How do I manage IBS-D and severe abdominal cramps?

Question

Hello doctor,

I am a 45-year-old male, weigh 172 pounds, and my height is 5 feet 8 inches. I have had IBS-D for about one and a half years, but recently something unusual has been happening.

Sometimes at night, around 3 am, I wake up with strong abdominal cramps and loose stool. After passing stool, the pain reduces. My blood tests and stool tests were normal earlier. I only take an antispasmodic tablet when the pain is severe.

However, the night symptoms are making me worried. Why does IBS wake me up at 3 am with cramps? Is that still typical IBS, or is it a more serious problem?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Your symptoms of recurrent loose stools with cramps relieved after bowel movement fit the pattern of irritable bowel syndrome with diarrhea predominance (IBS-D). In IBS, the bowel is structurally normal but becomes overly sensitive, and its movement can be irregular, which causes cramps, urgency, and gas.

Night-time symptoms can occur occasionally because the colon still has activity cycles even during sleep. Stress, late meals, caffeine, alcohol, or heavy food before bedtime may stimulate bowel contractions during the night and lead to cramps followed by loose stool. The fact that the pain improves after passing stool is also typical for IBS.

However, doctors pay attention to persistent diarrhea that regularly wakes a person from sleep, because that may sometimes suggest another condition, such as inflammatory bowel disease or infection.

Since your previous blood and stool tests were normal, IBS remains the most likely cause, but if night episodes become frequent or severe, it would be reasonable to review the diagnosis.

I suggest you follow these instructions for relief:

Avoid heavy or fatty meals within three to four hours of bedtime.
Reduce caffeine and alcohol.
Maintain regular sleep and meal times.
Consider dietary approaches such as a low-FODMAP (low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) plan to reduce gas-producing foods.

For your symptom control, I suggest you take medicines like Loperamide for diarrhea, or short courses of Rifaximin. I suggest you consult a specialist, talk to them, and take the medications with their consent.

If you develop warning signs such as weight loss, blood in stool, persistent night diarrhea, fever, or anemia, you should consult your gastroenterologist promptly for further evaluation.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.