💩 Talk: What You Need to Know About the 4 Types of IBS
You’ve heard of IBS. You may even be a card-carrying member of the #hotgirlshaveIBS club. But what is IBS, exactly? IBS stands for irritable bowel syndrome and it’s a common disorder that affects the large intestine. Let’s hover over the word “disorder” for a second though, because while “disease” and “disorder” are often used interchangeably in healthcare, there are some important differences that can be helpful to know here. A disease typically has a clear cause and set of symptoms—it’s measurable. Examples include the flu (infectious), psoriasis (autoimmune), and depression (mental). A disorder happens when your regular programming has been interrupted—something is obviously off, and you may experience a collection of symptoms, but it’s not as clear-cut as a disease. In the case of IBS, there is no biomarker for it, no test you can take that will say you’re positive or negative.
And that’s why women with IBS sometimes struggle to get answers. I say women because hello, this is Cosmo, but also because women are twice as likely as men to experience IBS, per the Cleveland Clinic. “The reason women have higher rates of IBS is not precisely clear but a disruption in the sex hormones will cause a change in the gut bacteria and increase inflammation, predisposing you to IBS,” says Jennifer Roelands, M.D., a board-certified OB/GYN and CEO of Well Woman MD. More on the risk factors and causes of IBS in a minute.
First, let’s go through the types. There are four main types of IBS, according to John Damianos, M.D., an internal medicine physician focusing on gastroenterology at Yale New Haven Hospital. To help you and your doctor figure out what type of IBS you’re dealing with, it can be helpful to start a “poop diary” to keep track of…the details. Ready? (Warning: We’re about to get really, really specific about 💩.)
What is IBS-D?
Here, the “D” stands for diarrhea. As a point of reference, let’s pretend a healthy stool is the consistency of a peeled banana. If you have IBS-D, you’ll notice when you look over your poop diary that more than a quarter of your stools are the consistency of a smoothie or even a glass of OJ versus that lovely banana. Less than a quarter of your stools are hard and lumpy, like bits of dried fruit or a crumbly cookie. You’ll feel frequent, pressing urges to get to a bathroom and in between visits, you’re probably feeling quite gassy. Abdominal pain is also an issue.
What is IBS-C?
The “C” stands for constipation—the opposite end of the spectrum from IBS-D. More than a quarter of your stools are hard, lumpy dried fruit bits and crumbly cookies, whereas you want them to be the consistency of that banana. You have fewer bowel movements in total—it’s like a gift when you do have to go, and even then, you may really exert yourself to get the job done. Like those with IBS-D, you are friends with abdominal pain, gas, and bloating.
What is IBS-M?
That would be category “mixed,” in that you alternate between periods of diarrhea and constipation, says Dr. Damianos. Sometimes, you’ll ping pong all within the same, super-exciting day. And you’re not excused from the standard symptoms: abdominal pain, gas, and bloating.
What is IBS-U?
The “U” stands for unspecified, which means you “don’t quite meet the criteria for D, C, or M, but you clearly have abdominal pain associated with changes in your stool,” says Dr. Damianos. Lucky you!
What are the risk factors of IBS?
Age <50
Females
Family history/genetic predisposition
Anxiety/depression/mental health issues
Poor quality of life
Dr. Roelands says one common example of poor quality of life is the SAD diet, also known as the standard American diet high in processed foods and sugar. “This diet creates a microbiome of bacteria that absorbs nutrients poorly, leading to weight gain and IBS symptoms,” she says.
And when it comes to mental health issues, “High stress or prior trauma disrupts the serotonin pathway in the brain and the gut. It also causes inflammation and disruption of the sex hormones.”
What causes IBS?
No matter what type of IBS you have, it’s difficult to identify the root cause because there are, like your friend with an undecided major, so many possibilities. But research shows some of the common factors are:
Gut-brain communication dysfunction, which can be impacted by stress and anxiety: “The brain and the gut are two sides of the same coin—biologically, they develop from the same initial cells—so if you have a problem with the brain, you're more likely to have problems in the gut, and vice versa,” says Dr. Damianos. “We see this clinically. If we look at people with psychiatric diseases, things like depression, anxiety, PTSD, and neurologic conditions like Alzheimer disease and Parkinson disease, these individuals are more likely to have GI dysfunction. Similarly, people with chronic gastrointestinal illness, things like inflammatory bowel disease (Crohn's disease and ulcerative colitis), irritable bowel syndrome, or celiac disease, are more likely to have neurologic and psychiatric issues including anxiety, depression, and PTSD.”
Prior gut infections or food poisoning: “This is known as post-infectious IBS and it can occur suddenly after a gut infection,” says Max Pitman, M.D., gastroenterologist and medical director at Salvo Health. “It’s a chronic condition that can take years to go away,” he adds, but unlike the previously mentioned types of IBS, which are determined based on your symptoms, with PI-IBS, you know the cause of your IBS.
Genetics: “Not in a direct inheritance sort of way (e.g. if my parent has IBS then I will have it too) but more generally, if IBS runs in your family, you may be more likely to develop it at some point,” says Dr. Pitman.
Other potential contributors include: Imbalances in the gut bacteria or overgrowth of bacteria in the small intestine (SIBO); changes in gut “motility” aka how fast or slow food and waste move through the digestive tract; and lastly, visceral hypersensitivity, as in sensitive nerves in the GI tract
When should I see a doctor for IBS?
If you’re experiencing symptoms for more than two weeks, it’s probably time to see a doctor. Dr. Roelands says you can make the most of your appointment by planning for questions like:
When did the pain start?
How often do you have digestive symptoms?
Do you have constipation or diarrhea typically?
How long have you been having this problem?
Does anything make your digestive symptoms better or worse?
In addition to your poop diary, Dr. Roelands also strongly recommends that patients bring a 5-day food journal. “Write down what you eat at each meal and snack, and then notice how you feel between 15 minutes and two hours later,” she says. “Take this information to your doctor to help them assess what is causing your digestive symptoms.” Once you have a diagnosis, you can then focus on possible treatments and show IBS who’s boss.
What are the possible treatments for IBS?
If you have only mild symptoms, some basic lifestyle adjustments may help: managing stress, getting enough sleep, exercising, and drinking lots of water. But we know, we know. Easier said than done.
So, if, nevertheless, your symptoms persist or get worse: Bank a couple days in your food journal and talk with your doctor about cutting down on or eliminating suspected trigger foods. Your doctor may also want you to avoid FODMAPs, gluten, and/or high-gas foods (including carbonated bevs and alcohol).
Depending on your symptoms, your doctor may also suggest:
Fiber supplements
Probiotics
Laxatives
Anti-diarrheal medications
Pain medications
Certain antidepressants
Prescriptions specifically for IBS (based on your type)
Because IBS is so closely associated with mental health issues like anxiety, depression, PTSD, and mood disorders, your doctor may also recommend therapy as part of your treatment.
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