Imagine this: You’re out for dinner with friends, finally enjoying a well-deserved night out which doesn’t happen too often. As you dig into your meal, a familiar discomfort starts to stir in your stomach, and soon you’re racing to the restroom, feeling the all-too-frequent urgency that comes with IBS-diarrhoea (IBS-D).
It’s not just an embarrassing moment; you feel the overwhelm of desperately trying everything to manage your symptoms for a long time. You thought you had it under control (finally) but once again it seems not to be the case.
Unfortunately this is the reality for those suffering with IBS diarrhoea. And I don’t mean the occasional bout that happens to us all, more so those who live with the daily apprehension of living with this condition.
I know from many years of helping clients with gut and digestive health issues just how absolutely awful IBS-D can be.
The unpredictability of IBS-D is perhaps the most challenging part. The sudden urgency, cramping, and discomfort create a constant anxiety about when the next flare-up will occur and whether you’ll make it to a bathroom in time. This daily uncertainty can turn every day into a guessing game: Will today be a “good” day or a “bad” one? The relentless worry and disruption can be exhausting, making it difficult to enjoy life without the shadow of IBS-D looming over you.
Simple things that others take for granted, like going out for lunch with friends or even to the shops become sources of immense stress. Is there a toilet nearby? What if I eat something that triggers my symptoms? These are questions that run through your mind every time you step out of the house.
Socialising can become increasingly difficult. I know many clients who have had to cancel plans last minute because of a sudden flare-up or opt out of social gatherings altogether.
I have had clients who avoid long car or bus journeys, who can’t eat if they need to go somewhere in the morning or who have had to cancel plans because of an accident to do with their condition.
Many are embarrassed and choose to suffer in silence. Not everyone is super comfortable talking about bowel movements and it can be hard and frustrating to explain having IBS-D to someone who isn’t affected by it or who doesn’t understand the problem. It can be mentally and physically exhausting.
In all my years of helping people with this condition, I still find it hard to believe how common it is and how little help there is out there for it. The struggle with IBS-D is compounded by a lack of effective, personalised solutions, leaving many feeling frustrated and unsupported. Let’s look at what exactly IBS-D is and some possible factors that can contribute to its complexity.
What are the main causes of IBS-D?
IBS-D is a subtype of Irritable Bowel Syndrome (IBS). It involves frequent, loose bowel movements, urgency, abdominal pain, and bloating. This condition is linked to a dysregulation in the connection between the gut and the brain. Additionally, it features visceral hypersensitivity, where the nerves in the gut are more sensitive than usual. This increased sensitivity can cause pain even with basic processes like digesting food. IBS-D also involves disordered motility, meaning the muscular movement of the intestines can be too fast.
Imbalances in the gut microbiota
Our gut is home to trillions of bacteria and other microorganisms that play a crucial role in maintaining digestive health and supporting immune function. A healthy balance of these microorganisms, often referred to as the gut microbiota, is essential for proper digestion and nutrient absorption. However, when this balance is disrupted—due to factors like poor diet, antibiotic use, stress, or illness—it can lead to an overgrowth of harmful bacteria and a decrease in beneficial bacteria. Such imbalances can trigger or exacerbate symptoms of IBS-D, including frequent diarrhoea, abdominal pain, and bloating. Research suggests that these imbalances may alter gut motility and increase gut sensitivity, contributing to the overall discomfort and unpredictability experienced by those with IBS-D.
Role of Probiotics
Since the gut microbiota is so influential, many people consider taking probiotics to help restore balance. However, not all probiotics are equal, and they do not work the same way for everyone with IBS-D. The effectiveness of a probiotic can depend on the specific strain and dosage, making it important to choose the right one for individual needs. It’s always a good idea to work with a professional to determine the best approach. For example, Alflorex is a probiotic often recommended for IBS, and while some studfies show promising results, I haven’t found it to be particularly effective in my practice for those with IBS-D.
Stress
This one is a double-edged sword! When you’re dealing with IBS-D, the stress of managing your symptoms can be overwhelming, and ironically, that stress can make your symptoms even worse. It’s a vicious cycle where anxiety about potential flare-ups can lead to increased gut sensitivity and more frequent bowel movements. Stress affects the gut through the gut-brain axis, a complex communication network that links your emotional and cognitive centres in the brain with peripheral intestinal functions. When you’re stressed, your body releases stress hormones like cortisol, which can affect gut motility, increase inflammation, and alter the balance of gut bacteria. This connection between the gut and the brain is incredibly powerful and particularly pronounced in IBS-D. Managing stress effectively is crucial because, without it, even minor stressors can trigger significant digestive distress, amplifying the challenges of living with IBS-D.
Food sensitivities
A few common sensitivities include high FODMAP foods, wheat, dairy, lactose, and gluten.
High FODMAP foods are short-chain carbohydrates that for some people are poorly absorbed in the small intestine. When they reach the colon, they are fermented by gut bacteria, leading to gas production and water retention, which can trigger diarrhoea and other IBS symptoms.
They include beans and lentils, cabbage, cauliflower, onions, garlic, some artificial sweeteners, apples, honey, wheat and lactose. Many of these are super healthy foods and having to remove them can be so difficult without the proper support. In my experience about half of clients with IBS-D are reactive to some of the high FODMAP foods.
Lactose is the ‘sugar’ in dairy products. Some people lack the enzyme lactase needed to properly digest lactose which can lead to bloating and diarrhoea.
Gluten is the protein found in wheat, barley and rye. If you have NCGS (non-coeliac gluten sensitivity) then eating gluten will exacerbate IBS-D symptoms.
A food and symptom diary can be helpful, although it can sometimes be challenging to pinpoint patterns between what you eat and your symptoms. It's not always a case of eating a particular food and then feeling the effects straight away; symptoms can develop gradually. However, over time, you may notice correlations between certain foods or meals and your symptoms.
While certain foods can sometimes cause problems for those with IBS-D, it’s important to remember that avoiding these foods doesn’t have to be permanent. Our aim is always to identify the possible triggers and manage them effectively, with the goal of reintroducing those foods later on. For instance, one of my clients with IBS-D was recently able to reintroduce garlic and onions—foods that were clear triggers for her—after we worked together on a personalised gut health plan for four months. With the right approach, it’s often possible to expand your diet over time and enjoy a wider variety of foods again.
Hormonal fluctuations
Many women find that their IBS-D symptoms worsen at certain times of their menstrual cycle, particularly just before or during the first few days of their period. This is likely due to hormonal changes that occur at this time, specifically the decrease in progesterone and the surge in prostaglandins. As progesterone levels drop, the muscles in the gastrointestinal tract can become more active, potentially leading to increased bowel movements and diarrhoea. At the same time, a surge in prostaglandins—hormone-like substances that help the uterus contract—can also affect the digestive system. Prostaglandins can increase muscle contractions in the intestines, leading to cramping and more frequent, looser stools. For women with IBS-D, these hormonal fluctuations can make symptoms worse, making this time of the menstrual cycle particularly challenging.
4 essential tips to begin managing IBS-D effectively
1. Focus on the main trigger foods
A first point of call would be to look at the overall diet.
Is it based on a largely unprocessed wholefood diet?
Are there any obvious triggers such as coffee, spicy foods, alcohol or high fat foods like fish and chips or very creamy sauces?
What about high histamine foods? Histamine intolerance can cause gut symptoms such as diarrhoea, reflux and bloating. High histamine foods include cured meats, smoked foods, tinned fish, wine, aged cheese and fermented foods like kefir and yogurt.
If you have environmental allergies, migraines or hives/skin rashes then you may have an overload of histamine in the body. For more info on histamine intolerance see our previous blog post Your Hormones & Histamine Intolerance.
Again, keeping a food diary to help identify patterns will help your Nutritional Therapist to develop a dietary plan that will help determine the root cause and alleviate symptoms. Often, the triggers can be unexpected or difficult to identify on your own, which is why working with a professional is so essential to achieving lasting relief.
2. Are you taking Medications or supplements?
Diarrhoea can be a side effect of some medications including antibiotics, Metformin (used to treat type 2 diabetes), some SSRI’s and PPI’s such as Esomeprazole or Lansoprazole. Laxatives, when taken in excessive amounts or used too frequently, can cause diarrhoea because they either speed up intestinal transit or draw too much water into the intestines. This can lead to the stool becoming too loose or watery.
I can recall one client some years back who was taking a magnesium powder. Magnesium is one of my favourite minerals but this particular magnesium was in citrate form and magnesium citrate is known to stimulate a bowel movement. This of course is good news if you are constipated, bad news if you aren’t. This was very quickly identified during our session and she removed the magnesium from her diet, problem solved!
If only it was always so easy to fix! Not all cases are straightforward, but taking a holistic view of your diet and lifestyle can reveal potential triggers that may otherwise be overlooked.
3. Mindful Eating
How you eat can be just as important as what you eat. Mindful eating involves paying attention to the experience of eating and recognising your body’s hunger and fullness cues.
Eating slowly and chewing thoroughly really does help to improve the digestive process and can reduce the likelihood of triggering IBS-D symptoms by ensuring that food is broken down properly. This allows for better absorption of nutrients and minimising stress on the digestive tract.
4. Stress Management
Chronic stress and anxiety can exacerbate IBS-D symptoms by affecting gut motility and sensitivity. Stress is a huge hindrance to health as we know but telling someone to manage stress better rarely helps. However by helping them to understand their stressors and to implement strategies that they can actually manage to do and want to do will work so much better.
The Importance of Personalised Support
As a nutritional therapist and health coach, my goal is to help you navigate the complexities of IBS-D with a personalised approach. What works for one person may not work for another, everyone is different even when they have similar symptoms.
How we approach IBS-D with clients
Health History – first we do a comprehensive health and symptom intake and look closely at your current diet and lifestyle. We gather information about your medical history, family history, and any previous diagnoses or treatments.
Symptom Diary – we encourage our clients to keep a diary of their IBS-D symptoms, to help to find any potential triggers (e.g. stress, food choices). This helps in identifying patterns and correlations between diet and symptoms.
Personalised Nutrition Plan – we get to know you, your eating routine and the types of foods that you like and dislike so that we can create personalised meal plans for you to support your gut and overall health.
Supplementation – we evaluate the potential need for supplements based on specific symptoms and needs. This may include prebiotics, probiotics, enzymes amongst others, all of which are evidence based and for the shorter term, often 12 weeks. If you are on the correct supplement for you then you won’t need to be on it long term.
Lifestyle modifications – we help you to identify lifestyle factors that aren’t serving you well such as staying up too late or eating too fast. Additionally we assist you in making long-term changes to benefit your health such as better managing stress or incorporating exercise into your week.
Education on gut health – understanding what is going in their gut is so helpful for clients and it gives a sense of empowerment and motivation. We love to help explain what is going on in your digestive system and how food, lifestyle and supplementation can influence it.
Support and accountability – we continuously monitor your progress, discussing any challenges and making necessary adjustments throughout your programme. Regular check-ins and online food journal reviews help keep you motivated and engaged, ensuring that you stay on track and achieve your health goals.
Navigating life with IBS-D can feel like a relentless challenge, marked by unpredictable symptoms and the vigilance required to manage them. From social anxiety to the stress of flare-ups, it’s easy to feel overwhelmed. However, there is hope.
IBS-D is complex, with triggers ranging from hormonal fluctuations and food sensitivities to stress and gut imbalances. Addressing this condition effectively involves more than just symptom management; it requires a personalised approach.
Detailed symptom tracking, dietary adjustments, and stress management can help you regain control. Working with a knowledgeable nutritional therapist can uncover personal triggers and facilitate meaningful changes. Professional guidance is crucial for transforming your daily experience and improving your quality of life. You don’t have to face this alone—personalised support can make all the difference in managing IBS-D.
If you would like more information about how we help clients improve their gut-health and manage conditions such as IBS-D get in touch today for a free no obligation health review!
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