Living with IBS Mixed Type: Helpful Tips

Living with IBS mixed type, also called IBS-A or IBS-M, is unique in that you can experience both ends of the IBS spectrum — constipation alternating with diarrhea. The most effective treatment for mixed-type IBS is often a combination of traditional and complementary therapies.

What is IBS mixed type?

IBS has traditionally been categorized into three subtypes according to the bowel habits most commonly experienced during an attack: diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or both (IBS-M or IBS-A). Pain-predominant IBS is a newly suggested fourth subtype. 

As the name implies, people with IBS-M might experience diarrhea or constipation during an IBS attack. Scientists don’t understand precisely why this happens, partially because there’s no one clear cause of IBS. What we do know is that living with irritable bowel syndrome is challenging, regardless of type. 

Still, there are things people living with IBS mixed type can do to manage symptoms and attacks. Keep reading to learn about strategies that others have found helpful.

Develop a range of therapies

Since IBS is such a complex gastrointestinal disorder, it’s hard to treat it with just one approach. Many people report their best results using a mix of different treatments and therapies. 

For people with IBS mixed type in particular, this means they should try a range of treatments, including complementary, alternative or integrative, therapies. 

Try dietary interventions

Diet changes are the first-line treatment for irritable bowel syndrome. Every type of IBS has certain “trigger” foods, like hot peppers. gluten, or fried food, that make an attack more likely. While some trigger foods are obvious, others may not be clear or may be tied to other conditions, like food allergies or sensitivities.

It can take a lot of trial and error to find a diet plan that works for your IBS symptoms. Elimination diets are often the first strategy a provider will recommend. Working with a dietitian or nutritionist can be invaluable as you work through the process. 

A nutritional therapist will look closely at your eating habits and help you rule out any foods that may be having a negative impact through a process of elimination and gradual re-introduction of foods into your diet.

Here are a few other recommendations a dietitian or nutritionist might recommend: 

Eat more soluble fiber

Soluble fiber absorbs water, and that makes it useful for people with IBS mixed type. If an attack trends towards diarrhea, the fiber will remove excess water from your digestive tract and give bulk to your stool, making it easier and less painful to pass. 

For people with constipation, soluble fiber can form a gel-like substance that helps lubricate the tract and make passing stool easier.

This dual action makes adding soluble fiber an ideal step for people with mixed-type IBS to take. It’s also an easy one: Soluble fiber can be found in a number of foods, and you can also include it as a supplement to your diet.

Try probiotics

Probiotics are helpful bacteria that live in your gut and help to keep your digestive system working properly. They’re found in fermented foods and can also be taken as supplements. Several studies have shown probiotics to be helpful for both constipation and diarrhea, so they may be especially helpful as part of a treatment plan for people with mixed-type IBS.

Consider a low-FODMAP diet 

FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. FODMAPs are common “short-chain” carbohydrates that are notoriously difficult for the body to digest, so they tend to be eaten by your gut bacteria instead. 

FODMAPs are found in every food group, processed or not, and limiting them has been shown to offer symptom relief for IBS. 

If you decide to try a low-FODMAP diet, working with a dietitian or nutritionist can be especially important. Implementing and sticking to a low-FODMAP diet isn’t easy because FODMAPs are so prevalent in our food supply. 

A nutritionist for IBS can help you identify specific FODMAPs that may be causing your problems and how to eliminate them from your diet without restricting your diet to the point that it’s no longer healthy. As a bonus, as you identify specific FODMAPs that aggravate your IBS symptoms, you will have to eliminate fewer foods. This can make your new eating plan easier to stick with.

Make other lifestyle changes

While diet changes are the most likely to be effective for your IBS symptoms, other lifestyle changes can also make a significant difference. These are common-sense steps that make sense for all individuals, but they can be particularly important for people with digestive issues like irritable bowel syndrome.

Cut down on caffeine and alcohol

Caffeine is infamous for stimulating the colon, whether you want it to or not, and may be an irritant for IBS. It’s generally recommended to consume no more than three cups of coffee or tea a day, depending on your tolerance.

As for alcohol, by itself it doesn’t appear to be a severe gut irritant, but chronic consumption or binge drinking can cause inflammation and aggravate IBS symptoms. It also impairs judgment, which can cause you to make poor food choices, so consider limiting your intake to a glass of wine or a beer with dinner.

Quit smoking

You know that smoking is bad for your health. Yet when it comes to your gut, it may be one of the worst things you can do, raising your chances of both gut motility disorders and more severe digestive tract diseases. 

So, if you’re smoking, quit. If you smoke cannabis, consider alternative consumption methods.

Develop mindful exercise practices

Exercise is useful for us regardless of our overall health. It helps us manage stress and can assist the body with its natural processes, including regulating our bowel habits.

Light exercise of any type will have a positive effect on your IBS symptoms and quality of life. A 2015 study found that people who participated in an increased exercise intervention for 12 weeks with improved IBS symptoms, maintained their symptom improvement 5 years later. 

The most common exercises performed were walking, aerobics, and cycling. The participants reported improvements in physical symptoms as well as disease-specific quality of life, anxiety, depression, and fatigue.

Mind-body practices like yoga and tai chi can also be helpful with digestive issues. These gentle exercises use a mix of breathing techniques and body movements that can help center you, tone your muscles, and help with emotional regulation. Yoga may also be helpful for constipation. 

Join an IBS support group

Many people find that joining an IBS support group can be beneficial.  Knowing that others have the same challenges can help as you compare strategies and gain support from people who have been there and found help. 

Evidence is emerging that online support groups, whether video or in chat rooms, can offer similar results as in-person meetings, making it easier to fit into a busy schedule.

Try integrated or complementary therapies 

A variety of complementary therapy types have research support for the treatment of IBS symptoms. Adding one or two to your care regimen could have a powerful effect on your symptoms and quality of life.

Acupuncture

Acupuncture for IBS is commonly associated with traditional Chinese medicine (TCM). It’s a therapy that’s rapidly becoming more common in Western medicine for the treatment of a variety of conditions. Acupuncture is increasingly offered in the integrative medication departments of large hospitals. 

One systematic review of acupuncture studies found consistent reports of acupuncture for IBS providing relief of symptoms, including abdominal pain and distension, sensation of incomplete emptying, number of bowel movements per day, and firmness of stool. 

A 2017 Chinese study found that for participants with IBS-D, acupuncture was at least as effective as Western medication at controlling abdominal pain and distension and diarrhea symptoms with long-term benefit and no major side effects.

Behavioral therapies 

Your emotional health is tightly tied to your gut health in a number of ways. IBS is a predictor of depression and anxiety, which may even be causes of IBS attacks. They may also make attacks more intense.

Behavioral therapies, particularly cognitive behavioral therapy (CBT) and gut-directed hypnotherapy, can be very effective for IBS. CBT will help you develop healthy coping strategies for everyday situations, such as the social stigma many people with IBS feel (particularly those who regularly suffer from diarrhea). 

CBT will also address cognitive distortions that can affect your mental state. People with IBS who have tried CBT have seen symptom improvement in a surprisingly short period of time.

Gut-directed hypnotherapy can also be effective for IBS symptoms. Hypnotherapy uses states of extreme concentration or relaxation to work on the gut-brain axis. The hypnotherapist will help you visualize the condition you want to reach, such as being free of pain or relaxing tense core muscles. 

Hypnosis was found to have short-term benefit to people with IBS, and half of the participants of the study maintained their improvements a year later.

Develop a meditation habit

Certain types of meditation for IBS, such as relaxed response, have been shown to be effective at reducing abdominal pain and bloating, both short-term and long-term. Meditation can also help with stress, anxiety, and depression, all common in people with IBS. 

Learn about herbalism for IBS

Every modern medical practice has its roots in herbal traditions across the world, from the Ayurvedic and Chinese traditions to the herbal practices of Native peoples. Peppermint is an example of an herbal remedy for IBS that has strong support.

Other herbs that are commonly used for IBS include slippery elm, bayberry, and chamomile. In many cases, herbalists will use combinations of herbs to treat an individual’s specific symptoms. For this reason, it’s best to work with a trained herbalist to find the formulation that works best for you. 

Before using any herbs or supplements, consult your doctor and let your herbalist know of any other medical conditions you may have. 

Explore other integrative and complementary approaches for IBS 

There are other integrative therapies that may help IBS symptoms, including traditional massage, LED light therapy, biofeedback, and hydrotherapy. In every case, talk with both the practitioner and your doctor about the symptoms you want to manage and whether that therapy is right for your medical history.
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