r/ibs Oct 01 '25

Hint / Information Just a reminder if you have IBS C or chronic constipation

167 Upvotes

A lot of people who are diagnosed with IBS C or chronic constipation, especially if they aren’t responsive to diet and lifestyle changes, often end up having one or more significant motility disorders.

Many different things can cause these.

When you have chronic constipation, there is an order of operations you/your doc should follow.

  • first try dietary and lifestyle changes (ALL of them); if that doesn't work...
  • then try over-the-counter medications and supplements. If those don't work...
  • then you need motility testing done. Depending on your results of them...
  • then you go to prescription medication. Try them in different combinations and try all of them. If those fail, as well...
  • depending on your diagnosis after your motility testing, you may be eligible for non-invasive and invasive treatments to treat it. If those don't work…
  • again, depending on your diagnosis, then surgery is an option

If you are seeing a gastroenterologist and this isn’t laid out for you, chances their specialty isn’t motility. Unfortunately, many people get sent to GIs who have a speciality in something other than what they need. For motility, you need to see a motility specialist or a neurogastroenterologist.

There is a PSA I wrote and it is stickied above. I’ve been living with this since I was born (over 40 years). I also have worked in this area, as well. I try to spread awareness and this is often falling off of the radar and patients are just told to eat fibre.

With motility disorders, fibre is often the menace.

Testing for motility includes, but is not limited to:

  • esophageal manometry
  • antroduodenal manometry
  • gastric emptying study
  • 72 hour emptying study
  • upper gi series barium swallow
  • there was a wireless motility capsule but it’s been discontinued. There are a couple new ones in trials. Don’t hold your breath.
  • sitz marker test (also called a shape study)
  • colonic manometry (very key test but hard to get)
  • anorectal manometry
  • defecogram (mri or xray)

If you have any questions on testing, treatment, where to go, and so on, let me know.


r/ibs Nov 25 '23

"DO I HAVE IBS?" Megathread

204 Upvotes

If you think you might have IBS, ask your questions here. No self-diagnosis or requests for diagnosis - see your doctor.

Please read the section on Irritable Bowel Syndrome in the Rome Criteria IV before posting: Rome Criteria IV. If your symptoms do not meet criteria, please post to the appropriate subreddit. There are relevant subreddits in the sidebar.


r/ibs 4h ago

Rant I literally don’t understand how people can eat and drink while flying

26 Upvotes

Gonna use an alt because this is kind of TMI.

I (23F) have IBS, and I genuinely don’t understand how some people are able to live their lives so casually when it comes to flying.

How are people so comfortable eating and drinking while waiting for their flights? I’ll walk past airport restaurants selling sushi, Chinese food, coffee, etc., and they’re packed with people casually eating like they’re not about to sit on a plane for hours. Especially places that sell coffee. Like I’ll literally void both ways after 20 minutes post drink.

Meanwhile, I’d rather be hungry and dehydrated than risk having to deal with my stomach on an airplane.

My IBS also causes a lot of bloating, and I already struggle with my ears hurting during takeoff, so I’m usually chewing a ridiculous amount of gum while also trying not to make my stomach situation worse. Basically every flight is me sitting there trying to hold everything in and clenching the entire time, even when I’m trying my hardest, my stomach still makes noises.

The bathrooms are also really tiny and even if I use it (I would never) there is barely enough space to wipe cause I need to stand and check while I do it. I’m really thorough and because of an event I’ll take to my grave.

I’m also like really poop shy, so I’d rather wait by the family restroom, but I can feel everyone can tell I’m there cause I’m poop shy.

People really do live a completely different lives. Anyone hate flying because of this?


r/ibs 7h ago

Question Please help: Severe Gi issues no alleviation for almost a decade

6 Upvotes

Please help: Over 8 Years Of Unexplained GI Issues

Age: 23
Sex: Male
Location: Canada
Duration of issue: 8 years
Current Medications: Probiotics

I am alive but feel I have no quality of life anymore and am not living:
I’ve been dealing with severe GI issues for about 8 years and despite extensive testing nothing definitive has been found other than fructose malabsorption. This has severely impacted me daily and has limited my activity. **I’ve also lost over 12kg in less than a year.**

My diet is extremely limited. I basically eat the same thing every day (plain chicken and rice or potatoes )because most other foods trigger symptoms even if they don’t contain fructose. I have no appetite because everything is bland and all the same everyday. I also have to call in a lot of times to work and miss out on life because I am in unbearable pain

Main Symptoms

\* **Severe lower to mid abdominal pain attacks** (sometimes 10/10 pain)
\* Daily **yellow diarrhea or soft flakey stool (bile??)**
\* **Burning** sensation when passing stool when flaring\*\*
\* Pain usually only improves after going to the bathroom
\* **Urgency** during flares
\* Extreme reactions when eating certain foods

Known Triggers

Symptoms are significantly worse with:

\* Fiber
\* High fat foods, pork, lamb
\* Anything that speeds up gut motility
\* Most foods outside of chicken and rice

Diet History

When I restrict my diet to \*\*only chicken and rice\*\* symptoms improve slightly - have tried to reintroduce turkey and I don’t tolerate it

For a few years I was able to occasionally eat foods that previously triggered symptoms even if it contained fructose. This would cause pain the next day but would settle after. Over the last year the symptoms have become severe again.

GI Testing (All Normal)

Over the years I have had extensive testing including:

\* CT scans
\* MRI
\* X-rays
Inflammatory Markers
\* Ultrasound
\* Colonoscopy x3 times
\* Endoscopy x3 times
\* Bloodwork - only a little vitamin D deficient, can’t remember if I had pancreatic enzymes checked
\*\* Stool test few days ago- no parasites or bacteria such as salmonella, e.coli
- no crohns or celiac
- food intolerances and allergy testing- fructose and some vegetables and hazelnuts only- but I don’t eat anything that contains these anyway
\* Suspected Nut Cracker syndrome then ruled it out

All results have been normal except *mild inflammation in the terminal ileum * found during scopes and **small amount of pelvic fluid - both did not raise concern from doctors**

SIBO Testing/ treatment

I had a **SIBO breath test** which came back negative, but doctors suspected it could have been **a false negative despite proper prep.**

More Treatments Tried

- went to a naturopath and nothing helped i tried probiotics prebiotics L glutamine, psyllium husk, peppermint tea/oil

Around 6–7 years ago I took **rifaximin,** which **completely eliminated symptoms for about a month.** Some mild daily GI discomfort remained but the severe flares stopped during that period. Eventually symptoms **slowly returned**.

Recently I tried rifaximin again but it **did not help this time**

I also tried **berberine and oregano oil\\. After stopping them I had normal formed stools for the first time in years although they were pale. After about 1–2 weeks the symptoms returned to **daily diarrhea and pain.**

**I also tried cholestyramine powder for suspected BAM for one day only but had trouble tolerating it.**

**Tried low fodmap diet**

Antifungal Trial (SIFO possibility)

Because SIBO treatment had helped in the past but the breath test was negative, I also tried **fluconazole** in case the issue was **SIFO** (small intestinal fungal overgrowth)

For the first time in years I noticed some changes in symptoms but around day 7 of treatment my symptoms became worse again. I stopped after 2 weeks.

Other Symptoms (Non-GI)

\* *Severe brain fog*
*\* Memory issues*
*\* Fatigue*
*\* Occasional numbness sensations in the body*

Pain Management

During severe attacks the pain is extreme. Especially lower sigmoid colon area. I have tried many medications including:

\* Dilaudid
\* Toradol
\* Gas-X
Pregablin
\* Buscopan
\* PPIs
Mirtazapine - made me only very sleepy and out of it

None of these have relieved the pain. **The only thing that seems to relieve the pain is passing stool which is usually extremely painful and burning and very temporary .**

Question:

How can someone have severe abdominal pain attacks and daily diarrhea for 8 years with mostly normal testing with nothing to alleviate the pain.

What conditions might still explain symptoms like this? GI docs suggest “IBS” but how come I do the typical IBS treatments and more it does nothing for me not even slightly?


r/ibs 7h ago

Question Weird head feeling correlation with bowel movements.

5 Upvotes

I (22M) have had post infectious IBS-A but lean more toward IBS-C since March. However, my problem is not with running to the bathroom or pain a lot of the time. Most of my days I struggle with this “off” sensation that nobody can understand. The best way I can describe it is kind of like when you are in a deep sleep and get suddenly woken up - those first 15 to 30 seconds after you get woken up where everything is disorienting, however mine lasts all day most days. It’s a combination of feeling dizzy, tired, and zoned out all at once. It gets worse with gas movements and bowel movements but also with heat, activity, and overstimulation. I don’t have any other health issues and the only thing I’m anxious about in life is the IBS itself.

My question is does anyone else feel this way? If so, please share either what’s similar, what’s different, or a success story with this problem or ibs in general. Whenever I have flares of this dizzyness off feeling it feels like I will never be my normal self ever again.

(Before you ask, I have had CT scans of my body and head, MRI of my head, have been to an ENT, and several other doctors, only thing I’ve been diagnosed with is ibs)


r/ibs 3h ago

Question Enema still working 2 hours later

2 Upvotes

This is my 3rd experience with an enema, and the previous times made me feel so good and unplugged; calmed down my gut. However, this one is different. 2 hours later, and its sloshing on the very bottom of my intestinal tract. Burning. Nothing much is coming out anymore. But its still fizzing on the bottom of my stomach. What is this? Hope i can sleep


r/ibs 11h ago

Hint / Information Why is IBS so frustrating? IBS 101 here

7 Upvotes

This is a 1990 article by an expert in the field (James Christensen) who, in a Socratic dialogue style, explains why IBS, as a diagnosis, leads to a frustrating diagnostic and treatment path for many. It wasn't the original publication (1990, published in the defunct journal 'Gastroenterology International'), but a 1991 German translation. The German version can be downloaded here: https://www.researchgate.net/profile/James-Christensen-6 Translation with DeepSeek.

Heraclides, or The Physician
J. CHRISTENSEN
University of Iowa College of Medicine, Iowa City, Iowa, USA
Translated from English by S. Müller-Lissner

Heraclides: I am looking for a rare plant that one of my patients told me about. He said it is in bloom at this time, and the flower makes it easy to find. However, I have not yet found a single specimen, and I am getting tired of the search in this heat. If we sit under that tree over there, we can chat a little, and I can refresh myself from your flask if you give me a drink.

Socrates: Of course, my friend. But tell me, why is this plant so important that you are up here on the hill on such a hot afternoon, when you could be resting at home in the cool shade?

Heraclides: The patient I spoke of told me that an infusion of the root, taken with a little wine, greatly relieves his complaints, and so I was eager to get some specimens to try this treatment on others who have the same disease.

Socrates: Truly, what dedication! Now I understand why you enjoy such a reputation as a physician. You are constantly trying to learn more, even when others are resting on such an afternoon. But tell me, what is this rare disease that demands such efforts?

Heraclides: I did not say it was a rare disease. In fact, it is quite common, chronic, and rather troublesome. We physicians call it Irritable Bowel Syndrome. Perhaps you have heard of it.

Socrates: Indeed, that is probably the disease that my wife Xanthippe claims to suffer from, but I pay little attention to it. She is constantly complaining about something, and I often find it hard to give it much heed. But tell me, what is the nature of this disease? What makes the bowel irritable?

Heraclides: I do not really know. We physicians are not sure whether the bowel is irritated, or even whether it is only the bowel that causes the complaints. The symptoms strongly suggest that the bowel is irritable, but we have no real proof.

Socrates: What are these symptoms?

Heraclides: Well, mainly abdominal pain and the feeling of difficulty with bowel movements, but there are also other symptoms. I find it hard to understand it, I admit. Perhaps you, Socrates, can help me organize my thoughts about it. You have such a clear mind regarding all puzzling phenomena.

Socrates: Truly, it is not quite my field, but I would like to know more about this disorder that occupies you so much. Why do you call it a syndrome and not a disease?

Heraclides: We physicians use that word to designate a group of symptoms, feelings, or abnormal examination findings that seem to occur together. A syndrome is almost the same as a disease, but not exactly. We call a disorder a "disease" when we think we know where the fault lies, but we call it a "syndrome" when we do not. Nevertheless, the two terms are often confused and used synonymously.

Socrates: But this is truly a syndrome, I suppose, since you say you have difficulty understanding it. What exactly are these symptoms of the body?

Heraclides: I admit that the symptoms are very diverse. Some patients have constipation, others diarrhea, and many have both alternately. Some complain of bloating, others of cramps, and some of a feeling of incomplete evacuation. There are also complaints of nausea, fatigue, and back pain. It is not a simple picture.

Socrates: Then is it not difficult to make a diagnosis? Especially since you seem to rely on the patient's report rather than on objective facts?

Heraclides: Yes, one must rely heavily on what the patient describes. There is no laboratory test or X-ray that can confirm the diagnosis with certainty.

Socrates: Really? But if the symptoms are so variable, how can you be sure that all these people have the same condition? Could it not be that you are lumping together several different diseases under one name?

Heraclides: That is possible, I admit. But it is a useful concept, and it helps us to comfort the patient and to avoid unnecessary surgery or dangerous treatments.

Socrates: But does it help you to cure the patient?

Heraclides: Not always, I confess. Many patients continue to suffer despite all our efforts.

Socrates: Then it seems to me that the name is more for the physician's convenience than for the patient's benefit.

Heraclides: Perhaps you are right, Socrates. But what else can we do? We must call it something.

Socrates: Could it not be better to say, "I do not know what is wrong with you," rather than to give a name that implies knowledge you do not possess?

Heraclides: That would be honest, but patients expect a diagnosis. They are reassured by a name, even if it is not fully understood.

Socrates: So you give them a name to comfort them, even though you cannot cure them? Is that not a form of deception?

Heraclides: It is not deception, Socrates. It is a way of saying, "I believe you, your suffering is real, and I will try to help you."

Socrates: I see. But tell me, if you cannot define the disease precisely, how do you know when you have treated it successfully?

Heraclides: We rely on the patient's report of improvement.

Socrates: And if the patient feels better, you call that success, even though you may not know why?

Heraclides: Yes, that is essentially correct.

Socrates: Then you are like a man who tries to find his way in the dark, feeling for the walls, but never knowing if he is in the right room.

Heraclides: That is a harsh comparison, but not entirely unjust.

Socrates: Forgive me, my friend. I do not mean to criticize you. I only wish to understand. It seems to me that Irritable Bowel Syndrome is a name for our ignorance, not for our knowledge.

Heraclides: You may be right, Socrates. But until we know more, it is the best we can do.

Socrates: And yet, not all animals with hooves are horses. Nevertheless, the combination of hooves, a tail, and a mane strongly suggests that it is a horse, does it not?

Heraclides: Certainly, or something very like a horse.

Socrates: If one of these features is missing – the mane, the tail, or the hooves – is it then another animal, or is it still a horse?

Heraclides: I see what you are getting at. If one of these features were missing, I would still call it a horse, but an atypical one.

Socrates: If you described a horse as carefully as you could, could you describe it so that it could be clearly distinguished from a donkey?

Heraclides: That would certainly be difficult.

Socrates: It seems to me that the horse has an essence* that defines it, an essence that eludes precise description. From whatever angle you look at it, or even if you cannot see the details clearly because of distance or lighting, or even if you cannot see some parts at all, you can usually say that it is a horse. Do you agree?

[*Translator's note: In the original, the word is ambiguous – "essence" = smell/stench or (philosophical) essence.]

Heraclides: Yes, and it is exactly the same with Irritable Bowel Syndrome.

Socrates: And yet it seems to me that Irritable Bowel Syndrome, however carefully you describe it, is difficult to distinguish in its description from other diseases, just as it is difficult to distinguish a horse from a donkey. Is that correct?

Heraclides: Yes, I admit that.

Socrates: The essence of a horse differs from that of a donkey, but they are really similar in many points, and so one can mistake them if you do not see the animal completely. Could it not be the same way that different diseases appear quite similar to you? It seems to me that you may not be justified in calling Irritable Bowel Syndrome a single disease entity.

Heraclides: Yes, I admit that is possible, but there are many people in whom we find no evidence of any other disease that we have defined or identified.

Socrates: Let me approach this point from another angle. You physicians have been at your work so long and with such dedication that you can now identify very many diseases.

Heraclides: Yes, very many.

Socrates: You can often make a positive diagnosis with great reliability, so that you can give the best advice and treatment recommendations with confidence.

Heraclides: Yes, that is so.

Socrates: Do you believe that you have identified all diseases of the gastrointestinal tract except for one?

Heraclides: I would like to believe that, but I am not presumptuous enough to do so. I know that many mysteries of the bowel remain and that other diseases will be discovered when we have the opportunity to examine the bowel in new ways.

Socrates: Truly, I praise your modesty. But I see a problem in your logic. If you admit that more diseases remain to be described, then the patients who report these variable symptoms we have discussed might not all have one specific disease, but any one of several diseases.

Heraclides: I admit that you are right.

Socrates: Then it seems to me that there is no sense in assuming that all have the same disease. If you place all these patients in the same category by calling them victims of Irritable Bowel Syndrome, are you not contradicting yourself?

Heraclides: Perhaps, but it must be a useful habit, otherwise we would not do it.

Socrates: Agreed, it must be useful, but what purpose does it serve? Does it help you to understand the nature of the disease better?

Heraclides: I admit, no.

Socrates: Does it help the patients?

Heraclides: Well, not very much in terms of relieving the complaints. It gives them a name, and that may reassure them. But in truth, many continue to suffer despite all our treatment. It gives us, the physicians, a sense of security, because we can say: "You have Irritable Bowel Syndrome" – and thus we avoid unnecessary investigations and surgeries. But as for a cure, we can do little.

Socrates: So, after all, the name serves the physician more than the patient?

Heraclides: Perhaps. But it is not completely useless. It helps us recognize patterns, predict the course of the disease, and give some comfort to the patient by assuring them that they do not have a serious or fatal illness.

Socrates: But if the very nature of the disease is uncertain, how can you predict its course?

Heraclides: Based on experience. Many patients improve over time, or at least learn to cope with the symptoms.

Socrates: Is that not true for all chronic diseases?

Heraclides: Yes, it is.

Socrates: Then you are not describing a specific disease, but rather a collection of common complaints that may have many different causes.

Heraclides: That is possible. But for now, it is the best we have.

Socrates: Would it not be more honest to tell the patient: "I do not know exactly what you have, but I believe you and I will try to help you," rather than giving a name that seems to explain what we do not explain?

Heraclides: Perhaps you are right, Socrates. But patients want a name. They are more at ease when they know that their condition has a recognized name.

Socrates: Is that not more of an illusion than true knowledge?

Heraclides: It may be. But sometimes illusion is part of the cure.

Socrates: Then medicine is, in part, an art of deceiving?

Heraclides: No, it is an art of comforting and helping, even when we cannot cure.

Socrates: I understand. But tell me: if one day you discover that Irritable Bowel Syndrome is not a single disease but many, will you be surprised?

Heraclides: No. I already suspect that. But as long as we do not have the means to distinguish those diseases, the best thing is to keep the name.

Socrates: And so you continue to call a horse anything that has four legs and a mane, even if it might be a donkey.

Heraclides: A fair comparison, Socrates.


r/ibs 1d ago

Question No matter what I do my anus smells horrible.

130 Upvotes

I have very good anal hygiene. I’ve tried diets, exercises, baby wipes, creams and more. I recently took magnesium citrate and I realized I might be slightly incontinent. I tested by putting toilet paper between my butt cheeks and when i have an urge to go poop I can hold it in but a tiny amount leaks out. Also my resting anus feels open. Like if I swim water easily gets inside my anal canal. I would be fine with this but the smell is really bothering me and my loved ones. I can clear out a 1800 square foot house even if my anus is clean the smell is still there. Im not sure what’s going on. I can wipe my anus completely clean with baby wipes and the smell will come back within 2-5 minutes. It’s a very strong smell too. My dad is very sensitive to smells and I can hear him coughing at night because I smell so strong of feces. Is there anyone here that might struggle with this? Any tips or medical solutions?


r/ibs 36m ago

Rant IBS-D and working in the office

Upvotes

Anyone else notice a sharp u-turn in their ibs when they have to go into the office? I don’t know what it is! The lack of sleep, uncomfortable environment or just the air but even though I only go in twice a week I’m really struggling.


r/ibs 11h ago

Question All my tests came back normal and no doctor will take this seriously

6 Upvotes

I’ve posted here a few times about my story, but this is just kind of the update but a little backstory first:

So back in December, I got food poisoning from eating chic-fil-a & started and a few weeks later started a garden of life probiotic and the l started having bloating and gas. Ever since then it has been a nightmare. For the past 7 months I’ve been bloating pretty much daily but only in my upper gut as I have a bowel movement daily. I’ve been working closely with my doctor and we have tried literally everything. Tums, a liquid diet, eating every 4 hours, going to the hospital and having multiple test done, going to a GI doctor and being prescribed Erythromycin, multiple teas, elimination diets, multiple gas medications, apple cider vinegar DGL licorice root, l've tried gas x and several other gas medications but they just make me more bloated with pain, l've tried probiotics, I've tried Omeprazole, warm water, heating pads, oregano oil, peppermint oil, Pepcid and L glutamine, but nothing is helping with the bloating. I even completed a 10 day prescriptions of metroNIDAZOLE 500MG & CIPROFLOXACIN HCL 500 MG but they didn’t help either. Now I’m taking 1mg motegrity and ginger root at night but not seeing any results either.

I recently completed both Sibo & H pylori breathe test and they all came back negative so I don’t have either, I had a stool test and that came back positive, I had a CT scan, x-rays and multiple blood tests, they all come back normal. At this point none of my doctors really know what to do because everything is coming back normal and nothing is showing that there’s anything wrong. I’m just not really sure what else there is to do. I ordered a massage gun to see if it can maybe help with my stomach movement, but I’m starting to think that this is just more of a functional problems because it almost seems like I have to forcefully press on my stomach to even hear any type of like movement. I’m not really sure what I can do without the doctors help because everything is coming back negative they just don’t really know what to do anymore and they’re running out of options and so am I especially because I don’t have insurance and already have a $20,000 bill I genuinely cannot afford any more treatment, especially if everything is coming back normal .Has anyone ever had an issue like this before it’s getting to the point that I’m even just eating one meal a day a very small meal and still am extremely incredibly bloated and this is really starting to affect my relationship.


r/ibs 16h ago

Hint / Information The psychiatrization of eating behavior in gastrointestinal disorders

14 Upvotes

In recent years, there has been a growing movement to screen for and diagnose Avoidant/Restrictive Food Intake Disorder (ARFID) in populations with gastrointestinal diseases, a phenomenon that warrants critical examination in light of the available evidence. At the heart of the issue lies the fundamental overlap between gastrointestinal symptoms and the diagnostic criteria for ARFID. In patients with inflammatory bowel disease, celiac disease, eosinophilic esophagitis, achalasia, or irritable bowel syndrome, the ingestion of certain foods triggers objective and measurable symptoms (like pain, diarrhea, nausea, abdominal distension) that result from well-characterized pathophysiological processes. Faced with this reality, dietary restriction or avoidance constitutes an adaptive, rational, and understandable response, analogous to withdrawing one's hand from a hot surface. However, the screening instruments currently employed, particularly the Nine-Item ARFID Screen (NIAS), have not been validated for gastroenterological populations and appear to significantly inflate ARFID rates. The study by Fink and colleagues (2022), published in Clinical Gastroenterology and Hepatology, is paradigmatic: in a sample of 289 patients with achalasia, celiac disease, EoE, and IBD, 53.7% met criteria for ARFID according to the NIAS, with 78.4% of achalasia patients reaching this threshold, figures that the authors themselves consider "likely inflated." A factor analysis of the instrument in the same sample revealed a two-factor structure, rather than the three factors originally reported, with the "fear of gastrointestinal symptoms" subscale contributing to half of the total variance, suggesting that the NIAS is structurally inclined to classify as pathological what is, in gastrointestinal patients, an adaptive response to their condition.

The lack of specificity of the NIAS is further corroborated by recent population-based studies. A 2025 investigation involving 4,002 adults in the UK and USA found that 25.8% of the general population screened positive for ARFID, meaning one in four healthy individuals would meet the questionnaire's criteria, raising serious doubts about its utility as a diagnostic tool. This finding is particularly relevant when compared with the prevalence of ARFID in gastrointestinal patients, suggesting that the instrument captures eating behaviors that are, in fact, normative in the general population. The psychiatrization movement extends equally to non-celiac gluten sensitivity (NCGS). Shiha and colleagues (2026), in a study published in the UEG Journal, demonstrated that 69.4% of individuals with self-reported NCGS had concurrent DGBI and/or ARFID symptoms, and concluded that "self-reported NCGS may represent a broader syndrome of food-related symptom attribution rather than gluten-specific pathology." This reinterpretation of NCGS as a DGBI phenotype represents a subtle but profound inversion of causality: rather than recognizing that gastrointestinal disease causes symptoms that lead the patient to avoid foods, it proposes that the patient's "fear" or "visceral hypersensitivity" is the origin of the restriction, shifting the problem from the body to the mind.

This trend has been criticized by some of the most respected experts in the field. Helen Burton Murray, PhD, director of the gastrointestinal behavioral health program at Massachusetts General Hospital, has publicly expressed concern about "overpathologizing patients for whom dietary management can be a normative strategy," questioning whether diagnosing ARFID "changes the patient's treatment course and improves outcomes for them." Martin and colleagues (2025) demonstrated that, depending on the severity criteria applied, the rate of ARFID in patients with refractory DGBI ranged from 33% to 49%, highlighting the inherent arbitrariness of diagnosis when applied to these populations. Scarlata and colleagues (2024), in a review article, issued a "call to action" to unravel the nuance of adapted eating behaviors in individuals with gastrointestinal conditions, warning of the "potential for overpathologizing" and the need to distinguish between adaptive responses in patients with known physiological food intolerance and truly maladaptive behaviors in healthy individuals.

The controversy surrounding the low FODMAP diet is particularly illustrative. In response to concerns that dietary restriction might precipitate or exacerbate eating disorders, some authors have recommended psychological evaluation prior to prescribing the diet. This recommendation, however, can be seen as an unnecessary barrier to accessing effective treatment and as yet another example of causality inversion: if the diet reduces objective symptoms, its prescription is a legitimate medical intervention; suggesting that patients should be "screened" for eating disorders before initiating a treatment that could significantly improve their quality of life implies that dietary restriction is, by default, suspect, rather than being recognized as a disease management strategy. The distinction between association and causation is crucial: that patients on restrictive diets may be more likely to screen positive for ARFID does not mean that the diet causes ARFID, the alternative, more parsimonious interpretation is that patients with more severe symptoms (which justify the diet) are also those who benefit most from restriction and, consequently, show greater adherence to it.

In light of this, it is essential to establish rigorous criteria for the diagnosis of ARFID in gastrointestinal patients. The diagnosis should only be considered when dietary restriction persists beyond what is clinically necessary (for example, after optimized disease control), when there are objective consequences such as significant weight loss, documented nutritional deficiencies, or dependence on supplements or enteral feeding, and when the restriction causes severe psychosocial impairment, such as complete social isolation or inability to eat in social settings. In the absence of these criteria, dietary restriction should be viewed as a legitimate adaptive strategy, not a disorder. If the goal is to improve patients' lives, perhaps it is time to resist the temptation to transform adaptive responses into psychiatric disorders and to remember that, in most cases, dietary restriction in gastrointestinal patients is not a symptom of mental illness.

References

  1. Fink M, Simons M, Tomasino K, Pandit A, Taft T. When is Patient Behavior Indicative of Avoidant Restrictive Food Intake Disorder (ARFID) versus Reasonable Response to Digestive Disease? Clin Gastroenterol Hepatol. 2022;20(6):1241-1250.
  2. Shiha MG, Sanders DS, Burton-Murray H, Simren M, Palsson O, Aziz I. Prevalence of Self-Reported Non-Coeliac Gluten Sensitivity and Its Association With Disorders of Gut-Brain Interaction and Disordered Eating. UEG Journal. 2026. DOI: 10.1002/ueg2.70256.
  3. Flack R, Brownlow G, Burton-Murray H, Palsson O, Aziz I. The Prevalence and Burden of Avoidant/Restrictive Food Intake Disorder Symptoms in Adults With Disorders of Gut-Brain Interaction: A Population-Based Study. Gastroenterology. 2025;170(2):365-374.
  4. Burton Murray H. Eating Disorder May Be Common in Celiac Disease. Medscape. 2022.
  5. Martin LD, et al. Finding the Line Between Avoidant/Restrictive Food Intake Disorder and Refractory Disorders of Gut-Brain Interaction Using Lenient vs. Strict Severity Criteria. Neurogastroenterol Motil. 2025;37(9):e70043.
  6. Scarlata K, et al. A Call to Action: Unraveling the Nuance of Adapted Eating Behaviors in Individuals with GI Conditions. Clin Gastroenterol Hepatol. 2024.
  7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

Original essay. Deepseek (AI) was used for data analysis.


r/ibs 15h ago

Rant It was microscopic colitis

7 Upvotes

I've been dealing with liquid bowel movements for several years now. Little cramping, no actual pain, no weight loss (in fact I've gained weight due to my eating disorder). Just watery, pure liquid poop. I haven't had a fully solid BM in several years.

Anyway, i finally had my first colonoscopy two weeks ago. They removed a polyp (benign) and took some biopsies. I got the results back today. Microscopic muthafuckin colitis.

It's treatable with dietary changes and meds, but ughhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh 😫

At least I have an answer, I guess. Has anyone else been diagnosed with this, or suspects they might have it? I also tested negative for all other bowel issues.

I'd also like to encourage everyone to get a colonoscopy if they haven't had one before or are due!


r/ibs 6h ago

Question I heard my friend gag multiple times on call now I’m in a flare?

0 Upvotes

I was just on call with someone they have a medical condition and they started gagging and spacing out it went on for 10 minutes I didn’t wanna be rude and leave but I had to eventually cuz I was starting to feel gagging and nausea and now I’m in a flare up it’s been 15 minutes for me but it hasn’t stopped I’m about to throw up. I also heard my stomach moving and gurgling. Can u get a flare up from this? Or am I possible weird?


r/ibs 10h ago

Rant Poop is mostly normal but my GI is still diagnosing me with and treating me for IBS-D?

2 Upvotes

I have diarrhea maybe once every other week, more often if I eat things I'm not used to, but for the most part my BMs are completely normal. My symptoms for the past 9 months have been appetite loss and overall excessive gas (constant burping, farting, horribly painful trapped gas, bloating, gurgling stomach). I also get bad pain, reflux and regurgitate my food if I eat just a little too much. I have recieved a very in-depth GI workup (colonoscopy, endoscopy, scans, infections, parasites, 3 negative SIBO tests) and nothing came back significant. Movement through my small bowel on one of the scans was a little weird but they didn't investigate any further. I had a gastric emptying scan done years ago that was normal and they aren't wanting to repeat it or get me any other motility tests, even though I didn't have this set of symptoms at the time.

I did have two weeks of diarrhea several months ago that I went to the hospital for but nothing like that since.

It seems my GI is really stuck on the occasional diarrhea I have. I don't think it's that weird, I've always had BMs like this. It's all the gas that is killing me.

I just don't think I fit the diagnostic criteria? My bowel habits have not changed since that one isolated event, and my pain has absolutely nothing to do with my BMs. I don't know how many times I've said it's gas pain, I know it's gas pain because I can press on it and move it and burp it out. None of the doctors have believed me on this.

I was told gas is normal, I have visceral sensitivity related to IBS, and was referred to therapy and antidepressants. Not happy. I don't think the average person has zero hunger cues, burps every two minutes, has a constantly gurgling, churning gut, and has to fart for a full minute straight every morning. Does this sound like IBS at all?

This all started after I quit omeprazole and Paxil. I don't know which one did it. I tried going back on the omeprazole but it made my early satiety worse.


r/ibs 11h ago

Question IBS and hormones?

2 Upvotes

Has anyone noticed a correlation between IBS flareups and their cycle? I feel like my symptoms are always worse when I’m ovulating.


r/ibs 15h ago

Question Why can't stool stay compacted together and is it even a real problem? Rough week

3 Upvotes

Ibs-d diagnosed. Never found any issues on colonoscopies. Just told IBS. I never really understand why a bowel movement can come out super fast fall apart in the toilet and look really abnormal. Aren't we taught that we are supposed to have Bristol 4 logs? I thought metamucil was working but then I have these days like the last three where stool does not stay compacted. It looks like mush and is disgusting. Husband tells me I should stop worrying about it and flush and forget because all my tests have been normal. I think I just am on a mission to not have these rushing out stools of mush and it's really bothersome. There's also aching in the colon under the belly button before and after it happens. Is the answer truly just taking a half dose of Imodium everyday? I'm tired of trying to get tasks done and then be rushing to the toilet again because of a cramp. It's truly putting a damper on my getting things done.


r/ibs 1d ago

🎉 Success Story 🎉 Success story! No more IBS for me!

52 Upvotes

Hey all, wanted to share my story to give hope to whoever is scrolling this sub feeling hopeless. About 7 years ago, I developed IBS-D in my early 20s after a lifetime of never giving my stomach health a second thought. It destroyed my life pretty quickly and left me feeling incredibly hopeless for maybe 12-16 months. I had tons of doctor visits which resulted in nothing except “this is just your life now, try FODMAP diet, take some Imodium, etc”.

A few years later, I am 100% back to normal. It really is possible. I don’t have medical assurance of what for sure caused it, but I’m pretty sure that I got the initial upset from some antibiotics for a kidney infection and then my own anxiety kept the problem going for at least a year longer than probably was physically necessary. (Side note - I also think I’m extremely sensitive to artificial sweeteners and protein supplements). I never took “it may be psychosomatic” seriously, but looking back, I think it genuinely was. I was in a terrible relationship and had crazy anxiety and no ability to control my own thoughts. Once I learned that I can change rumination patterns and that “growth mindsets“ exist and I can better my mental health through repeated efforts, I’ve literally cured my anxiety AND my stomach issues. it sounds cheesy, but this is what worked for me. If anyone is out there feeling like their life is over and they’re forevermore chained to their few comfortable locations due to IBS-D, please don’t lose hope. I’m 29 now, never have an upset stomach unless I really deserve it via poor choices, and went from being diagnosed by a professional with anxiety and depression to genuinely being pretty unflappable and content with life.


r/ibs 18h ago

Question Got diagnosed this morning :(

6 Upvotes

Any tips/tricks? Been prescribed some peppermint capsules and recommended buscopan. Because I’m 16 they can’t prescribe the NHS dosage of buscopan because I would go loopy. Looking for holistic tricks that actually work!

For extra context, I also suffer from HSD (hypermobile spectrum disorder) and GAD (generalised anxiety disorder).


r/ibs 10h ago

Question Medication Combination is Killing Me but Recommended by Gastro - Dicyclomine 20 mg x Viberzi 100 mg - is Zofran a Plausible Replacement?

1 Upvotes

My Gastroenterologist recommended the mentioned drug combination for IBS-D. I started out with Viberzi 100 mg at twice a day which was ok for awhile but the cramping from a lack of Dicyclomine persisted. I told him about the issue and he recommended that I take both meds and that led to extreme constipation. I told him about the drug interaction and he said that I could go down to taking the drugs once every 24 hours. The problem being that I am still very constipated.

These medications are paired with Bupropion 300 mg which already has a side effect of constipation. I asked him if this might make things worse and he said no.

I'm a little frustrated with this situation because going to work is fine. I have my normal symptoms and traveler's diarrhea before the bus trip, then work is fine-ish.

I have a question about if anyone has had luck with Zofran? I see that it has the description of doing what I need. I'm just not sure about medications right now because most of my doctors never list all of the negative reactions from them. I've done research on these drugs but would like some of your personal experiences.

Edit: Diarrhea may be overspill from constipation. I was also originally on Dicyclomine 20 mg x Loperdamine 4 mg, once a day. That worked most of the time but I would end up constipated on my days off and unable to go anywhere because I might shit myself. This is really no way to live.


r/ibs 1d ago

Research Study of 2.7 million people shows IBS genes tied to high triglycerides

161 Upvotes

A huge new genetic study in Neurogastroenterology is expanding how researchers think about IBS.

An international team analyzed genetic and health data from more than 2.7 million people across 22 biobanks. They found that IBS risk genes do not just involve the gut-brain axis and nervous system. Those risk genes also overlap with genes tied to metabolic health, especially triglycerides.

One key finding involved a gene called GCKR, which helps regulate how the liver handles sugar and fat. A variation in this gene is already linked with higher triglycerides and fatty liver risk. In this study, that same variation also showed up as a strong genetic signal for IBS risk.

My takeaway? IBS is a gut-brain disorder, but it’s not just a gut-brain disorder. For some people, IBS may also involve metabolism, fat processing, and your whole-body biology.

And it definitely means that checking basic metabolic markers such as triglycerides may be useful for some IBS patients.

The good news? Soluble fiber, a really helpful foundation of an IBS diet due to its gut motility regulating properties and prebiotic effects, is also key to lowering high cholesterol and triglyceride levels. So at least there's something concrete we can actually do here.


r/ibs 22h ago

Rant IBS PI - 8 years outcome

9 Upvotes

Hi everyone - first of all I feel you all, living with this, is just awful.

I'm 35 male and started this journey with 27 after getting a terrible gastroenteritis.

Like many of you did all the exams, colonoscopy, endoscopy, in the first year after getting the symptoms. After everything came out clear, I was put into the IBS bucket, or as they call over here, nervous colon.

First 2 years were just miserable, I was doing a Chrons medication, anti-inflammatory med, but after a while GI told me to stop because it was just placebo. Fast forwarding up to past year, I got better with gym and some diet changes, but never was the same.

I tried going to different dieticians, and different doctors, it never fixes nothing. Nowadays I'm able to be more or less pain free and have no urgency, but on my daily go to the bathroom, normal stool is a mirage. It does happen, every full moon. But normally it is either diarrhea or floating stool - for floating stool is better because they have form, but yeah still don't like it. I believe I developed some absorption problem maybe, but ultrasound last year and my blood work seems to not indicate that.

I ended up developing extreme anxiety with my health, always super vigilant and thinking that I'm dying or with something severe that nobody takes it seriously. It got worse after being a father, because I just want to be healthy and be with the little ones, so the anxiety took over me. And the more the anxiety the worst I get from this, the brain-gut axis is real. The only thing that kinda gives me some sense of reassurance, is that I do a full blood work every 8 months or something, because I have hypothyroidism and my doctor is cool and passes a more complete blood work.

Things that work with me, when I'm not flaring are going to the gym - I try to eat as clean as possible, but after wasting so much money on different diets, I kinda gave up - to be fair, GI told me it would be very difficult to get a diet right. Nowadays I don't even like going to the doctor for this, because they look at me as I'm crazy, I don't like sharing with my family because they are tired of my complaints. I'm just tired, fully exhausted.

I'm just ranting, compared to what I was 8 years ago I'm much better, but daily sense of going to the bathroom and not being normal, it's just awful.


r/ibs 14h ago

🎉 Success Story 🎉 Unusual food trigger

2 Upvotes

tl;dr I'm nearly confident all my problems relate to vinegar (of any kind). Vinegar as in olives, pickles, salad dressing, but also as an additive in stuff like bread. It seems not to be a common trigger, and as such probably isn't considered very often. I've been stalking this forum for ages now and not seen it pop up very often. Might be worth consideration for all of you who, like me have a love for the flavor of vinegar and eat things like olives, salads, pickles, etc., often.

Longer story: I've had on and off issues with digestion for a decade+ at this point. Tests always came back relatively normal, though some immune markers have been slightly off here and there. These were always brushed off as possible allergies, which is fair since I also occasionally get mild reactions like hives.

It was never "typical" IBS in that I could not tie standard treatments to any measure of improvement. Nor could I do it with consistency. Sometimes low fodmap seemed to help, but other times it was useless; sometimes fiber supplements like psyllium/chia seeds were great, others not so much.

Similar for my diet. I eat a pretty regimented bodybuilding-esque diet, and I track all my food. Nevertheless, days where I ate basically the same foods seemed to have different digestive results.

Anyway, my story isn't particularly interesting other than to say I thought through (and was tested for) all your standard things: FODMAPs, non-IGE allergies, eosinophilic gastroenteritis, IBD, other food additives like binders, gums, preservatives, etc. The single thing that reliably stops my stomach issues nearly immediately (2-ish days later) is not consuming any vinegar. Might not be of relevance for any of you, but I hope it helps someone out there consider another option.

I've not yet figured out the why of it all. My small amount of googling thus far mostly ties it to histamine, but I don't think that's the issue since I eat plenty of high histamine foods without issue.


r/ibs 11h ago

Question Linzess and foul smelling stool

1 Upvotes

I had my first visit with a GI last week and got prescribed Linzess (72 mcg). Is it normal for my stool to smell like death?? I know diarrhea is a normal side effect but I’ve never had diarrhea smell this bad. Although these stools aren’t even that loose or watery, so I wouldn’t fully consider it diarrhea.
 
I’ve been reading online that it’s normal since the Linzess clears out stagnant waste that’s been stored from constipation, but I wasn’t exactly overly constipated before starting the medication. I had daily bowel movement (usually normal stools with occasional straining) prior so I can’t imagine I had that much stool stored? I just don’t want the smell to be from other potential reasons. Curious if anyone else has experienced this.


r/ibs 1d ago

🎉 Success Story 🎉 It was my gallbladder all along

19 Upvotes

chronic lurker of this sub. 22y/o female, like many of you I have suffered from confusing digestive symptoms for many years with no answers. I’ve had bouts of constipation, diarrhea, blood in stool, cramping, a bit of everything. I had just written it all off as Ibs and had a colonoscopy scheduled for the following month.

however, last week out of no where I developed severe pancreatitis from a gallstone, and had my gallbladder removed as a result, and in the aftermath I am now seeing how many of my symptoms were connected to my gallbladder, I truly feel like I have a second chance at life without crippling stomach issues!

I had very few symptoms before my gallbladder attack, but here were the 3 I was most effected by:

  1. increase in acid reflux- I have always had acid reflux but it sud got a lot worse out of nowhere prior to my attack

  2. unexplained metabolism stall- I am fairly active, cook at home and track what I eat, despite this I was barely losing weigh/ even gaining in some cases despite being in a calorie deficit, it was driving me insane

  3. skin sensitivity/ hives- I would break out into hives due to the amount of inflammation present in my body, my skin was so inflamed that I could no longer use products that I had used to

I hope that everyone will have their aha moment that finally allows them to understand their digestive issues once and for all!


r/ibs 16h ago

Question How did you manage your wedding with IBS? I’m terrified already

2 Upvotes

I’m really hoping someone can offer some advice because I feel completely stuck.

My partner and I want to get married next year, and I genuinely want the wedding. I’m excited about it, I want to wear the dress, celebrate with family and friends and have the day I’ve always imagined.

The problem is my stomach and the anxiety that comes with it.

I’ve had digestive issues for over 10 years (urgency, IBS-type symptoms mostly, but now constipation alternating with soft stools, etc.) and because of it I’ve become terrified of being away from a toilet. My diet is now incredibly restricted because I’m scared of triggering symptoms, and I barely leave the house anymore.

We’ve actually changed our plans to try and make things easier. We’re thinking of doing the legal ceremony separately with just a couple of witnesses, then having the reception/celebration another day. We’ve also chosen a venue that’s only about 4 minutes from our house because it makes me feel safer knowing there’s not a long drive and I’m closer to home etc.

I originally thought separating the ceremony would solve my worries, but then I realised that even the legal ceremony itself is making me anxious. It’s only a 13 minute drive away and won’t take long, but I’m already imagining the journey there, wondering what if I get a stomach twinge, what if I suddenly need the toilet, what if I feel awful. It feels ridiculous because I know it’s such a short event, but my brain goes straight into overdrive.

One minute I’ll be thinking, “This is going to be amazing, I can absolutely do this.”

Then I’ll get a stomach twinge or have a bad bowel day and suddenly I’m convinced I need to cancel the whole idea because I’ll end up having diarrhoea at my own wedding.

The worst part is that I’m so hyper-aware of my body now. Every tiny twinge or change in my stomach makes me panic. Then the anxiety itself seems to make my stomach feel worse, and before I know it I’m spiralling and imagining the entire day going wrong.

I keep thinking:

What if I wake up feeling awful?
What do I eat the day before?
What do I eat that morning?
What if I need the toilet during the reception?
What if I spend the whole evening feeling ill?

It’s got to the point where I’m almost avoiding booking anything because it suddenly feels too real.

The strange thing is that when I’m having a good stomach day, I genuinely believe I can do it. It’s only when I have a flare-up that I convince myself it’s impossible.

Has anyone else planned a wedding (or another huge life event) while dealing with IBS, digestive issues or anxiety?

How did you stop yourself letting fear make the decisions?

Did you have a plan that helped you feel calmer?

How did you stop putting so much pressure on yourself to feel “perfect” for one day?

I don’t want to look back in years to come and realise I let anxiety steal something I really wanted. I just don’t know how to get out of my own head, and I’d really appreciate hearing from anyone who’s been through something similar.