Constipated Diarrhea

Can a person have “constipated diarrhea”?

QuestionHas anyone else experienced ‘constipated diarrhea’? I have been dealing with IBS for about 10 years. My symptoms are constant and occur daily and include bloating, gas, and constipation. Strangely enough, more times than not I experience what I refer to as ‘constipated diarrhea.’ I found it disturbing that the doctors I visited wanted to know if I was either constipated or if I experienced diarrhea. My IBS (as I’m sure is most of yours) cannot be so easily classified as one or the other. [Taken from ‘Personal Stories,’ a feature on IFFGD’s web sites; this question and story appeared on]

Answer – Pain and discomfort related to altered bowel habits are the hallmarks of IBS. But what is ‘altered bowel habit’? The commonly used terms diarrhea and constipation mean different things to different people . . . and to physicians as well. Yet bowel symptoms affect treatment choices, so it is important that you and your doctor speak the same language.

How do we ‘translate’ bowel symptoms in a meaningful way? Does diarrhea mean frequent stools, or loose stools? Most people endorse a loose stool as diarrhea more than the frequency of bowel movements. What about constipation? Doctors consider constipation a hard pellet-like stool, because that reflects that the stool has remained in the colon for a long time. But to many individuals, constipation means infrequent stools, difficulty or straining at stools, the sensation of wanting to go but cannot or of not having finished a bowel movement. So while it may seem strange to have ‘constipated diarrhea,’ if one has difficulty having a bowel movement or feels he or she hasn’t finished but has a loose stool it all makes sense.

The Rome III committees have designated 4 subtypes of IBS based on criteria that describe diarrhea, constipation, mixed (both diarrhea and constipation), and alternating (shifting pattern of diarrhea and constipation). The diarrhea subtype of IBS has been designated to be loose/watery stools more than 25% of the time and hard pellet-like stools less than 25% of the time. Conversely, the constipation subtype of IBS is the hard pellet-like stools more than 25% of the time and loose watery stools less than 25% of the time. In ‘mixed IBS’ individuals have both loose watery stools more than 25% of the time AND hard pellet-like stools more than 25% of the time. When this pattern shifts between diarrhea and constipation it is called ‘alternating IBS.’

– Douglas A. Drossman, MD

Adapted from IFFGD Publication #265 by Douglas A. Drossman, MD, Drossman Gastroenterology PLLC, Chapel Hill, NC. Published in Digestive Health Matters, Vol. 16, No. 4.

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