Can You Have IBS-C and IBS-D at the Same Time?

It is a common question among people with irritable bowel syndrome (IBS): “Can I really be having constipation and diarrhea at the same time?”

There are several reasons why you might be experiencing both of these symptoms together. As always, changes in your typical IBS symptoms should be discussed with your doctor. IBS is often unpredictable, and by definition it is associated with altered bowel habits. But if new symptoms or patterns emerge, they could be a sign of another condition and they should be investigated.¹

IBS with constipation and diarrhea

Mixed IBS (IBS-M) is a common IBS subtype. It is defined as 25 percent of stools being loose and watery and 25 percent of stools being lumpy and hard when you are not taking laxatives or antidiarrheals.^1,2

IBS is different for each person, and the mixed subtype of IBS is an especially diverse category. People with IBS-M report symptoms that are common in people who have IBS with constipation (IBS-C), such as straining, the feeling of having an incomplete bowel movement, and manual evacuation of the bowels. They also report urgency, which is more typical of IBS with diarrhea (IBS-D).^1,2

More studies of people with IBS-M are needed to understand this condition more accurately.

Diarrhea and constipation definitions

Diarrhea is loose stools that may or may not come with abdominal cramping. On the Bristol Stool Form Scale, types 6 and 7 indicate diarrhea.²

To doctors, constipation is hard, round stools, or types 1 and 2 on the Bristol Stool Form scale. However, many people think constipation is also:^2,3

• Infrequent bowel movements
• Straining or pushing during a bowel movement
• Feeling that you cannot completely empty your bowels
• Feeling like you need to have a bowel movement but can’t

Loose stool followed by a feeling of having had an incomplete bowel movement might seem like constipated diarrhea. In order to get the right treatment, it is important to be as clear as possible when describing your symptoms.⁴

Other conditions

A small number of people who have had constipation for a very long time have what is called fecal impaction with diarrhea. This could happen when a large lump of hard stool is stuck in the rectum. The rectum stretches out, and liquid stool flows around the fecal mass. Symptoms of overflow diarrhea are small, pellet-like stools alternating with watery diarrhea.^5,6

Other symptoms include abdominal cramps, bloating, and straining. Long-term use of laxatives, certain pain medications, and anticholinergic medications can be a cause of fecal impaction.^5,6