5.0 Diarrhoea and Constipation together

This is an overview of when it is both Diarrhoea and Constipation together and gives you all of the background knowledge that you need to understand the problem. Our Diet Treatment Plans specifically are targeted to which symptoms you have whether they be Bloating alone or Diarrhoea/Constipation with or without Bloating.

5.0.1 Overview

When we get IBS with both Diarrhoea and Constipation, it is often named "IBS-Mixed", or “Alternator” type. The main symptom to focus on is the Constipation- solve the “blockage” and the Diarrhoea will resolve. So, please have a look at the section we have on Constipation, this will tell you a lot about the background to the problem

5.0.2 Some important points:

5.0.2.1 A “normal” bowel habit is to pass a motion anything between once / twice a day up to once every three days - you don’t have to go every day!

5.0.2.2 Everyone’s bowels change from time to time, even if we don’t change our diet

5.0.2.3 Stools normally vary quite a bit in frequency, consistency, shape and colour

5.0.2.4 Age has nothing to do with bowel habit

5.0.2.5 Excessive straining, a sensation of a lump “coming down” or the need to aid stool out with a finger needs to be discussed with your doctor/nurse

5.1 Alarm symptoms
If any of the list below applies to you, highlight it to your doctor as it is vital that conditions other than IBS are looked into:

5.1.1 Unintentional weight loss that has not been explained

5.1.2 Bleeding on going to the toilet

5.1.3 Symptoms that wake you up in the middle of the night

5.1.4 A relative who has had cancer of either the lower bowel or ovaries

5.2 Key things to look out for?
It is very important to make sure that the diarrhoea bit of our problem is not what is called “overflow” diarrhoea. It is also important to make sure that there is nothing “mechanical” going on with our pelvic muscles needed to make going to the loo happen ("obstruction" or "pelvic floor" constipation).

5.2.1 Overflow Diarrhoea
Imagine the constipation to be like a cork blocking things, that is swept away by the pressure building up behind it. It’s an important one to know about- we always incorrectly think that the diarrhoea needs to be stopped as this is the symptom that can cause the most upset. Targeting the diarrhoea will just makes matters worse, whereas sorting out the constipation generally improves both. See more about this under the Constipation section.

5.2.2 Obstruction Constipation
Judging this really boils down to: “how much do I strain?” Some signs to look out for:

5.2.2.1 Excessive or prolonged straining (even with soft stools)

5.2.2.2 Needing to put pressure on the “muscle” in front of the bottom to push things up

5.2.2.3 Having to use a finger to help scoop the stool out

5.2.2.4 A lump appearing when we strain (sensation of “something coming down”)

We all strain a bit, on occasions even more than just a bit, but, if this list really does ring a bell with you, please highlight it to your doctor.

Many things can cause this type of constipation and some of them may be a “learned” habit such as: “I supress the urge because it’s embarrassing for me to go at work”; "I prefer to hold on until I get home in the evening".

Some people have had an eating disorder and some have been abused - these are very real causes and the constipation can be treated very well, but you do need to tell your doctor or nurse about any such background history.

Several tests are done to investigate this "straining" problem, by a hospital “Pelvic Floor" unit under the guidance traditionally of a bowel surgeon (a surgeon because this is just the way that things developed over many years, not because surgery is commonly needed).

Again, do please have a look at the Constipation section, as this gives a lot more background.