How can my dad manage his IBS-D at age 55?

Question

Hello doctor,

My father, 55 years of age, has been experiencing recurrent diarrhea and abdominal cramps for almost a year. After several normal test results, the gastroenterologist suggested that it is likely IBS-D. Recently, he has started avoiding many foods because he believes that almost everything triggers his symptoms. This has severely limited his diet, and he sometimes feels weak.

He often wakes up early in the morning with an urgent need to pass stool, which disrupts his sleep. Could IBS-D cause such early-morning episodes, or should we consider other gastrointestinal conditions?

Additionally, are there specific medications that can help reduce stool frequency without causing constipation? We are trying to find a balanced treatment plan.

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you so much for sharing your concern with me.

Your father’s symptoms are consistent with irritable bowel syndrome with diarrhea predominance (IBS-D), especially since investigations have been normal. IBS-D commonly causes recurrent loose stools, abdominal cramps, and urgency that improves after passing stool. Many patients also develop food anxiety and begin avoiding multiple foods, which can lead to fatigue or poor nutrition.

Early-morning bowel urgency can occur in IBS because the colon naturally becomes active after waking (the gastrocolic reflex). However, if diarrhea regularly wakes someone from sleep, or is associated with weight loss, blood in stool, fever, or anemia, doctors usually reassess to exclude other conditions such as inflammatory bowel disease or infection. If these warning signs are absent and tests are normal, IBS-D remains a likely explanation.

Diet should not become overly restrictive. Instead of avoiding many foods, it is better to identify specific triggers. Common ones include caffeine, fatty foods, artificial sweeteners, alcohol, and sometimes lactose. A structured low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet guided by a dietitian can help identify triggers without causing nutritional imbalance.

For medication, several options can reduce stool frequency while avoiding severe constipation. Loperamide is commonly used to control urgency and frequency when needed. In some patients, doctors may prescribe Rifaximin, which can help modify gut bacteria and improve IBS-D symptoms.

Stress management, regular meals, good sleep, and physical activity also play an important role because the gut and brain are closely connected. With a combination of a balanced diet, lifestyle changes, and targeted medication, most patients achieve better control of IBS-D symptoms while maintaining proper nutrition and daily comfort.

I hope this helps you.

Thank you.

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