How to differentiate between functional diarrhea/constipation and IBS?

How do we differentiate between functional constipation/diarrhea and IBS?

According to ACG grand rounds, you must rely on Rome IV criteria, but it’s straightforward if you look at the picture below:

If your patient has stool type 7 according to the Bristol scale and NO pain, it`s functional diarrhea.

If your patient has stool type 1 according to the Bristol scale and NO pain, it`s functional constipation.

However:

If your patient has pain+stool type 7-its, IBS-D

If your patient has pain+ stool type, 1-it`s IBS-C

And bloating and distension can overlap both functional diarrhea/constipation and IBS!

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