What is mixed IBS (IBS-M)?

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Mixed IBS (IBS-M), also known as IBS with mixed bowel habits, is a subtype of irritable bowel syndrome (IBS) where individuals experience both constipation and diarrhea, often alternating between the two. This type of IBS can be particularly challenging because the symptoms vary, sometimes causing periods of constipation (hard or infrequent stools), and at other times diarrhea (loose or frequent stools), often within the same day or week.

Key symptoms of IBS-M:

Alternating constipation and diarrhea: Individuals experience shifts between hard, difficult-to-pass stools and loose, watery stools.
Abdominal pain or cramping: Pain or discomfort in the abdomen, often relieved after a bowel movement, regardless of whether it was diarrhea or constipation.
Bloating and gas: Many individuals report bloating, excessive gas, or feelings of fullness.
Urgency or incomplete bowel movements: Some people with IBS-M feel an urgent need to have a bowel movement, yet they may still feel like they haven’t completely emptied their bowels.

Potential causes and contributing factors:

Similar to other forms of IBS, the exact causes of IBS-M are not fully understood, but several factors may play a role, such as:

Gut-brain interaction issues: Problems with the signals between the brain and the gut can disrupt bowel function.
Altered gut motility: IBS-M is characterized by fluctuations between fast transit (leading to diarrhea) and slow transit (leading to constipation) in the intestines.
Gut microbiota imbalances: An imbalance in the gut bacteria may contribute to the symptoms.
Stress and mental health: Stress, anxiety, and other emotional factors are known to exacerbate symptoms.
Food sensitivities: Certain foods can trigger episodes of diarrhea or constipation in those with IBS-M.

Management of IBS-M:

Because IBS-M involves both constipation and diarrhea, treatment often focuses on managing the fluctuating symptoms and may include:

Dietary adjustments: Avoiding known trigger foods (such as fatty foods, dairy, or gas-producing foods), eating smaller meals, and following a low-FODMAP diet may help reduce symptoms.
Fiber management: Soluble fiber may help regulate bowel habits, but it needs to be adjusted carefully to avoid worsening either diarrhea or constipation.
Hydration and physical activity: Staying hydrated and engaging in regular exercise can help regulate bowel movements.
Medications: Medications to address both constipation (such as laxatives or stool softeners) and diarrhea (such as anti-diarrheal drugs) may be prescribed as needed.
Probiotics: Probiotics can help maintain gut health and potentially alleviate symptoms in some individuals.
Stress management and therapy: Stress-relieving techniques like mindfulness, cognitive behavioral therapy (CBT), or other relaxation methods can be effective, especially as stress can worsen symptoms.

People with IBS-M often need to adopt a flexible management approach, addressing each symptom as it arises, and learning what strategies work best for their particular symptom pattern.

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