may be benefits of antibiotic-based therapies for IBS. Rifaximin is a nonabsorbable antibiotic that demonstrates no clinically relevant bacterial resistance. Some studies have demonstrated the efficacy and durable improvement of IBS symptoms after treatment with rifaximin. 

It is important to discover in the evaluation of the patient presenting with either hemorrhoids or fissures whether IBS may play a factor. If so it needs to be addressed rather than just focus on the symptoms that will persist or recur if the IBS is not controlled.

Dr. Shapiro is experienced in the treatment of patients with IBS and understands its relationship to many anorectal problems. His office, the Hemorrhoid Treatment Center of Florida, treats patients throughout Tampa Bay, including Clearwater, and St. Petersburg, and all surrounding areas.

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