IBS Diarrhea: Flare-Ups, Overflow, Food Intolerances and How to Stop the Cycle

Jessie Wong 00:00:00 Welcome to the IBS Nutrition Podcast, your go to source for navigating the complex diagnosis of irritable bowel syndrome. Here, we dive deep into IBS and discover the power of diet and lifestyle to find freedom from your IBS symptoms. I’m your host, Jesse Wong, Fodmap dietitian and a gut expert. For years, I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today, I’m in control of my IBS, able to eat the food I love again, travel whenever I want, and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started! Welcome to another episode of the IBS Nutrition podcast. Today we are tackling a challenging topic that affects many IBS, diarrhea and mixed bowel type. We’ll discuss the different types of Diarrhea and share personal stories and provide practical tips for managing these symptoms. You’ll hear about flare up, diarrhea, overflow, diarrhea, food intolerance, diarrhea, and learn from real life experiences.

Jessie Wong 00:01:13 Plus, we will offer valuable tools and strategies for long term control. And here with me today is my amazing co-host Brooke, who is also our lead team, IBS dietitian. Hi, Brooke.

Brooke Keenan 00:01:26 Hi, how are you?

Jessie Wong 00:01:28 I am doing great. How are you today?

Brooke Keenan 00:01:31 I’m good.

Jessie Wong 00:01:33 Okay, well, diarrhea. This is a topic very near and dear to us, right? So I think a lot of our clients come to us crying because they don’t know what to do about their diarrhea. And of course, it is more common than we think. And oftentimes with diarrhea, people are afraid of leaving their homes. They are afraid of going to places. They always map out where bathrooms are and and the anxiety of having to deal with diarrhea when you don’t know when it will happen. That’s a lot to handle. So if you are dealing with diarrhea, remember you are not alone. And this is more common than we think. But first, to prevent your diarrhea from happening. You need to know what type of IBS diarrhea you have.

Jessie Wong 00:02:18 I know it sounds so strange, like there are subtypes of IBS and within the subtype of diarrhea there are multiple different types as well. And this is because there are different reasons why you have IBS diarrhea. Let’s start with the first one, which is also probably the more common one. And that is what we call flare up diarrhea. It is also IBS mixed bowel type broke, which would help us explain what that might be.

Brooke Keenan 00:02:46 So flare up diarrhea is really what you, you kind of think of think of as IBS D so you get flares of diarrhea, and then you may have some calm times where you’re not having diarrhea. You may have some normal stools in there too, but for whatever reason, your diarrhea flares up and it can last for an afternoon days, hopefully not longer than days. But it’s it’s the typical kind of diarrhea that we think of multiple days or afternoons of diarrhea.

Jessie Wong 00:03:19 Yeah, exactly. And sometimes this is caused by constipation, right. Sometimes we see it caused by food intolerance.

Jessie Wong 00:03:27 But a lot of the times we actually see it caused by chronic constipation. And people may not realize. And what usually happens is people maybe start having constipation. They get more and more bloated, they get more and more constipated and more symptom comes on, and then all of a sudden their body cannot take it anymore. And they have this humongous flare up of diarrhea. And one way to tell that whether you have flare up diarrhea or this kind of diarrhea is when you have that flare up, is there a lot of stool that comes out all at once? If it’s a lot of stool, then, you know, there were a lot of things that were built up inside your colon. They’ve been just stuck in there for a long time. And then you have this, what would you call it? Would you say floodgates kind of opens and it just doesn’t stop and goes, yeah. Stays in the bathroom for hours and sometimes maybe even overnight and then a few drinks. They feel terrible for a few days and the cycle repeats itself.

Jessie Wong 00:04:28 It’s more common than we think. And the treatment for this is really resolving your constipation and knowing what is causing your constipation. And actually one of our past clients, she is a classic example of this case and her name is Kinsey. Kinsey is amazing. She is a dietician herself, but she’s been dealing with diarrhea for a long time and she went to see her GI. Her GI recommended probiotics and fiber supplements, which didn’t quite really help. So she gave up on trying that. And then a guy recommended for her to do the low Fodmap diet. Now giving given that she is a dietitian herself, and she looked at the low Fodmap diet and she knew immediately she needed help going through the low Fodmap diet. So that’s when she came to join our program. And actually at the point when she joins our program, she’s already cut out 50% of the foods that she was eating because she thought food was triggering her symptoms. And this is where we started. We do, of course, every time.

Jessie Wong 00:05:27 We always do a deep dive of what is going on with the person, look at their medical history, look at all the tests they have. And what we find was that she was actually very constipated for many days. She would be fine. And then it leads up to a flare up at bouts of diarrhea. And because she was so afraid of that diarrhea, what happened? She stopped going out, leaving, going out. And she was afraid to even be in a car ride for 5 to 10 minutes because she doesn’t know when it would happens. But after looking through all of this and what I told her is, I think you are actually very backed up and the backed up is causing you to have these kind of flare ups. And once I told her that a light bulb moment kind of went through her head and she was like, oh, how could I not know that? So what we did was really help her to have better evacuations every day, and retraining her colon to have good poops every single day, and also work on expanding her diets like she’s a dietician herself.

Jessie Wong 00:06:26 Like being so restricted. It was very hard for her. But once we stopped her constipation, her diarrhea stopped completely. I remember she wrote in the testimonial. She said my diarrhea stopped immediately since working with Jessie, and she’s not had any kind of flare up for months when we were working together and after we were working together and she was able to drive us. So when we were working together, she actually changed the job because her symptoms were way better managed. Then she was able to pick up work that she much wanted to do, but it was a further drive for her. And at the end of the program, she was driving an hour to work and an hour back. Like if she didn’t have her diary under control, she was not going to be able to do that. And she came to us for the low Fodmap diet. But we did not do the low Fodmap diet at all with her because she was already really afraid of food and she was already eating very little things to begin with.

Jessie Wong 00:07:25 And we know as dietitians and well, our goal in our clinic is always to help our client expand on what they can eat when it is not necessary to do the low Fodmap diet. We don’t recommend it. Even the low Fodmap diet because she was getting so much better. Her symptoms basically resolved within 2 to 3 weeks. So we were like, let’s not go through with the elimination. If she wanted to challenge the FODMAPs, we can still do that. Even without being on the low Fodmap diet, we could still do reintroductions. But for her case, she just went back to eating everything normally after resolving her chronic constipation that led to diarrhea. And I think this is something we don’t talk about enough, because when people come to us, their first thought is we are doing an elimination diet. So we need to do this. We need to work through it in reality is not for everyone. And sometimes elimination diets can have long term negative effects on your gut, especially if you don’t know how to do it properly.

Jessie Wong 00:08:28 You’re not really introducing the foods in a timely manner. All right, so that is the first type of diarrhea that we wanted to share with you. And that is the flare up type of diarrhea. Now another type of diarrhea we see very often is actually the overflow diarrhea. And Brooke, will you explain what that means? What is overflow? Diarrhea?

Brooke Keenan 00:08:50 Yes. So this is a big backup of stool and the. It’s it’s large usually. And it’s so big that the liquid stool then comes around it. So you actually get liquid stool. So it looks like diarrhea, but it’s actually caused by a big blockage of diarrhea. I mean, excuse me of constipation. And the liquid stool moves around it. So you really need to resolve the constipation before it’s going to go away.

Jessie Wong 00:09:24 Yeah. And with the overflow diarrhea what tends to also happen is people will have multiple bowel movements every day. And they would be very liquidy, very soft. Basically, your body is trying to have a bowel movement every time there’s any stimulation when you’re eating food or when you are maybe exercising a bit more.

Jessie Wong 00:09:45 And people sometimes in these situations are afraid to move because they’re so afraid of the diarrhea coming. but your body is actively trying to have a bowel movement to clear out that blockage. However, it’s not able to move the solid stool that is like, kind of stuck, at the entrance or at the exit of your colon or near the exit, the colon or the rectum. And that can cause a lot of pain, that can cause a lot of bloating and worse, as it cause multiple diarrhea throughout the day. And it can be pretty devastating and pretty debilitating for patients experiencing these kind of symptoms. And again, you’re not alone in these kind of situations. But of course, we don’t talk about it enough. And one of our previous clients who experienced this a lot, I think her name is Kathy. She is a very successful entrepreneur and she has seen and went to many, many providers for her BSD and they tried so many things elimination, diets, protocols, supplements and she works with her GI as well, multiple GIS to try to resolve her diarrhea.

Jessie Wong 00:10:57 None of those things worked because what she really had was chronic constipation that led to overflow diarrhea. So if you’re trying to resolve a diarrhea, which is caused by constipation, that can really backfire. And so for her, realizing that was the problem was our first step working together. It’s like, hey, maybe you don’t have IBS, maybe this is overflow diarrhea. And it is more common than we think. And she I remember her messaging me. It’s like I worked with so many people. I tried so many things. Nobody could help me because we were treating the wrong problem. And whatever they were doing to treat diarrhea was making her constipation worse. So thinking about this, like you really have to go to an experienced provider who knows that. And we are sharing this here to help you better understand different types of IBS diarrhea so that you have the tools to or you have the knowledge to advocate with your provider to get the right test to understand better. And of course, we have a free symptom tracker.

Jessie Wong 00:12:03 I’ll put the link in the show notes for you to start tracking your symptoms so that you better understand what is happening. And we actually talk about this extensively and visually on our free IBS masterclass. So we have pictures to show you what it looks like when there is a blockage, what it looks like when you have regular diarrhea, and what it looks like when you have a regular bad move. And so by seeing it visually, it might help you understand better what is going on. Now for Kathy, actually, what we did was of course first resolving her constipation so that she wasn’t backed up and her diarrhea stopped pretty quickly. But then when we dive deeper into learning more about what was happening was that we found out she actually had a food intolerance, and the food intolerance caused her to have slower gut motility, and that slower gut motility was what caused her to have the significant constipation. So once we figured that out, we know and she knows how to manage her IBS moving forward and with her food intolerance.

Jessie Wong 00:13:07 Like if she eats the food accidentally, she knows exactly what to do to manage and prevent the constipation from coming back. And in turn, when when she was preventing the constipation from coming back, she’s really preventing the overflow diarrhea from coming back as well. So if you are somebody who struggles with diarrhea multiple times a day, or many times throughout a day in just fluffy and watery pieces that are coming out, or if you have to wear, have to use a pad or have to bring pants with you everywhere you go. Extra pants, extra underwears. You know, this could be something else to look into with your provider, but start by tracking your symptoms so that when you go to your provider, you can show a full picture of what may be happening, and they can help you create a treatment plan that really works for you. So our free symptom tracker is on a PDF walk. We actually have an article on PDF talk that talks about overflow diarrhea as well. So you can go to pdf.org/resources to get our free symptom tracker.

Jessie Wong 00:14:10 All right. So that’s another type of diarrhea. We’ve already talked about two types of IBS diarrhea. One is the flare up diarrhea. One is the overflow diarrhea. And then the third one is diarrhea caused by food intolerance. Now now for flare up and overflow diarrhea. If you want to learn more, if you want to see more of the visuals of what it looks like so you get a better understanding, go watch our free IBS masterclass and that is on IBS dietician.com/masterclass. Go register. Join us for a session to learn more about different types of IBS. And of course you can pick our brains too by asking some questions. But I know in our sessions we get so many questions. So if we don’t get back to you, please maybe reach out to us via social media or send us an email. All right. Now, another type of diarrhea that we see all the time as dietitians is food intolerance diarrhea. Do you want to share with us, Brooke? Do you want to share with us what this means?

Brooke Keenan 00:15:12 Yes.

Brooke Keenan 00:15:12 So if you eat a food that you are intolerant to, that is going to trigger a spasm of the gut, and possibly with FODMAPs, it would, encourage water to be drawn into the intestine and then diarrhea. It can also be accompanied, well, all of them with gas and bloating. But if you’re having eating a food that you’re intolerant to gas, bloating and diarrhea can be a symptom of the intolerance.

Jessie Wong 00:15:45 Right. And that is of course something we see the most often. And because people come to us to find your food triggers. Right. I want to share a story with you. This is Jessica. She has she actually came to us for Sibo because she was she went to her physician and then she didn’t get enough help from her physician. She’s actually a nurse practitioner herself, and she’s in a family physician practice group, and she sees a lot of patients as well. But she wasn’t able to get the care she needed from her physician, and she actually went to alternative medicine to get tested for Sibo.

Jessie Wong 00:16:22 And she was positive for people. So she actually came to us for Sibo, and the practitioner and the alternative medicine practitioner told her to get on the low Fodmap diet. Now, this is something, you know, I really wish whenever practitioners are recommending these kind of restrictive diets, they are making a referral to a dietitian because oftentimes we we see people getting stuck on these kind of diets. And in the long run, it can really hurt your gut and it can hurt you and can cause you to have more symptoms. But anyways, Jessica is a practitioner herself, so she knew she needed help from a registered dietitian to help her work through the format protocol and also help her identify what was causing her Sibo. So one of the things that also happened to her was that she had multiple multiple bowel movements throughout the day. Whenever she eats, she runs to the bathroom. And it was full evacuations every single time. So that was also another indication to me that it’s a food intolerance. It’s not overflow diarrhea.

Jessie Wong 00:17:21 It is not the flare up type of diarrhea because it is. She always feels empty after running to the bathroom, but she’s distended. She is also bloated. And what happened was that once I recognized that, and once I asked her more detailed medical history, I learned that she also has other conditions that could impact her guts. And I suggested that I think you have a foot intolerance. How about we try your removing this food from your diet and see what happens? And after talking to her and because she is a health care provider as well, she said the lightbulb moment just went off and everything just clicked. Like all of these other things that is happening in her life, they all clicked. And because of that, she follows through with my recommendations. And actually her diarrhea stopped pretty quickly and she was able to learn more about, her intolerance, her actual food trigger. And once we removed her food trigger from her diet for her, actually, she has what we call non celiac wheat sensitivity.

Jessie Wong 00:18:22 And once we removed gluten from her diet, she was actually able to reintroduce all the fault maps back into her diet, and she was really excited when she was able to tolerate garlic and onion back into her diet, because that was one of her biggest concern. Now with gluten intolerance, again, this is not something we recommend lightly. We only recommend it if it’s necessary, and we always go through elimination and a challenge before we say, hey, this is probably what you have. And for most people who are traveling the gluten free diet by themselves, what we want to say is most people are not doing it correctly. And if you’re not doing it correctly, you’re not going to find symptom relief. And doing it correctly can be very restricting if you’re not doing it accurately. And of course, it is really unnecessary to do the gluten free diet for most people, especially most IBS patients, there’s maybe one third of IBS population that may need it, but you don’t want to just put yourself into a restrictive diet without, you know, really eliminating and testing it properly.

Jessie Wong 00:19:26 Okay, Now, we’ve talked about the three types of IBS diarrhea that we see very commonly in our practice. One is flare up diarrhea, the other one is overflow diarrhea. And the third type is a food intolerance diarrhea. and then there’s also post infectious IBS, which usually results in diarrhea as well. That’s something we see a lot too. And then let’s also talk about what are certain things that we see in our practice that makes people’s IBS worse.

Brooke Keenan 00:19:58 So number one is probiotics. That’s sometimes I get excited when I see that we’re taking a probiotic, because I know if we stop it, a lot of times they’re going to get better pretty quickly once they stop that probiotic. Other supplements, that can just aggravate symptoms or too many supplements for no good reason. Really. sugar alcohols in certain products. low carb products that have a lot of sugar alcohols in them. I’ve had a client who, once she cut out all those sugar alcohols, her diarrhea stopped stress. And then, of course, food triggers or can make diarrhea worse for sure.

Jessie Wong 00:20:40 Right. It is, food triggers and stress. I think stress is something that a lot of people may recognize, but they may not be able to break the stress and symptom cycle. So if you need help, there are some tools out there. Maybe gut directed hypnotherapy or even counseling can be very helpful in learning to manage stress and intern manage your IBS symptoms. Now let’s talk about what are some of the tools that people can use if they are struggling with diarrhea right now?

Brooke Keenan 00:21:13 So Imodium can be a quick fix. Although we don’t we we want people to be cautious in their use of Imodium. But it is safe and I mean cautious because we don’t want it then to be causing constipation and then triggering a whole, you know, potentially different kind of diarrhea. Going low Fodmap is a good way to try, but again, we’d like it to be done with a dietician so you’re not on it too long and you can kind of figure out relatively quickly what’s causing the problem. the deep breathing to again stop that that stress, IBS cycle and fiber can help bulk up your stool and slow it down if it is true diarrhea.

Brooke Keenan 00:21:55 Well, fiber can help both for constipation and diarrhea, but fiber can also help bulk up your stool and slow down that transit time. So it’s you can consolidate sometimes stools. So you’re not having quite so many.

Jessie Wong 00:22:07 Yes. And we actually have a lot of clients podcast episode where they talk about how these different tools were able to help them. And as you are going through the tools about Low-fodmap, for example, one of our previous clients, her name is also Kathy, but a different Kathy that I mentioned earlier. she had post infectious IBS and she was on a low Fodmap diet for a long time before she came to us, actually. And I remember one of the things she said was, is either low-fodmap or running to the bathroom multiple times a day. So we know, like Low-fodmap is really, really helpful for managing or reducing incidents of diarrhea. However, it’s only one tool. It’s probably not the ultimate tool. You really want to understand what’s causing your diarrhea first, and staying on low Fodmap for a long time can be more harmful for you.

Jessie Wong 00:22:55 And we also have another client episode that I don’t know if, if we’ve aired it at this time or not, but her name is Lindsey. She also suffers from a lot of diarrhea. She was running to the bathroom multiple times a day, so much so that she was afraid to drop her kids off at school or even going to the grocery store. And for her, it was the lifestyle triggers that really, made the diarrhea a lot worse. And when she walked through the program, she made a lot of lifestyle changes. And in that episode, we talked about what are the things that really helped her to make the changes that she needed to manage her IBS. So if you need help, go listen to those episodes. All right. let’s go back to talk about long term control. Right.

Brooke Keenan 00:23:45 Once we identify the trigger, if it’s food related, then you it’s important to not only identify the food, but your tolerance level. So we can make sure that you’re liberalizing your diet as much as possible.

Brooke Keenan 00:23:59 If it’s a lifestyle trigger, learn how to manage that. If it’s stress, if it’s sleep, all of which can be helped with deep breathing. But yeah, learning the lifestyle and possible food triggers and incorporating all of the changes into your life.

Jessie Wong 00:24:15 Right. And and when we talk about changes, we’re really talking about small changes that you can do without working with us and the episode with Lindsey. If you have time, I would really encourage you to hear it because she talks about what really helps her. It was the sleep, the exercise, the breathing, and also other things that she mentioned in the podcast. So you are not alone in this journey. And that’s it for today’s episode on IBS, diarrhea and mixed bowel type. We hope you find the stories and tips helpful in managing your symptoms. Remember, understanding your triggers and making the right adjustments can make a difference. If you want to learn more, check out our free masterclass where you can see visuals and get more detailed information. And don’t forget to subscribe and leave a review if you enjoyed this episode.

Jessie Wong 00:25:04 Your support helps us continue to bring you valuable content. Stay tuned to our upcoming episode where we’ll discuss how lifestyle change help one of our past clients, Lindsey, regain her freedom from diarrhea and afraid of leaving her house. Take care and we’ll see you next time on the IBS nutrition podcast.

Brooke Keenan 00:25:25 Bye.

Jessie Wong 00:25:26 Thank you for tuning into the IBS Nutrition podcast. We hope today’s episode has brought you closer to understanding and managing IBS. Remember, you are not alone on this journey and finding freedom is possible. For more on IBS, make sure to follow us on your favorite podcast platforms and please leave us a five star review! We would really appreciate that you can access links mentioned in this episode in the show notes. To learn more about your type of IBS and how to identify your own food or lifestyle triggers, Register for a free IBS masterclass. Three steps to IBS relief for our proven, holistic, three steps approach to managing IBS once and for all, head to IBS dietician.com/masterclass to register and till next time, take good care of your gut and here’s to your health and happiness.