IBS-M: Understanding the Mixed Type of Irritable Bowel Syndrome

Living with Irritable Bowel Syndrome (IBS) can be a daily struggle filled with discomfort and uncertainty. IBS is a common digestive disorder that causes symptoms like stomach pain, bloating, and unpredictable bowel habits, which can disrupt your routine and affect your well-being. 

IBS isn’t the same for everyone. There are different types including IBS-C, where constipation is the main issue, IBS-D, which involves frequent diarrhea, IBS-M, the mixed type that combines both constipation and diarrhea,  and IBS-U (unclassified). 

This article will guide you through understanding IBS-M. We’ll break down what it is, how it’s diagnosed, and the steps you can take to manage it effectively, to help you regain control and live more comfortably.

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What is IBS-M?

IBS-M, or Irritable Bowel Syndrome-Mixed, involves both constipation and diarrhea, with symptoms that can alternate unpredictably. This variability makes IBS-M distinct from other IBS subtypes like IBS-C (constipation-predominant) and IBS-D (diarrhea-predominant). 

While IBS-C is marked by infrequent, hard stools, and IBS-D involves frequent, loose stools, IBS-M includes both, making it challenging to manage.

Traditional treatments targeting just constipation or diarrhea may not be effective for IBS-M and could even worsen symptoms. For example, increasing fiber may help constipation but trigger more diarrhea, while anti-diarrheal medications could lead to more constipation. 

Managing IBS-M often requires a personalized approach focused on balanced dietary adjustments, stress management, and tailored medication use.

Symptoms of IBS-M

People with IBS-M experience a range of symptoms, most commonly the following:

• Constipation: This involves having infrequent bowel movements, often with hard, dry stools that can be difficult to pass.

• Diarrhea: This is the opposite problem, where stools are loose, watery, and you might feel an urgent need to go to the bathroom.

• Abdominal Pain: Many people with IBS-M feel pain or discomfort in their abdomen. This pain can come and go and is often linked to bowel movements.

• Bloating and gas: Many patients with IBS-M report feelings of bloating, gas, and abdominal distension, which can be both uncomfortable and embarrassing.

The symptom patterns in IBS-M are often unpredictable. Some patients may have several days of constipation followed by sudden diarrhea, while others might experience both within the same day. This variability adds to the challenge of managing the condition.

The severity and frequency of symptoms can also differ, with some experiencing mild, occasional flare-ups and others facing persistent, severe symptoms that disrupt daily life.

The unpredictability of IBS-M can make planning difficult. Not knowing whether you'll face constipation, diarrhea, or both, can make everyday tasks like running errands or attending meetings feel overwhelming.

IBS-M symptoms can also affect work, as frequent bathroom breaks or discomfort might hinder your focus. Social activities become challenging too, as the fear of sudden symptoms or needing a bathroom can lead to avoiding outings or limiting social interactions.

Causes and Triggers of IBS-M

The exact cause of IBS-M isn’t fully understood, but several factors are believed to contribute to its development:

• Gut-Brain Interaction: one of the key factors of IBS is the gut-brain communication. In people with IBS-M, this communication might be disrupted, leading to abnormal bowel movements and pain [26., 29.].

• Stress: stress plays a significant role in IBS-M. When you're stressed, your body produces chemicals that affect how your intestines function, which can worsen symptoms.

• Diet: certain foods can trigger symptoms, and some people with IBS-M might be more sensitive to specific foods, like those high in fat or certain carbohydrates.

• Genetics: There’s also some evidence that IBS-M can run in families, suggesting that genetics might play a role.

Common Triggers

While the causes of IBS-M are complex, several common triggers can make symptoms worse:

• Certain Foods: foods that are high in fat, spicy foods, dairy products, and certain types of carbohydrates (like those found in beans, lentils, and some fruits) can trigger symptoms in people with IBS-M.

• Stress: emotional stress or anxiety can trigger or worsen symptoms. Stress management techniques like relaxation exercises can sometimes help reduce symptom flare-ups.

• Hormonal Changes: some people notice that their IBS-M symptoms worsen during their menstrual cycle or in early menopause, suggesting that hormones might also play a role.

• Medications: certain medications, especially those that affect the digestive system, can trigger symptoms [43., 48.]. It’s important to talk to your healthcare provider about any medications you’re taking to ensure they are not contributing to your symptoms.

The Role of Gut Microbiota

Your gut is home to trillions of bacteria, known as gut microbiota, which play a crucial role in digestion and overall health. 

In people with IBS-M, there may be an imbalance in these gut bacteria, which can contribute to symptoms. When the balance of these bacteria is disrupted, it can lead to inflammation, altered gut motility, and increased sensitivity, all of which are associated with IBS symptoms.

In IBS-M, specific patterns of gut bacteria may be linked to the alternating symptoms of constipation and diarrhea. For example, an overgrowth of certain types of bacteria may contribute to diarrhea, while a lack of beneficial bacteria could be associated with constipation. 

‍Probiotics, which are supplements containing beneficial bacteria, may help restore a healthy balance of gut microbiota and alleviate some symptoms of IBS-M.

Diagnosing IBS-M

The diagnosis of IBS-M (Irritable Bowel Syndrome with mixed bowel habits) is primarily based on the Rome IV criteria. These criteria are used to identify functional gastrointestinal disorders, including IBS, by focusing on symptom patterns rather than specific test results. 

For IBS-M, the Rome IV criteria require the presence of recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following:

• Pain related to defecation

• Change in stool frequency

• Change in stool form (appearance)

In the case of IBS-M, patients experience a mix of both constipation and diarrhea, distinguishing it from other IBS subtypes.

Differential Diagnosis

Given the overlapping symptoms between IBS-M and other gastrointestinal disorders, it is crucial to rule out conditions with similar presentations before confirming a diagnosis of IBS-M. 

Some conditions that may mimic IBS-M include:

Inflammatory Bowel Disease (IBD): this includes Crohn's disease and ulcerative colitis, both of which cause inflammation in the digestive tract and can lead to symptoms like diarrhea, abdominal pain, and weight loss. Unlike IBS-M, IBD can cause significant damage to the intestines and is often associated with blood in the stool.

Celiac Disease: celiac disease is an autoimmune disorder where ingestion of gluten leads to damage in the small intestine, causing symptoms like diarrhea, weight loss, and malnutrition. Celiac disease can be differentiated from IBS-M through specific blood tests and biopsy.

Infections or Parasites: certain infections or parasitic infestations can cause symptoms similar to IBS-M, including alternating diarrhea and constipation. These conditions often require stool tests for proper diagnosis.

Lactose Intolerance: Difficulty digesting lactose can lead to bloating, diarrhea, and abdominal pain, which may be mistaken for IBS-M. A hydrogen breath test can help diagnose lactose intolerance.

Tests and Procedures

To diagnose IBS-M, healthcare providers may recommend several tests and procedures to rule out other conditions and confirm the diagnosis:

• Stool Tests: These tests can help detect infections, parasites, or blood in the stool, which could indicate a condition other than IBS. Stool tests are particularly useful in ruling out IBD and infections. Here are some examples offered through Rupa Health:

• Comprehensive Stool Analysis - Access Med Labs

• GI-MAP + Zonulin - Diagnostic Solutions

• Calprotectin - Diagnostic Solutions

• Blood Tests: Blood tests can be used to check for anemia, inflammation, and celiac disease. Elevated inflammatory markers may suggest IBD, while specific antibodies could indicate celiac disease. Examples offered through Rupa Health are:

• Complete Blood Count - Boston Heart Diagnostics

• High Sensitivity C-Reactive Protein (hsCRP) -  ZRT Laboratory

• Celiac Disease Evaluation - Access Labcorp Draw

• Colonoscopy: A colonoscopy involves inserting a flexible tube with a camera into the colon to examine the lining for signs of inflammation, polyps, or other abnormalities. This procedure is particularly important if there are red flags such as unexplained weight loss, rectal bleeding, or a family history of colorectal cancer.

• Lactose Intolerance Tests: If lactose intolerance is suspected, a hydrogen breath test may be performed to confirm the diagnosis. Here are some examples offered through Rupa Health:

• Lactose Intolerance Breath Test - Aerodiagnostics LLC

• Lactose Malabsorption Breath Test - Commonwealth Diagnostics International, Inc.

Treatment Options for IBS-M

Many treatment options are available for IBS including diet, lifestyle, and medications. It is essential to work with a healthcare provider to create the best treatment plan for your unique presentation, particularly if you have been diagnosed with IBS-M.

Dietary Management

One of the most effective ways to manage IBS-M is through dietary changes. Identifying foods that trigger symptoms such as bloating, constipation, or diarrhea is crucial. 

Keeping a food diary can help you track what you eat and how it affects your symptoms. Once you identify your trigger foods, avoiding them can reduce the frequency and severity of symptoms.

The low FODMAP diet is a popular approach for managing IBS symptoms. FODMAPs are certain types of carbohydrates that can be hard to digest and may trigger IBS symptoms. 

The low FODMAP diet involves temporarily eliminating high-FODMAP foods (like certain fruits, vegetables, and dairy products) and then gradually reintroducing them to see which ones cause problems. Many people with IBS-M find that this diet helps reduce their symptoms.

Medications

In some cases, doctors may prescribe medications to help manage the symptoms of IBS-M:

• Antispasmodics: these help relieve gut spasms and cramps, such as dicyclomine and hyoscyamine.

• Laxatives: used to manage constipation, these medications help regulate bowel movements.

• Antidiarrheal Agents: medications like loperamide can help control diarrhea by slowing intestinal transit.

• Antidepressants: low-dose antidepressants may be used to reduce pain and improve gut motility.

Stress Management

Stress is a known trigger for IBS-M symptoms, so managing stress is an important part of treatment. Stress can affect how your gut functions, leading to more frequent or severe symptoms. 

Strategies for managing stress include practicing mindfulness techniques such as meditation or deep breathing, and activities like yoga, progressive muscle relaxation, and gentle exercise.

Probiotics and Supplements

Probiotics are beneficial bacteria that can help restore balance in your gut microbiota, which might be disrupted in people with IBS-M. Taking a probiotic supplement or eating probiotic-rich foods like yogurt can sometimes help reduce symptoms like bloating and irregular bowel movements. 

Other supplements such as fiber supplements may be recommended to help manage constipation or diarrhea.

Behavioral Therapies

Behavioral therapies are another option for managing IBS-M symptoms, particularly when stress and anxiety play a significant role. 

Cognitive Behavioral Therapy (CBT) is a type of therapy that helps you change negative thought patterns and behaviors that may be contributing to your symptoms. It has been shown to be effective in reducing the severity of IBS symptoms.

Gut-Directed Hypnotherapy is a specialized form of hypnotherapy that focuses on the gut-brain connection and uses relaxation techniques to help reduce symptoms. Studies have shown that it can be particularly helpful for people with IBS.

Living with IBS-M

Living with IBS-M can be challenging, but there are practical ways to manage symptoms and maintain a good quality of life:

• Meal Planning: plan your meals and snacks around foods that you know are safe for you. Eating smaller, more frequent meals can help prevent overeating, which may trigger symptoms.

• Stay Hydrated: drinking plenty of water throughout the day can help with both constipation and diarrhea. Avoiding caffeinated and carbonated beverages, which can irritate the gut, is also helpful.

• Exercise Regularly: regular physical activity can aid digestion and reduce stress, both of which are important in managing IBS-M. Gentle exercises like walking, swimming, or yoga can be particularly beneficial.

• Mindful Eating: paying attention to how you eat is just as important as what you eat. Eating slowly, chewing thoroughly, and avoiding distractions during meals can help your digestion work more smoothly.

Dealing with IBS-M can feel isolating, but connecting with others who understand can make a big difference. Joining a support group, whether in-person or online, offers a community where you can share experiences, gain practical advice, and find emotional support.

Talk to your friends and family about your condition so they can offer support during tough times. Regular check-ins with your healthcare provider are crucial to keep your treatment plan effective and address any new concerns. Be open about how your treatment is working and discuss any needed adjustments.

Even with careful management, flare-ups can happen. Having a plan and knowing which medications or strategies work best for you can help manage these episodes more effectively. Stay informed about new treatments and strategies for IBS-M to better control your condition.

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Key Takeaways 

​​IBS-M, or Mixed Irritable Bowel Syndrome, is a form of IBS characterized by alternating symptoms of constipation and diarrhea. It can be challenging to manage due to the unpredictable nature of these symptoms, but understanding the condition is the first step in taking control. 

While IBS-M is a chronic condition, it's important to remember that it can be managed effectively. With the right approach, including identifying and avoiding triggers, managing stress, and working closely with healthcare providers to create an individualized treatment plan including diet, lifestyle, and possibly medications, you can significantly reduce symptoms and improve your quality of life. 

You're not alone in this journey, and support is available.