23 Oct Irritable Bowel Syndrome: Of Belly aches, gas, and crazy poops!
Irritable Bowel Syndrome (IBS) is one of the most common chronic health conditions. In fact, it is the most common gastrointestinal disorder and affects 30 million Americans (10-15% of the population!).
IBS is characterized by a number of symptoms including diarrhea (IBS-D), constipation (IBS-C), or both (IBS-mixed), bloating, and abdominal cramping.
A Difficult Diagnosis:
IBS is sometimes difficult to diagnose and has been called a “diagnosis of exclusion”. In order to make the diagnosis, a doctor must exclude inflammatory, anatomic, metabolic and cancerous processes that could otherwise explain the patient’s symptoms. Only once all of these other conditions have been ruled out can IBS be diagnosed.
IBS is diagnosed when there is abdominal pain or discomfort occurring once a week for at least two months which (at least 2 out of 3 of the below):
- gets better when the patient makes a bowel movement OR
- is associated with a change in bowel movement frequency OR
- is associated with change in bowel movement appearance.
These diagnostic criteria really are not all that specific (in fact, more than 60% of patients with IBS in one study did not meet these diagnostic criteria).
A New Lab Test:
A new test is being offered by some laboratories (including Quest Labs) which is thought to differentiate Irritable Bowel Syndrome from Inflammatory Bowel Diseases (IBD) such as Crohn’s Disease and Ulcerative Colitis. This test identifies antibodies against a protein called vinculin which is found in the guts of patients exhibiting IBS symptoms. Interestingly, anti-vinculin antibodies are found in high amounts in patients having suffered an acute gastroenteritis (“stomach bug”). Incidentally, having suffered an acute gastroenteritis is a risk factor for IBS.
There are many factors to consider in the treatment of IBS.
- Stress tends to be an exacerbating factor for many patients and should be addressed.
- Food intolerances tend to be the norm. I typically start with a diet called the Low FODMAP diet which significantly reduces fermentable carbohydrates in the diet. This diet is very often helpful in treating gas, bloating, and stool changes associated with IBS. Though I start with this diet, other food intolerances may be involved.
- Herbs can be very helpful! Enteric coated peppermint oil, a preparation called Iberogast, and fennel seed are my first line herbal go-tos. Other herbs such as chamomile and lemon balm can be helpful too.
- Probiotics can also be of great value but should be used with caution.
- In constipated patients, long term use of stimulant laxatives (such as senna) should be avoided. Magnesium has a natural laxative effect and is safe for most people to consume long-term.
- A frequent cause of IBS is a condition called Small Intestine Bacterial Overgrowth (SIBO). It is a condition in which naturally occurring bacteria from the large intestine invade the small intestine. These bacteria ferment certain types of carbohydrates in the diet and create gasses (hydrogen and methane) which can contribute to gas, bloating, stool changes, and abdominal discomfort. This is a treatable condition (though recurrence rates are high). Diagnosis of SIBO involves a 2-3 hour breath test for these exhaled gasses. Any patient with IBS should be tested for SIBO.
Irritable Bowel Syndrome is an incredibly common health condition for which conventional medicine typically does not have much to offer. In contrast, this is an area where Naturopathic medicine truly shines! With a focus on finding the underlying cause and using nourishing herbs, addressing stress, and making selective dietary changes, naturopathic care can be life-altering for many patients.