Many people with IBS suffer from diarrhoea caused by irritation in the lining of the bowel. This can be perhaps the most challenging and embarrassing of IBS symptoms, as often you will need to use the toilet urgently and without much warning. Once your doctor has ruled out other possible causes of your diarrhoea, such as inflammatory bowel disease and bacterial or parasitic infection, they will need to manage your diarrhoea to minimise inconvenience to you, as well as possible damage to your bowels and side-effects from dehydration.
Removing Dietary Triggers
The first step in controlling diarrhoea is identifying the triggers, which can quite commonly be certain types of foods or drinks. Common dietary triggers include:
- fizzy drinks
- artificial sweeteners
By keeping a food and toilet diary, and possibly eliminating these foods/drinks and reintroducing one-by-one you should be able to identify those that worsen symptoms for you specifically. If diarrhoea is one your main symptoms, it’s likely that your doctor will want to test you for lactose and wheat intolerances to ensure your IBS diagnosis is correct.
Over the Counter Remedies
There are many over the counter remedies for diarrhoea. Loperamide (Imodium) is amongst the most effective of these. Loperamide acts on the muscles in the bowel, causing them to relax and slowing the passage of the stool. This not only reduces the frequency of the bowel movements, it also allows more time for water to be absorbed from the stool, firming it up.
Other drugs that act by relaxing the bowel (antispasmodics) include dicyclomine (Bentyl), hyoscyamine (Levsin) and hyoscine butylbromide (Buscopan). They are all usually taken before or with meals to relax the bowel and prevent diarrhoea and cramping.
Your doctor might also want to prescribe medicines for your diarrhoea.
One of the most exciting new treatments in this area is the drug rifaximin. Rifaximin is actually an antibiotic, which is not absorbed into the body. It works directly on the gut. It has recently been shown to be effective in relieving diarrhoea in IBS patients. An increase in intestinal bacteria is common in IBS sufferers and leads to inflammation; treatment with this antibiotic can restore the balance of bacteria in your gut, reducing irritation.
Many patients given a 10 day course of rifaximin have actually reported a complete cure of their symptoms. In fact, rifaximin was the subject of a paper in the top medical journal New England Journal of Medicine showing that it was very successful in correctly identified patients with diarrhoea predominant IBS. That has certainly been our experience also.
Dehydration is a common side effect of diarrhoea, particularly if the weather is warm. So, as well as treating the diarrhoea itself, it is important that you also remain well hydrated by drinking plenty of water, and keep your electrolytes topped up by taking replacement supplements such as Dioralyte drinks or sachets.