Irritable bowel syndrome (IBS) is a complicated disorder. You and your friend could be diagnosed with IBS, but have very different triggers and symptoms. If you have alternating bouts of constipation and diarrhea, your subtype is mixed, also known as IBS-M.


IBS-M shares symptoms of both IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D). The main difference with IBS-M is that these symptoms alternate. The symptoms present in all subtypes of IBS include:

  • abdominal pain or cramping (dull or sharp)
  • an urgent need to go to the bathroom
  • feeling as though your bowels are not completely empty after a bowel movement

Many people with IBS also have non-gastrointestinal symptoms. These include fatigue, muscle pain, sexual dysfunctions, and sleep disturbances. They may also overlap with other conditions.


If you’ve experienced these symptoms for roughly three or six months, you should see a doctor to get an official diagnosis. Your doctor will take a complete health history before trying to rule out other more serious conditions. You’ll likely have to complete several lab and stool tests, as well as an x-ray exam, colonoscopy, and endoscopy. These tests will be negative if you have IBS.

For an official IBS diagnosis, you need to have recurrent abdominal pain or discomfort for a minimum of three days per month for the last three months. During this time frame, you should also have at least two of the following:

  • an improvement in your pain or discomfort after a bowel movement
  • a change in how often you have a bowel movement
  • a change in how your stools look

If you have IBS-M, you’ll have alternating periods during which constipation and diarrhea are your primary symptoms. IBS-M is the most common subtype.

Lifestyle Changes

After you’ve been diagnosed with IBS, your doctor or gastroenterologist will likely recommend lifestyle changes. Dietary changes are often the most effective. Many IBS-M patients report that certain foods make them feel worse. These foods include:

  • alcohol
  • chocolate
  • drinks that contain caffeine, including coffee and tea
  • dairy products
  • sweets
  • fatty or greasy food
  • certain sweeteners, such as fructose and sorbitol

Keeping a food journal can help you find out what foods are triggering your symptoms. Carbonated beverages, raw fruits, and certain vegetables like broccoli and cabbage are particularly known to contribute to gas and bloating.

Stress is another significant component of IBS. Although stress doesn’t cause IBS, it’s a trigger for many people. Yoga, meditation, and other relaxation techniques are all good ways to reduce stress.


Several classes of medication may be helpful for people with IBS-M. These include antibiotics, antidepressants, and antispasmodics. Antibiotics may alter gut bacteria in a positive manner. Antidepressants may help with the aspects of IBS related to stress and may also reduce intestinal cramping. Antispasmodics reduce the amount of cramping and spasms in the intestines.

Because the primary symptoms of IBS-M alternate, use caution about taking over-the-counter medications for diarrhea or constipation.

Complementary and Alternative Treatments

IBS is a complicated disorder that affects everyone in different ways. Finding treatments that work for you may require some trial and error. Besides lifestyle changes and medications, complementary and alternative treatments are another option that you may find helpful.

Many IBS patients report relief from following a gluten-free diet. Gluten is a protein found in wheat, rye, and barley.

Acupuncture is the practice of inserting fine needles into the skin to relieve pain. Studies about the effectiveness of acupuncture in treating IBS have been mixed. But it’s usually safe to try if you choose a licensed provider.

Probiotics are live bacteria and yeasts that you can consume. They may change the balance of bacteria in your gut to improve your digestion.

Always talk with your doctor before starting or adding an alternative treatment.