My wife has IBS with severe diarrhea. What diet to take?

Question

Hello doctor,

My wife is 31 and was diagnosed with IBS-D last year after a normal colonoscopy. She has severe bloating, gas, and sudden loose stools, especially after eating outside food. She is currently taking Dicyclomine and peppermint oil capsules with partial relief.

Can hormonal changes worsen IBS-D symptoms?
She notices flares around periods. Should she avoid dairy and gluten completely or only during flares?

Also, are antidepressants really used for gut problems, because one doctor mentioned low-dose Amitriptyline, and we are unsure about side effects or long-term use.

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your wife’s symptoms are consistent with irritable bowel syndrome with diarrhea predominance (IBS D).

Bloating, gas, and loose stools after certain foods are common in IBS, especially when the intestines are more sensitive to dietary triggers. Hormonal changes can definitely influence IBS symptoms.

Many women notice worsening abdominal pain, bloating, or diarrhea around menstruation because estrogen and progesterone affect gut motility and sensitivity. This pattern is well recognized in IBS.

Regarding diet, it is usually not necessary to permanently eliminate dairy or gluten unless a specific intolerance is confirmed. Instead, it is better to identify personal triggers.

Some patients benefit from reducing lactose or following a low-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet trial, which targets fermentable carbohydrates that can worsen gas and diarrhea.

Outside restaurant food may contain high-fat or high-FODMAP ingredients that trigger symptoms.

Medications such as Dicyclomine and peppermint oil help by reducing intestinal spasms. In patients with persistent symptoms, doctors sometimes prescribe low-dose antidepressants such as Amitriptyline.

These are used not primarily for depression, but because they help regulate the gut–brain axis, reduce pain sensitivity, and slow bowel motility. At low doses, they are generally well tolerated, though possible side effects include dry mouth, mild drowsiness, or constipation.

If symptoms continue to affect quality of life, combining dietary adjustments, stress management, and carefully selected medications can significantly improve control of IBS-D. Regular follow-up with a gastroenterologist will help tailor treatment to her specific triggers and symptoms.

I hope this helps.

Thank you.