How to manage the symptoms of IBS-D at 41?

Question

Hello doctor,

I am 41 and have been suffering from IBS-D for almost eight years, but it has gotten so much worse over the last six months. I have explosive diarrhea six to eight times daily without warning, which has made it impossible to leave my house. The cramping pain in my lower abdomen is so severe that it wakes me up at night and doubles me over during the day.

I have tried Loperamide, Dicyclomine, and even Eluxadoline, but nothing controls the symptoms for more than a few hours. My gastroenterologist did a colonoscopy last month, which showed no signs of IBD or celiac disease, and just confirmed the IBS-D diagnosis. Blood tests showed normal CRP and no signs of infection.

I have lost 17 pounds because I am afraid to eat anything. Even drinking water sometimes triggers an episode. The anxiety about having an accident in public has led to panic attacks, where my heart races and I can not breathe. I tried the FODMAP diet for six weeks with no improvement, and the latest prescription of Rifaximin did not help either.

My doctor mentioned something about bile acid malabsorption because I had my gallbladder removed three years ago. Yesterday I had blood in my stool for the first time, which terrified me. Could this still be just IBS-D, or is something more serious going on? How do I manage these symptoms when all the standard treatments are not working? The constant diarrhea has completely taken over my life.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I do not think that you have any serious illness like IBS-D (inflammatory bowel syndrome with diarrhea) or cancer, given the fact that you had a normal Colonoscopy almost a week before. IBS can be very serious and can cause frustration, including uncontrollable bowel movements with cramps.

If an IBS did not get better with conventional medications, we always consider giving medications that control the symptoms besides controlling the underlying mechanisms that cause IBS.

I recommend you take the following medication for one week and see me after one week, and let me know if that helps your symptoms. I also want you to avoid foods that are gassy and high in carbohydrates.

The particular list of foods that you should avoid is available online, named FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). Some foods are high in carbohydrates and are called high-FODMAP foods, and there are foods that are low in carbohydrates and are called low-FODMAP foods. You should consider taking a low-carb diet to decrease the symptoms of IBS diarrhea.

Tablet Rifixamin 550 mg, three times daily.
Tablet Anafortan (Phloroglucinol), three times daily.
Ispagol husk two tablespoons full with water daily.
Avoid the high FODMAPs diet.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.