Recognize the Symptoms

The first step in helping your patients.

IBS Up Close

Irritable bowel syndrome (IBS) is a common disorder characterized by chronic, recurrent abdominal pain associated with altered bowel habits that occur in the absence of other organic gastrointestinal (GI) diseases.1

  • IBS is the most commonly diagnosed GI disorder1
  • IBS drives 25% to 50% of all referrals to gastroenterologists1
  • At least 75% of people affected by IBS are undiagnosed2
  • More than half of individuals affected by IBS do not seek medical care1,3

What about IBS-D?

IBS with diarrhea (IBS-D) is the most common subtype of IBS, affecting approximately 40% of patients with IBS.4 In addition, an estimated 23% of patients with IBS have mixed bowel habits (IBS-M) and also experience frequent diarrhea.4,5 The prevalence of IBS-D is similar between women and men.6,7

Using the Bristol Stool Form Scale (BSFS), IBS-D is classified as1,5:

  • More than 25% of stools categorized as BSFS 6 or 7 (loose or watery stool)
  • Less than 25% of stools categorized as BSFS 1 or 2 (hard or lumpy stool)

IBS-D Symptoms

IBS-D symptoms can vary among patients, and the clinical expression of IBS may change over time within an individual.8,10 Flare-ups occur between periods of remittance and can vary in severity.8,9 In a survey conducted by the American Gastroenterological Association that included 3254 individuals with IBS, more than 75% of patients with a diagnosis of IBS-D (n=1001) stated they remain symptom-free for only a few days or less before symptoms return.11

In some patients, symptoms can be triggered or exacerbated by certain foods or stress,5,9,12,13 yet approximately one in five (21%) patients with IBS-D surveyed say they are not able to accurately predict symptoms on any given day.11

Symptoms of IBS-D include:
  • Abdominal pain image
    Unlike other pain that is often accompanied by tissue injury and inflammation, the visceral pain experienced by patients with IBS-D may be a result of hypersensitivity to normal bowel functioning.2,14
  • Diarrhea image
    Bowel habits associated with IBS-D are defined as loose or watery stools (Bristol Stool Form Scale 6 or 7) >25% of the time and hard or lumpy stools (Bristol Stool Form Scale 1 or 2) <25% of the time.5 Diarrhea is generally considered to be associated with accelerated intestinal transit and may be caused by a multitude of factors in IBS-D.5,15
  • Bloating image
    Bloating can occur with or without distention.5 Bloating may be directly related to alterations in the gut microbiota that cause excess production of intestinal gases.16
Understand the Causes

Let’s explore the science behind the symptoms.

Get a Closer Look
Treatment Options

There are many treatment options for the symptoms of IBS-D, click below to learn more about one potential option.

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References +


  • Defrees DN, Bailey J. Irritable bowel syndrome: epidemiology, pathophysiology, diagnosis, and treatment. Prim Care Clin Office Pract. 2017;44:655-671.
  • Lacy BE, Moreau JC. Diarrhea-predominant irritable bowel syndrome: diagnosis, etiology, and new treatment considerations. J Am Assoc Nurse Pract. 2016;28(7):393-404.
  • Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123(6):2108-2131.
  • Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712-721.
  • Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393-1407.
  • Herman J, Pokkunuri V, Braham L, Pimentel M. Gender distribution in irritable bowel syndrome is proportional to the severity of constipation relative to diarrhea. Gend Med. 2010;7(3):240-246.
  • Saito YA, Schoenfeld P, Locke GR. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol. 2002;97(8):1910-1915.
  • Windgassen S, Moss-Morris R, Chilcot J, Sibelli A, Goldsmith K, Chalder T. The journey between brain and gut: a systematic review of psychological mechanisms of treatment effect in irritable bowel syndrome. Br J Health Psych. 2017;22(4):701-736.
  • Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313(9):949-958.
  • Collins SM. The intestinal microbiota in the irritable bowel syndrome. Int Rev Neurobiol. 2016;131:247-261.
  • American Gastroenterological Association. IBS in America: Survey Summary Findings. December 2015. Accessed March 19, 2018.
  • Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol Hepatol. 2016;1(2):133-146.
  • Camilleri M, Ford AC. Irritable bowel syndrome: pathophysiology and current therapeutic approaches. Handb Exp Pharmacol. 2017;239:75-113.
  • Chen L, Ilham SJ, Feng B. Pharmacological approach for managing pain in irritable bowel syndrome: a review article. Anesth Pain Med. 2017;7(2):e42747.
  • Camilleri M. Intestinal secretory mechanisms in irritable bowel syndrome-diarrhea. Clin Gastroenterol Hepatol. 2015;13(6):1051-1057.
  • Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(26):2566-2578.
Bristol Stool Form Scale5
  • Type 1
    Bristol Stool Form Scale
    Separate hard lumps, like nuts (hard to pass)
  • Type 2
    Bristol Stool Form Scale
    Sausage-shaped but lumpy
  • Type 3
    Bristol Stool Form Scale
    Like a sausage but with cracks on its surface
  • Type 4
    Bristol Stool Form Scale
    Like a sausage or snake, smooth and soft
  • Type 5
    Bristol Stool Form Scale
    Soft blobs with clear-cut edges (passed easily)
  • Type 6
    Bristol Stool Form Scale
    Fluffy pieces with ragged edges, a mushy stool
  • Type 7
    Bristol Stool Form Scale
    Watery, no solid pieces; entirely liquid
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