How can I manage alternating constipation and diarrhea?

Question

Hello doctor,

I am 35 and have been dealing with unpredictable bowel movements some days, it is constipation, and other days it is urgent loose stools. My colonoscopy was normal, and they called it IBS-M. I have tried the FODMAP diet and Peppermint Oil, but my bloating and discomfort continue, especially after stress or certain foods.

Are there any medications that help with both types of symptoms?
How do I know if this is truly IBS or something else, like SIBO?
Can you explain in simple words what causes this imbalance in the gut?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

What you are describing sounds like irritable bowel syndrome mixed type (IBS-M), where the bowel switches between constipation and diarrhea. It is very common and can be triggered by stress, certain foods, or gut sensitivity, even if tests like a colonoscopy are normal.

Sometimes the gut nerves become too reactive, and the balance of bacteria gets off, which is why you feel bloated or uncomfortable even after eating.

You are already doing well with the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (FODMAP diet) and Peppermint oil.

But since symptoms continue, I would suggest:

Ask your doctor about small intestinal bacterial overgrowth testing (SIBO testing) (a breath test).
Consider a short course of Rifaximin if small intestinal bacterial overgrowth (SIBO) is suspected.
Low-dose medications like Amitriptyline can also calm gut nerves.

Irritable bowel syndrome (IBS) is tough, but with the right support, it can get much better. You are not alone. Let us take it one step at a time.

Please follow up in three to four weeks or sooner if:

Your symptoms worsen or become more frequent.
Complete a breath test for small intestinal bacterial overgrowth (SIBO).
Have you tried any new medications or supplements?

If your symptoms persist despite dietary measures, testing for small intestinal bacterial overgrowth (SIBO) or starting a medication trial (like Rifaximin or a gut-directed neuromodulator) may help guide the next steps.

For further queries, you can consult me at iCliniq.

Thank you.