Trying to figure out my IBS-D

[ET336]

I have had IBS-D for about 15 years (I am 40 now).  I think I have had it for most of my life, but don't recall if I had these issues when I was a kid.  More than 10 years ago, I was traveling in Thailand and came back with Giardia, which went undiagnosed for a while, then finally found and treated with antibiotics.  My biggest issue was always cramping, waves of nausea and then extreme urgency about 15-30 minutes after eating a meal.  It wasn't every day, but was multiple times a week.  As soon as I went, it was like I had taken a laxative (like an explosion of liquid, barely solid), and within 5 minutes of going, the nausea went away and I felt back to normal.

My previous GI doctor did 2 endoscopy over 3 years (I also had reflux), and a colposcopy.  None of them showed any abnormalities.  I did the FODMAP diet, cut out dairy, and thought I might have a food allergy or intolerance.  But I can eat the same food one day and be entirely normal, the same thing the next day, and it's nothing but diarrhea. My current GI doctor has a theory that I actually have IBS-C and because I am not getting full evacuations with normal stools, this is my body's way of evacuating.  So previously I was told not to take fiber supplements because it could make IBS-D worse, now I am taking them.  My GI Dr. also has done an MRI and bloodwork and gallbladder etc. are all normal.  I have not had a normal bowel movement in about a week (all liquid).  I usually will have good days and bad, but this is one of the worst episodes I have had.  

Is anyone else experiencing any of the same symptoms, and have you found any relief or solutions?

Thank you all in advance!

[Jeffrey Roberts]

I am glad that you have had a good workup to make sure nothing else are the cause of your symptoms.

Some people do have what is called "overflow" diarrhea from constipation. They think they are diarrhea predominant IBS (IBS-D), but in fact have constipation predominant IBS (IBS-C). Not suggesting that you are one or the other - but it's possible. The best way to determine if you are IBS-C is to do a sitz marker study. Somehow I doubt that you are. Instead you might have post-infectious IBS (PI-IBS) from your giardia infection.

You might have what is called visceral hypersensitivity. When you eat, you get amplified signals in your colon and it just wants to empty everything out. Antispasmodics might help with that. Viberzi or Lotronex are also a good options. I think you need to figure out the constipation part first because all of those meds can make constipation quite severe.

Lastly, the other thing I would check is your pancreatic enzyme levels and bile acid that is released. Either of those could also give you symptoms like you described.