Mucus In Your Stool With IBS: Causes & When To Worry [Dr. Farahat]
Mucus in the stool with IBS is one of the signs of irritable bowel syndrome. According to this study, approximately half of IBS patients may experience mucus in stool. Its presence supports the diagnosis of IBS.
The famous Rome IV criteria didn’t include mucus in stool. But another less famous criteria for IBS called “Manning criteria” did so.
According to Manning criteria, mucus in stool promotes the likelihood of IBS. So, it is usually (not always) apart of your IBS.
If this is your first landing on my blog, I’m Dr. Farahat, a gastro-enterology doctor and IBS sufferer. So, I am probably the perfect guy to hear from (about your IBS).
Today I will try to answer the most important questions running in your head about mucus in stool with IBS.
If you don’t like reading, we made a short video for you explaining the main points
(Q1) Is Mucus In Stool With IBS Normal?
Answer: In short, yes but not always.
Mucus is a natural part of your stool. It is secreted in small amounts by the mucous cells lining your colon and small intestine.
In normal conditions, you will not notice mucus in the stool because of its clear color and small amount.
And it has beneficial effects:
- Help easy passage of your stool.
- Traps harmful organisms in your gut.
Mucus could present in the stool of some of IBS patients. it is more common with IBS-Diarrhea. mucus in stool with IBS is characterized by:
- it is clear white or yellow in color.
- associated with abdominal cramps or tenesmus.
- not associated with red flag signs like:
- blood or pus with mucus.
- nocturnal diarrhea (diarrhea that awakens from sleep).
- weight loss.
(Q2) what are the causes of mucus in stool other than IBS?
Answer: Mucus in stools occurs due to a variety of conditions. It is difficult to differentiate between IBS mucus in stool and other causes. This is because the symptoms of IBS are similar to other diseases causing mucus in stool.
I will try to break down the major causes of mucus in stools other than IBS.
The value from this article is not to substitute medical advice by your doctor, but to:
- Initially help you to evaluate your condition.
- Guide you to know when to consult your doctor.
The other causes of mucus in stools are:
A- Bacterial infections of your intestine (Gastroenteritis/Bacillary dysentery):
Bacterial gastroenteritis is a very common cause of mucus in stool. And it is common for gastroenteritis to be confused with IBS flare-ups.
Bacterial gastroenteritis caused by a variety of bacterial species like:
- Salmonella (typhoid fever).
- Shigella (bacillary dysentery).
- Campylobacter Jeujeni.
- And others.
Symptoms and differences from IBS:
- Abdominal cramps, more intense, not related to meals, and can awaken you from sleep.
- Usually, diarrhea, which is more severe, not related to food (can occur at any time0.
- The mucus in stool may be associated with blood (dysentery).
- Fever usually occurs with bacterial infections. It may be a high-grade fever (exceeds 40° c).
- These infections are foodborne. The severe form is called “food poisoning”.
What to do:
- If your mucus in stool is associated with the symptoms above you have immediately to consult your doctor.
- Your doctor may ask for a stool sample to define the causative bacteria.
- The condition is usually more severe than the regular IBS flare-up and requires treatment with antibiotics and strong symptomatic treatment.
B- Not drinking or eating for many hours.
As we mentioned before, mucus normally presents in small amounts in your stool. The color is clear white or yellow making it difficult to notice.
With dehydration, mucus tends to become more think and stool contains less water. Also, the amount of mucus tends to increase relative to stools. At this point, the mucus becomes visible in the stool.
Usually, dehydration causes both constipation and mucus in stool.
- Not drinking water or recurrent vomiting for any reason causing dehydration.
- No other symptoms of IBS like colics, bloating and distension.
- No evidence of bacterial infections like fever, vomiting, and severe abdominal pain.
- Usually, the stool is hard with dehydration (constipation), mixed with mucus or preceded by a small amount of mucus.
- The mucus is clear (no pus nor blood).
C- Anal Fissure:
An anal fissure is a breakdown in the mucous membrane lining your anal canal. The most common cause of anal fissures is chronic constipation.
Anal fissure causes chronic irritation to the inside of your anal canal. This irritation stimulates mucous cells inside your rectum and anus to produce more mucus.
So, Mucus in stool with IBS-Constipation may indicate that you have an anal fissure. But the severe pain during defecation is the most specific symptom.
Symptoms & differences from IBS mucus:
- The most common presentation of the anal fissure is intense pain during defecation.
- Usually, you have constipation for a long time (anal fissures are more common with IBS-Constipation.
- The mucus in stool usually passes at first then the stool (as it is formed in the last part of your colon).
- Mucus in stool may be associated with bright red blood due to bleeding from the fissure.
What to do if you think you have anal fissure:
- Get an appointment with your doctor to confirm your case by doing an examination of your anal area.
- Your doctor will usually prescribe a topical cream to decrease the pain and relax your anal muscles.
- Also, you should take a laxative to decrease constipation which is the cause of your anal fissure.
C- Inflammatory bowel disease or IBD (Ulcerative Colitis and Crohn’s Disease):
IBD is a group of disorders characterized by true inflammation and ulceration of your intestine. It is caused by a faulty immune response to your gut cells and bacteria. Your immunity attacks your own colon and intestine causing ulcers and bleeding.
The condition is usually more severe than IBS. it causes mucus in stool with or without visible blood.
Symptoms and how it is different from IBS mucus:
- IBD is mainly associated with diarrhea, the diarrhea is not related to food and may awaken you from sleep.
- Mucus in stool is usually not clear; associated with pus or blood.
- Weight loss.
- Iron deficiency anemia (pallor and easy fatigue).
- May be associated with fever.
- The fever, anemia, and weight loss are not present with IBS.
What to do if you suspect inflammatory bowel disease (IBD):
- Weight loss, anemia, fever, and unclear mucus (with pus or blood) are not a part of IBS; you should get tested immediately.
- If you have such symptoms your doctor will ask to do some blood and stool tests.
- Usually, the definitive diagnosis of ulcerative colitis and Crohn’s disease is by colonoscopy.
- Treatment includes a drug called “mesalazine” and in more severe cases steroids and other treatments may be tried.
D- Intestinal obstruction (Uncommon).
Intestinal obstruction is a medical emergency. It occurs when your colon or more commonly small intestine gets obstructed.
The most common causes of intestinal obstruction are:
- Most commonly (60%): Fibrous adhesions around your bowel loops (especially if you have previous operations inside your abdomen).
- When a bowel loop stuck inside a hernia.
- A block by a cancer mass like colon cancer.
- Volvulus: when stomach or intestine twists around itself.
This bowel obstruction prevents stool from passing through your colon, leaving mucus secreted by your colon to pass alone during poop.
Symptoms and how it is different from IBS mucus:
- The main symptom of intestinal obstruction is “absolute constipation”; when you poop you only pass clear mucus without a stool (unlike mucus in stool with IBS).
- Usually associated with severe distension, abdominal cramps.
- Persistent vomiting usually occurs as the food unable to pass.
What to do:
If you have the triad of (absolute constipation + persistent vomiting + absolute constipation) you should consult your doctor immediately.
This a medical emergency and usually requires surgical intervention to treat the cause.
(Q3) when should I worry/consult my doctor?
Mucus in stool with IBS is usually a benign condition that is a part of your IBS. If you habitually pass mucus in stool with IBS attacks you don’t have to worry.
The mucus in stool with IBS is usually clear white or yellow. It is not associated with blood or pus.
Consult your doctor in you experience one of the red flags:
- Passage of pus (unclear mucus) with severe tenesmus.
- Passage of blood with mucus.
- Diarrhea associated with fever and/or vomiting.
- Intense pain at the anal canal during defecation (anal fissure).
- Diarrhea with mucus that awakens you after sleeping.
- Persistent vomiting.
- Weight loss, anemia.
- Recent antibiotic use.
- Passage of mucus without stool with severe distension and persistent vomiting (intestinal obstruction).
All the above-listed flags don’t naturally occur with IBS mucus. They indicated that the underlying cause of mucus in stool is not your IBS.
If you don’t experience any of the above red flags, then the mucus in your stool is mostly due to IBS.
(Q4) How to prevent and treat mucus in stool with IBS?
Mucus in stool with IBS is commonly associated with IBS diarrhea, and its treatment is no different from the usual treatment of IBS-D.
The treatment options you can try:
A- Modify your Diet
The best awarding dietary modification to control IBS-D and decrease mucus is sticking to a low FODMAP diet. FODMAPs are short-chain highly fermentable fibers and polyols.
Eating a diet high in FODMAPs is linked to IBS-Diarrhea symptoms like:
- Diarrhea and mucus in stool.
- Abdominal cramps.
- Bloating and distension.
You can try to restrict diets high in FODMAPs like:
Instead, you can try these diets that are low in FODMAPs:
B- Take Probiotics (over the counter supplement):
probiotics are available in many forms (capsule supplements, probiotic yogurt, probiotic milk). Unfortunately, there are no standard dosing, duration, and strains that fits all IBS. patients.
All we know that probiotics containing “Bifidobacteria” and combinations of multiple strains have better results. but remains lots to be studied about the perfect types, dosing, and duration.
the standard rules to take probiotics:
1- only choose probiotics containing strains that research has proved its efficacy.
2- take probiotics that contain combinations of different strains in full doses.
3- Adhere to one type of probiotics for 3 to 4 weeks, if no improvement, you can shift to another type (trial and error).
4- only choose established brands from a quality manufacturer.
C- Try Peppermint Oil (over the counter supplement):
Peppermint oil is one of the most widely used over the counter drugs for IBS
It is also known for its good safety profile. pharmacists think that the soothing effects of peppermint oil are due to a substance called menthol.
How to peppermint oil works for IBS
It decreases the contractions of smooth muscles of the colon thus decreasing your abdominal pain.
It regulates the motility of your gut it is specifically beneficial in IBS diarrhea.
It also helps to reduce IBS gas and bloating.
When to take peppermint oil
Many clinical trials studied the antispasmodic effects of peppermint oil. Most of them concluded that people menthol can be used as a first-line therapy or abdominal pain.
This is because of its efficacy and in the safety of the drug over other prescription antispasmodics
You can use peppermint oil for:
- IBS abdominal pain
- IBS gas and bloating
- IBS diarrhea and mucus in stool
- Also, with mild constipation.
D- Take Loperamide (ImmodiumⓇ) to stop IBS-diarrhea with mucus:
Loperamide or Imodium is the go-to drug used for diarrhea.
It is an extraordinarily safe drug that is used for people with IBS predominant diarrhea.
How Imodium works
It decreases the movement of your interest thus slowing down the passage of contents.
It increases the absorption of fluid and nutrients from your intestine into the blood.
It prevents the secretion of fluids into your intestinal lumen thus preventing the formation of loose stools.
When to take Imodium:
You can take Imodium if you have IBS diarrhea with or without abdominal pain.
Imodium is also beneficial if you have the mixed type of IBS where there is constipation alternating with diarrhea
When not to take Imodium:
- If you have IBS constipation.
- better not use with Buscopan IBS relief.
- If your diarrhea is not due to IBS (diarrhea not associated with food, awakens you at night or associated with fever). It is better to consult your doctor
- If you have IBS pain without diarrhea.
- If you have dysentery, inflammatory bowel syndrome, or a condition called membranous colitis.
E- Consult your doctor:
If the previous strategies don’t work for you, consult your doctor.
Your doctor will evaluate you for the causes of mucus in stool other than IBS. Also, he will prescribe medications that may be more effective for your condition.
The treatment of IBS is highly individualized and what applies to a certain patient may not apply to you.
Mucus in stool is with IBS may be a normal sign. But it is usually get confused with other conditions that may be similar to the IBS attack.
This table summarizes these conditions and how to differentiate between each of them:
|conditions||How to diagnose|
|Mucus in the stool with IBS attacks|
|Bacterial gastroenteritis mucus in stool|
|Anal fissure mucus in stool|
|IBD (inflammatory bowel disease) mucus in stool|