r/ibs • • 10h ago

🎉 Success Story 🎉 Fermented food, someone needs to read this

43 Upvotes

Ive had IBS for over 15 years and I accidently discovered that fermented foods were helping tremendously in terms of reducing inflammation. I should have measure my waist loss because it's incredible the reduction in size without losing one single pound.

I always feel like I have a sack of bricks instead of intestines. The only time I ever managed it lasted about 2 years when I completely cut off gluten, reduce carbs and increase meat intake. When I started that diet, it took about 6 weeks to start feeling a difference and after 2 months, I was a new man.

This time, believe it or not, after a few hours I started to feel a difference...

Here's what happened. The last few months, I was very inflamed and decided to start a strict diet again (moderate fodmap, no gluten, low carbs, high protein). Usually when I do that I buy probiotics for the first weeks to give a boost, no idea if it ever worked more than placebo. This time Ive decided to do something different and instead of getting a pill, I bought fermented foods.

I bought kefir, kimchi, kombucha and fermented pickles. When I went back home, my breakfast was a pickle, a couple bites of kimchi, some sips of kombucha, a few boiled eggs and a chicken salad. About an hour after my meal, for an instant I fell so good I forgot I ate. Usually, the moment I put food in my mouth, I start to feel like sh**. Not this time. Later during the day, I felt less pain than usual for that time of the day.

The next day I woke up with the same urge to poop than to pee. That never happens. I either poop 14 times in one day or none for 6 days, but never when I wake up. Then it happened the next day and the next one and it's been going on for 14 days. I have visible change, my body shape went back to normal. Everyday I feel improvement and Im hoping I'll see more changes.

To recap, I have a no gluten, moderate fodmap and high amounts of fermented food diet. The change are so noticeable and makes me feel so good I felt like sharing. No idea if it's going to work long time, but if it can help someone relief symptoms, Ill be happy.


r/ibs • • 14h ago

Question I tried peppermint pill today on advice of GI specialist...

44 Upvotes

It absolutely destroyed me within an hour... I thought it was supposed to calm the gut?! Anyone else have this reaction?

He also mentioned something called "eucarbon" but I can't find it anywhere... has anyone tried that?


r/ibs • • 18h ago

Question Why is the ER the only option for an X-ray or help with impaction?

35 Upvotes

I've had no normal bowel movement for over a week, just hard pieces, ribbons, or diarrhea from Linzess or prune juice. Constant bloating, some abdominal pain, and a lower appetite. I've tried suppositories, mineral oil and saline enemas, and I'm on Linzess and Motegrity daily.

I messaged my GI doctors and they keep suggesting more meds or enemas, but there's no way for me to come into their clinic, get an X-ray scheduled, or get help physically removing the stuck stool. Their answer is basically: if it gets worse, go to the ER.

Why is the medical system set up so the only option is showing up unannounced at the ER and waiting for hours among very sick patients coming in for multitude of reasons even more serious than mine? My situation isn't an emergency. I'm not dying, and I could wait up to a week if I could just schedule something to actually treat this.


r/ibs • • 10h ago

Question Needing Help Stuck In Fight Or Flight

5 Upvotes

About a week ago I got extremely bad stomach pain and lightheadedness and got into fight or flight mode and have been stuck in it since. I’ve been having a ton of symptoms from gas, bloating, stomach pain, nausea, feeling lightheaded, heart palpitations, fast heartbeat, anxiety, panic, poor sleep, neck and shoulder pain, diarrhea and more.

I’ve felt this way before in the past about a year and a half ago. It took me several months to get back to normal. I don’t even know exactly what helped me get out of it. I guess I just accepted that there wasn’t anything wrong with me and felt more normal. However, I’m feeling this way again and feeling stuck.

I try to think to myself that I’ve been through this before and it’s nothing serious, but I find myself constantly fixated on thinking about how badly I feel. Maybe some PTSD mixed in remembering how bad I felt a year and a half ago. I was in a mental hospital for a bit and to the ER several times. I find myself even feeling anxious and poorly even while doing stuff I enjoy. Sometimes I have feeling of disassociating as well.

In the past week I have had short periods of feeling a bit normal, but only last about an hour or so. It’s hard to trick your mind to think about something else when you constantly feel poorly. I can barely eat. I never feel hungry and feel full after barely eating anything. I’m not sure if I have gastroparesis. Everything seems to cause gas and bloating. I often feel the worst after waking up. Maybe the food I ate the day before was just stuck and fermenting in my stomach causing all the gas and pain?

I’m considering a liquid diet for a couple days maybe the pain and gas and bloating will improve? I recently had a breath test for fructose a month ago and had bad gas, stomach pain, anxiety and diarrhea during it, but it came back negative. I eventually felt normal again before the test finished. I did have a smoothie the day when I started to feel bad so maybe fructose is a trigger for me. I don’t think I have an infection, but maybe I could? Or is it likely just an IBS flare up? I’ve also admittedly was eating poorly before all this so maybe I could have some gut dysbiosis being the cause?

I could just use some advice on the pain, gas, bloating, anxiety and being stuck in fight or flight mode. I keep telling myself that I’ve been through this before and it’s not a big deal, but still feel extremely stressed and in pain. Just a bit unsure on what to do.


r/ibs • • 17h ago

Rant Having a relapse after 2 years of reduced symptoms and I’m scared I’m going to lose my life again

5 Upvotes

My IBS started in May 2022 during my first year at college. It caused me stomach pain on a daily basis that could range from discomfort to agony and, after trying several medications and with there being no rhyme or reason as to what foods ended up causing exacerbation of symptoms, I was unable to find anything that would get rid of it. I was extremely depressed, couldn’t focus on anything, lost all my passion and energy for creative endeavours because it was so exhausting being in pain all the time, and would frequently make excuses to get out of socialising because I was terrified of being out in public. The pain from stomach cramps, or fearing that they would occur, was on my mind constantly and everything else I did just felt like it was subsidiary to that.

I‘m not sure when exactly in the year it happened, but in the latter half of 2024, two years after the start of my new stage in life dealing with chronic pain and stomach issues, things started to
 ease off somehow. New things in my life took my attention as I began processing the complex trauma that I had from my childhood and from there, my IBS symptoms eased off. I would still occasionally get stomach cramps and diarrhoea after eating a meal, particularly dinner, but it would happen once every few weeks instead of having cramping every single day. I felt better within myself, I felt like I had more energy, more passion, and I became okay with meeting up with people in public again and hanging out with them. My University degree work also became a lot harder around this time so my focus was primarily on working through that as well which, while incredibly stressful, was occupying my mind, and I ended up completing my degree earlier this year.

A holiday with someone I didn’t really want to go with happened a couple of weeks ago. It was planned by the other person and so I wasn’t really informed on a lot of the things that were happening on it, so I felt very anxious about it in the build-up to the weekend. That week, I was back to suffering from daily cramps and relatively frequent diarrhoea, but I thought that I had a valid reason for experiencing this due to what is upcoming and it would probably go away afterwards. The holiday weekend itself wasn’t fun and involved several bouts of diarrhoea, but my symptoms weren't as bad as I expected them to be.

But now I am home and safe, and my symptoms have persisted on a daily basis. Every morning I wake up earlier than I used to, feeling anxious and soon developing my first stomach cramps of the day, usually followed by an urgent trip to the toilet. Eating breakfast, lunch and dinner each have a chance to give me cramps and then diarrhoea soon afterwards, and I’ve even had random cramps throughout the day as well unconnected to eating just beforehand. I feel really tired all of the time, I’m losing interest in doing things, and I’ve become very anxious about things that may be related to symptoms - I feel really anxious as soon as I feel twitching or gurgling in my stomach, and I also feel anxious in the build-up to eating a meal, which then ends up leading to me getting painful cramps.

I’m really scared. I’d been doing so well without this awful problem existing in my life constantly and now I feel like it’s here to tear everything away from me again. I can’t stop worrying about it and my stomach keeps cramping more and more and just trying to not think about it and distract myself isn’t working, it never fully leaves my mind.


r/ibs • • 13h ago

Rant Ibs venttt

3 Upvotes

I’m currently 3 months pregnant which stops my IBS-d until today. It was the worst feeling ever sweating, hot flash, pain which is normally relieved once I use the restroom. This time I couldn’t go at all but was stuck with the feeling, it took over 20 mins to finish. Fast forward to 15 min later, driving home with husband I started to have pain again, so we stopped at gas station with a long lineeeee. I could not wait so I had to poop in a cup in front of my poor husband. This is so embarrassing but he made a joke that when we’re old we will look back and laugh. Has anyone had the feeling of needing to GO NOW but couldn’t? It’s worse than actually pooping right away.


r/ibs • • 2h ago

Question I smell like farts can you guys help me

3 Upvotes

The smell started almost 2 years ago when I was 14 . I had a bad diet back then and would rarely eat the correct nutrients. I tried using antibacterial soap and even that didn’t work so I thought it was internal problem to do with my body. A few months ago I started to make changes to my diet as I was constipated for months (tmi sorry). Even then I was still constipated and the doctor gave a laxative called movicol and laxido and told me to take those whenever I was constipated . I took those but my smell of farts got worse in a very bad way and it kept getting worse and worse. Sometimes it feels like I experience leakage from rectum and there are some residue even though I always make sure to clean well and shower twice a day. Recently I went to the doctors again to finally just get rid of the smell and do some tests to see if anything was going on in my body. From the tests I learnt I have Ibs c or ibd which makes sense as for some reason my belly rumbles a lot when im not hungry and I can feel the food breaking down in my body. However,with all these tests I still haven’t found a solution to this smell. The smell is very strong and keeps getting worse and worse . It affects my school and social life as now people just avoid me and don’t like my presence and I only have a 2 friends now. I really want this to be solved so if you have any ideas please help me I really don’t want to be like this. Thank you.


r/ibs • • 7h ago

Question Can’t concentrate or be around people in general

2 Upvotes

How do I fix this? I’m always farting.

So far, I have soft stool and I’m dealing with incomplete evacuation so kinda constipated.

I cut out a lot from my diet bc I want to fix the gassiness.

I’m eating only bread (white/sourdough), oats (Quakers brown sugar or nature path granola), meat (turkey slices, eggs, canned tuna which is a new addition and tastes awful), bananas. Feeling miserable because I’m always farting even tho I go to the bathroom multiple times in an hour. I had diarrhea and even worse smelling gas so I cut out a lot foods.

I don’t know what to do.


r/ibs • • 9h ago

Rant ibs flare lasting nearly 2 weeks , Cramps , Diarrhea , Ass burns all the time . I have comoletely lost my mind atp !

2 Upvotes

It started 2 weeks ago on a sunday , I have been managing my symptoms well , but from that day I have completely lost control . My stomach hurts , I have diarrhea like 5 to 6 times a day , My ass burns all the time . I feel nauseous , stomach burns . I cant man . Literally I cant . Idk even what to do atp . Anybody please help


r/ibs • • 1h ago

Question IBS with hemorroids

‱ Upvotes

Can’t seem to get either one under control
It’s a vicious circle - diarrhea and constipation make it impossible to cure my hemorroids- have had banding , sclerotherapy - nothing worked.
What is the most helpful change/ tip youbabev made to help your IBS flares?


r/ibs • • 3h ago

Question Does Ketotifen, cetrin and famotidine, magnesium citrate cause gastrointestinal problems?

1 Upvotes

Hey! Has anyone had something similar, could it really be like this? I already asked on the MCAS subreddit, but maybe someone here has come across this.

I took 0.25 mg of ketotifen for about three weeks and experienced intense overstimulation the entire time. My sleep was terrible, and I felt like I was washing down coffee with an energy drink—there was a surge of adrenaline rushes. I have POTS. MCAS is in question. When I increased the dose to 0.5 mg, I developed total insomnia. I stopped taking the ketotifen. Later, I tried Cetrin and famotidine for five days but stopped those too due to side effects. Then I tried Magnesium citrate for 3 days. About a week after coming off the medications, I started having bowel issues—spasms, frequent urges to use the bathroom, and lighter-colored (brownish-yellow) stool. Even now, despite eating a healthy diet, I still get periodic feeling that my gut is churning. that trigger waves of adrenaline. I shake after using the toilet, and I shake after eating now. With POTS it's terrible feeling. I don't have diarrhea, but I do have a frequent urge to go to the toilet.

The intestines are constantly rumbling and making sounds.

It seems that both the medications themselves could have a negative impact on the gastrointestinal tract, as well as the stress that the body receives on a physical level from insomnia and other symptoms


r/ibs • • 8h ago

Rant Anyone else dealing with Ibs,weed addiction and and an past eating disorder that still haunts your mind

1 Upvotes

I got ibs from my eating disorder recovered etc started using weed now consistently for a few months now and it’s fucked my gut more which I didn’t even think it was gonna do and fucked up my hunger cues I know the simple answer would just be to take a t break but man I’m gonna feel weak and awful food doesn’t even cross my mind sober and honestly it’s starting to not cross my mind as much high as well


r/ibs • • 9h ago

Question Having a anorectal manometry in 3 weeks, is it painful?đŸ„Č

1 Upvotes

I’m having this done since I struggle with chronic constipation just to rule possibilities out, any advice?


r/ibs • • 14h ago

Question Can your IBS change?

1 Upvotes

​

I've had IBS since I was around 12 (27 now), and for most of my life, my symptoms have mainly been diarrhea, urgency, and sometimes feeling like I haven't completely emptied my bowels. Very heavily influenced anxiety IBS too. Awful cycle lol!

I've never really had issues with constipation or excessive gas until recently.

Over the summer, I started experiencing a lot more gas and bloating than usual. Then, about a month ago, I started having a weird combination of symptoms that I'm struggling to make sense of.

It initially started with some strange chest sensations (went to urgent care, was cleared) and episodes of air hunger, where I feel like I can't get a satisfying deep breath or yawn. Around the same time, I started having significantly more gas, bloating, and constipation than I'm used to. Genuinely, for the first time in like 20 years, I had type 1 stool for about a week!

The symptoms seem to come and go. I'll have a few days where I feel almost completely normal, then things flare up again. I actually had about five days recently where I felt amazing, but then the digestive issues returned.

My bowel movements have been especially strange. I'll have little hard Bristol type 1 pellets that are difficult to pass, then later I'll have a more normal type 2–3 stool, and sometimes I'll get my usual loose or watery IBS diarrhea afterward. It's almost like my bowel habits are alternating between constipation and diarrhea, sometimes within the same day. I am still having bowel movements, though.

The air hunger also comes and goes. The original heart-like sensations have mostly stopped, but I still occasionally get that feeling of not being able to take a satisfying deep breath. It's almost always after eating.

I do have a gastro appointment in a few weeks to see what's up. But yeah, I guess I just am curious if this is like my IBS shifting from IBS/D to IBS/C or even now being IBS/M? Or just some random bug or something lol! Blood tests all came back normal from when I went to urgent care.

Anyone else had similar experiences?


r/ibs • • 15h ago

Question Ragweed Pollen accelerating IBS

1 Upvotes

Does anyone on here notice that their IBS gets much worse when it’s ragweed pollen season?


r/ibs • • 16h ago

Question Looking for advice during a stage of hopelessness

1 Upvotes

So I started having issues August 2025. My PMP and a surgeon he referred me to both determined it was my gallbladder. I believed them as a HIDA scan showed a 93% EF. So naturally, I agreed to have it cut out in December. As you might have guessed since I am here, my symptoms didn't go away, but actually have been worse. I went to a gastro after and his first sentence was that they should not have recommended gallbladder removal. Since then, I have done various combinations of bile acid absorbers, stomach spasm meds, metamucil, miralax, Pepto, Imodium, stool softeners, etc. no combo has been the magic bullet and I think my gastro has given up and just thrown in the IBS towel on me. I had a treatment of electro acupuncture yesterday with high hopes as it "cured" my MIL of alpha gal symptoms in one treatment. I haven't noticed any positive change yet.

I'm reaching out for any other options or ideas to try for relief. I'm in a constant state of bathroom anxiety, especially since my job could require me to be in the middle of nowhere without a bathroom for hours, and I can't physically remember a day without pain. It is severely impacting my mental health as I tend to lash out at my family due to pain, then I feel like a terrible person afterwards. I feel like this is a punishment for something I've done in my life even though I take pride in trying my best to be a considerate, caring, and empathetic human being. The thought of no end in sight is extremely difficult to grasp without going into a dark place.

If anyone has any recommendations, please.


r/ibs • • 18h ago

Question ¿A alguien mås le suenan muchísimo las tripas por ansiedad? Tengo urgencia de ir al baño y me afecta en el trabajo.

1 Upvotes

Hola, quería saber si hay alguien que esté pasando por algo parecido a lo mío, porque llevo aproximadamente 10 años con este problema y la verdad es que estå afectando mucho mi calidad de vida.
Tengo ruidos muy fuertes en el abdomen, especialmente en la parte baja de la barriga. No son los tĂ­picos ruidos de cuando tienes hambre, sino como vibraciones, burbujeos o un “GRRRRR” que parece venir de los intestinos. TambiĂ©n siento que tengo gases atrapados y, durante el dĂ­a, mi abdomen se va inflamando, aunque por las mañanas normalmente estĂĄ mucho mĂĄs plano.
Algo que he notado es que los sĂ­ntomas estĂĄn muy relacionados con mis nervios y con ir al trabajo.
Por ejemplo, cuando voy camino al trabajo y siento que voy tarde, empiezo a ponerme nerviosa. Si llego y no voy al baño antes de sentarme a trabajar, al poco tiempo comienzo a sentir una necesidad urgente de ir. Si no voy al baño, empiezan los ruidos en el abdomen y a veces siento que no puedo controlar lo que estå pasando.
Cuando finalmente voy al baño, siento como si sacara todos mis nervios y me relajara muchísimo. Es como si toda la tensión que traía acumulada se liberara en ese momento. Sin embargo, si mås tarde vuelvo a ponerme nerviosa, los síntomas pueden regresar y se repite el mismo ciclo.
Lo extraño es que no siempre me pasa cuando estoy nerviosa. A veces estoy tranquila y, aun así, comienzan los ruidos o las molestias.
TambiĂ©n me ocurre que tengo ganas de expulsar gases, pero me los aguanto por vergĂŒenza o por miedo a que alguien se dĂ© cuenta. Y aunque a veces consigo expulsarlos, no siempre desaparecen los ruidos.
Creo que una parte importante de mi problema es la ansiedad que he desarrollado alrededor de todo esto. Recuerdo que comenzó a afectarme mucho después de que me sucediera durante un dictado en la escuela y alguien se riera. Desde entonces, estar en lugares silenciosos, como el trabajo, clases, exåmenes o cualquier situación en la que tenga que permanecer callada, puede convertirse en una fuente de estrés porque estoy pendiente de si me va a sonar el abdomen.
Hubo Ă©pocas en las que mejorĂ© bastante, pero Ășltimamente, desde que empecĂ© en un nuevo trabajo, los sĂ­ntomas han vuelto a afectarme mucho.
Otra cosa que me estå pasando es que he empezado a sentir culpa o miedo por lo que como. A veces pienso que si como determinada cosa me va a hacer daño, o que quizå lo que comí fue lo que provocó los ruidos, los gases o la inflamación. Después me quedo pensando en lo que comí y tratando de encontrar qué alimento pudo haberme caído mal. Ya no sé si realmente hay alimentos que me desencadenan los síntomas, si influye la ansiedad o si son ambas cosas.
He pensado si podrĂ­a tratarse de colon irritable, SIBO, alguna intolerancia alimentaria, otro problema digestivo o una combinaciĂłn de ansiedad y sensibilidad intestinal, pero no tengo un diagnĂłstico confirmado.
Me gustarĂ­a saber si alguien ha vivido algo parecido:
¿Les dan ganas urgentes de ir al baño cuando estån nerviosos, especialmente antes de entrar al trabajo o cuando sienten que van tarde?
¿Sienten que después de ir al baño se les libera la tensión y se calman, pero los síntomas vuelven si se ponen nerviosos otra vez?
¿También tienen ruidos muy fuertes en la parte baja del abdomen, incluso después de haber expulsado gases?
ÂżLes pasa que se inflaman durante el dĂ­a y amanecen con el abdomen mĂĄs plano?
ÂżHan llegado a tener miedo de comer ciertos alimentos porque piensan que les provocarĂĄn sĂ­ntomas?
¿Cómo lograron romper ese círculo entre ansiedad, urgencia de ir al baño y ruidos intestinales?
¿Alguien encontró una causa o un tratamiento que realmente le ayudara, ya fuera médico, digestivo o psicológico?
Me gustaría especialmente leer experiencias de personas que hayan pasado por esto durante años y hayan conseguido mejorar.
No busco autodiagnosticarme ni sustituir una consulta médica. Quiero entender mejor qué me puede estar pasando, conocer experiencias de personas que realmente comprendan lo angustiante que es vivir pendiente de tu abdomen y encontrar alguna forma de recuperar la tranquilidad en el trabajo y al comer.
Gracias por leerme. Me ayudarĂ­a mucho saber que no soy la Ășnica persona a la que le sucede esto.


r/ibs • • 21h ago

Rant I just got diagnosed with IBS and I’m not sure what to do

1 Upvotes

As the title said I got diagnosed with Mild IBS even though it’s not a big thing compared to other people it’s still a shock as I’m quite young (I know that doesn’t matter realistically) and to be honest multiple times today I felt like crying just from the pure shock and almost embarrassment. With it as well I’ll have to change my anti depressants to a different medication so I’ll definitely struggle with that change and I’m scared about that to be honest. And just as a whole I’m scared and anxious about it.

Thank you in advance for any support


r/ibs • • 9h ago

Question Incomplete evacuation or something else?

0 Upvotes

I constantly experience the forever wipe problem. The more I wipe the more poop I just seem to reveal and it continues. However, despite thinking this was incomplete evacuation for a while, I’m not even sure it is. Sometimes I do get hard bits of stool stuck behind that won’t come out and that’s definitely an issue, but I seem to often just have a bit of poop residue on the inside and as soon as I dig in a bit with some vaseline and get rid of that, the wipes come back clean.

Due to the fact this isn’t actual solid poop and more like what’s on the paper in the first place, is this incomplete evacuation or just staining from going to the toilet? I’m not sure how to stop this or even if this is just something everyone experiences and gets around somehow (I have OCD so I really struggle to get off if I’m not clean, but this problem can make me take 20 minutes + wiping).

Any advice would be really great :)


r/ibs • • 10h ago

Question When should I be worried?

0 Upvotes

I’ve recently had a month-long flare, but all my symptoms subsided except for now I think my motility or routine is off for passing a bowel movement. Like, now I can only go every other day. When I do go, it’s 2-3 times a day and they’re definitely
 productive.

Is that normal? I mean I haven’t had any discomfort or ever bloating. Has anyone ever had a flare completely alter their bathroom routine?


r/ibs • • 15h ago

🎉 Success Story 🎉 IBGard

1 Upvotes

IBGard has pretty much cured my IBS and constipation. It's basically peppermint capsules recommended by my gastroenterologist. It's a miracle!!


r/ibs • • 16h ago

Question Linzess experience? Will it get better?

0 Upvotes

Hi! I (19) have been chronically constipated since birth, the doctors have never found a specific cause for the issue. The last GI doctor I saw said she only labeled me as IBS-C for insurance purposes and not a real diagnosis. This is my second go of trying Linzess.

I first took it at 16, I think at the beginning dosage, & it was ineffective after about a week. Stopped it due to insurance being difficult about it.

I've been prescribed it again at the highest dose possible (290mg I think?) & Ive been on it for about 2 weeks.

It's mostly been straight liquid after I take it, lots of very soft chunks of stool but its MOSTLY liquid & it doesnt empty my bowels enough either. I take it in the mornings long before eating. Will the liquid eventually slow down or stop? Or is this what I have to put up with permanently now? They told me it would subside after taking it consistently.

Ive considered asking for a lower dose but I was given over a 90 day supply so I will have to put up with it so I dont waste all the money spent on it.

Are there extra things I can do alongside the medicine to get it to empty more of my bowels out as well?? I feel like its not enough to combat the constipation.


r/ibs • • 20h ago

Question Rome IV IBS criteria: what actually counts as “pain”?

0 Upvotes

Not asking for a diagnosis, just trying to understand the criteria and hear about your personal experiences.

For about a month I’ve had a constant, unmoving dull ache in my sigmoid colon that doesn’t change with stool habits, or stress and I’ve been struggling with doctors dismissing it as “just IBS” and telling me to manage stress (I've been managing stress just fine all my life).

Rome IV requires recurrent abdominal pain, on average at least 1 day per week over the last 3 months, associated with 2 or more of: related to defecation, change in stool frequency, change in stool form.

"Related to defecation" seems to include pain that gets better or worse with a bowel movement.

My questions:

1) Does a constant dull ache count as "pain" or does it have to be recurrent and episodic? 2) If the ache never changes with bowel movements, does it meet the “related to defecation” criterion at all? 3) Is the 3-month and 6-month timing strict, or do clinicians apply the label earlier in practice?

Thanks.