Why has my husband lost weight with IBS-D and cramping?

Question

Hello doctor,

My husband, aged 41, has had IBS-D for two years, but in the last month, he has complained of more intense cramping pain before loose motions, almost six times a day. He feels tired and has had slight weight loss recently. Fiber supplements sometimes increase bloating instead of helping.

Are these changes still typical for IBS-D or something more serious?
Should he stop fiber completely?
Is there any safer long-term medication to control frequent flare-ups?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Your husband’s symptoms may still fit irritable bowel syndrome with diarrhea predominance (IBS-D), where abdominal cramping before bowel movements, loose stools, and symptom fluctuations are common.

However, the recent increase in frequency, fatigue, and some weight loss should be reviewed carefully because these changes can sometimes indicate another condition that may mimic IBS, such as inflammation, infection, or malabsorption.

It would be reasonable for his doctor to reassess with basic tests such as blood work, stool tests, and possibly screening for celiac disease (an auto-immune disease where one’s immune system reacts against the gluten present in one’s body, which can cause harm to one’s small intestines)or inflammation.

If symptoms persist or red-flag features develop, such as persistent weight loss, anemia (a common, usually treatable condition where blood lacks sufficient healthy red blood cells or hemoglobin, reducing oxygen transport to organs), blood in stool, or nocturnal diarrhea, further evaluation, like a colonoscopy, may be considered.

Regarding fiber, some patients with IBS-D feel worse with certain insoluble fibers because they increase gas and bloating. Instead of stopping fiber completely, he may try small amounts of soluble fiber (for example, psyllium), which is usually better tolerated.

A number of methods that are considered to be safe under medical supervision are recommended for chronic symptom management. Antispasmodic medicines used for muscle cramps, gut directed antibiotics such as Rifaximin where necessary; bile acid sequestrants; and medicines designed specifically for IBS like Eluxadoline can be suggested.

Among other suggestions may be a special type of treatment known as diet therapy involving low FODMAPs diet, which includes a restriction on eating of caffeine containing foods.

A gastroenterologist can help tailor treatment and ensure that no other condition is responsible for the recent changes in symptoms.

I hope this helped.

Please let me know if I can assist you further.

Thank you.