Do I have Irritable Bowel Syndrome?

What is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome (IBS) is a recurring and chronic functional bowel disorder consisting of abdominal pain, cramping, bloating, gas, diarrhoea, and constipation (Hungin et al., 2014). It affects the small and large intestines, causing these symptoms in the gut or bowel. It is a “syndrome” because it is a group of various symptoms that aggravate the gut; however, these symptoms may be expressed differently depending on the individual (Gucht, 2015). IBS is also considered a “gut-brain interaction” or disorder because the brain influences the gut, for instance, through stress and anxiety (Drossman, 2016).


IBS is usually diagnosed by using symptom-based criteria because there are no specific biological markers for the diagnosis (Hungin et al., 2014).


As there are no tests available in allopathic medicine that allow doctors to be absolutely positive about the diagnosis, the diagnosis is often given on a balance of probabilities, depending upon the type of symptoms, severity and any known factors that make them better or worse. For this reason It has recently been suggested by a group of experts that there are a set of symptoms that can be used to make a positive diagnosis of IBS, with a good degree of reliability, via the use of the “Rome criteria”.


In simple terms IBS can be diagnosed when a patient presents with symptoms which are either continuous or recurrent for at least three months and include abdominal pain or discomfort which is:

  • relieved by defaecation
  • and/or associated with a change in the frequency of stools
  • and/or associated with a change in the consistency of stools plus two or more of the following, at least a quarter of occasions or days
  • more than three stools per day or less than three per week
  • altered stool form (lumpy/hard or loose/watery)
  • altered stool passage (straining, urgency or feeling of incomplete evacuation)
  • passage of mucus
  • bloating or feeling of abdominal distension.

In other words, a doctor can be fairly certain of making a diagnosis of IBS if this pattern of symptoms is present, if there are no other major symptoms and if physical examination is normal. So, it is very important to see your GP in the first instance to discuss your symptoms and to be examined and to receive an official diagnosis.

large icon for SIBO

There is a lack of formal diagnostic criteria for IBS, so it is typically diagnosed by exclusion of other bowel conditions such as Inflammatory Bowel Disease (IBD), Diverticulitis and Colon Cancer. When a full blood count, erythrocyte sedimentation rate (ESR) or plasma viscosity, C-reactive protein (CRP) and antibody testing for coeliac disease come back negative, you’ll be diagnosed with IBS if you continue to present with the symptoms.

ibs and gut health word cloud
simplified ibs image

Causes of IBS

Because IBS symptoms are largely generalised, it is often difficult to diagnose the underlying cause of the condition, and there is as yet no specific known reason for its development.

Some scientists have suggested it is due to an over sensitive colon or an immune system irregularity. There is also a chance that it may be caused by a bacterial infection of the digestive tract, genetic factors, altered intestinal permeability, abnormalities in serotonin metabolism or changes in bile salt production.

Triggers are more the focus of IBS. Factors like stress are well-known to have an impact on the digestive system, and it is believed that heightened nervous system output may overstimulate the bowels and disrupt regular digestive processes. Women are also at higher risk of developing IBS symptoms. It is believed that a woman’s menstrual cycle can disrupt normal bowel function, which is why many women experience more severe IBS symptoms during their periods.

Diet is another huge consideration for the management of IBS symptoms, and many patients can manage their condition by eating the right types of foods. Additionally, the way in which you eat can have an impact. Eating too quickly, while distracted, constantly grazing, or eating on the run can trigger symptoms.

Finding the root cause of IBS

While IBS is one of the most common gut conditions we see, it is important for us to consider what else is going on when you are affected by a variety of gut-related and other possible symptoms. When we begin investigating your symptoms.

Treatment

What happens when you get an IBS diagnosis?

When an individual is diagnosed with IBS, the GP may refer them to a dietician, who may recommend a special elimination diet called the FODMAPS diet. This diet seems to work by altering the inflammation in the gut often found with IBS, which is caused by altered gut microbiome. FODMAPs are fermentable, short-chain carbohydrates which for some sensitive individuals, become fermented in the colon because the small intestine cannot complete absorption of these foods. (this may be because the individual has SIBO (see SIBO section)). In other words, when foods containing FODMAPs are fermented in the colon, gas, pain, bloating, diarrhoea and/or constipation, and other gut sensitivities, may result.


Occasionally, the GP may suggest that an OTC generic probiotic could be tried. Probiotics are beneficial bacteria that can have various health benefits when taken. There is some good evidence that selected key strains of probiotics may be helpful for individuals with IBS, but the GP may not be able to recommend these specific probiotics as few have been officially included in NICE guidelines.


Patients with IBS are often prescribed medication for their symptoms. Pharmacological treatments are prescribed based on specific IBS symptoms. For IBS-C, laxatives are used, such as lactulose or Movicol, to name a few. Unfortunately, common side effects from laxatives are abdominal pain, diarrhoea, nausea, and distention. For IBS-D, loperamide (brand name Imodium) is usually the first medication prescribed. For bloating and gas symptoms of IBS, an antispasmodic is used (Buscopan), which helps relax the muscles. Typical side effects for antispasmodics include nausea, vomiting, altered taste, dry mouth, blurred vision, dysphagia, palpitations, and urinary hesitancy and retention. If there are psychological diagnoses, the first-line medication is typically a selective serotonin reuptake inhibitor (SSRI). SSRIs are proposed to change an individual’s threshold of pain for IBS symptoms; however, it is not known how they treat depression or anxiety for an IBS patient specifically. The second line of pharmacological treatment includes tricyclic antidepressants, which have the potential for more negative side effects than SSRIs.


How does IBS clinics use functional medicine to resolve IBS?

Functional Medicine differs from the standard conventional or allopathic medicine model in that it determines how and why illness occurs and restores health by addressing the root causes of disease for each individual.


The Functional Medicine model is a highly individual, patient-centred, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors and leverages that data to direct personalised treatment plans that lead to improved patient outcomes. By addressing root cause, rather than symptoms, it is possible to identify the complex nature of disease. It is often found that a health condition has a variety of different causes and, likewise, one cause may result in many different conditions. As a result, Functional Medicine treatment targets the specific manifestations of disease in each individual.


Special functional tests may be recommended to uncover the underlying causes for an individual’s IBS. Comprehensive stool tests are one such test commonly used to assess digestive and metabolic gut function, identify gut infections and bacterial imbalances or overgrowth. The vast majority of IBS clinics patients will be recommended to test for SIBO as this is a common contributing factor to IBS, between 60-73% of our patient demographic will have SIBO as a single contributing factor, but often accompanied by other factors. Food intolerance testing can also be helpful to identify problem foods which may be contributing to IBS and there is some good research to support this in IBS sufferers.

Fodmap on backboard surrounded by food
medicinal representations of parasiites