Irritable Bowel Syndrome (IBS) is a functional bowel disorder. It’s considered a chronic condition and is characterised by symptoms (changes in function) that flare and change over time. They include anything from abdominal pain, distension, altered bowel motions and alternating bowel motions, excessive flatulence and bloating – often described as that feeling of needing to pop an air bubble in your abdomen.
In the developed world it’s a relatively common condition, with a prevalence rate of around 8% in Australia, the United States and the United Kingdom.
For those who’ve never suffered from IBS, or any other chronic condition, the disruption caused by the condition might be hard to grasp. To help shed some light – the severe impact of IBS symptoms was highlighted in data showing that individuals with IBS would be willing to relinquish 15 years of their remaining life to attain perfect health. As someone with a history of IBS, I could attest to this!
If you suspect yourself or a loved one’s symptoms are driven by IBS, I’ve written this to guide you on what to do next.
IBS isn’t life threatening nor does the evidence suggest an increased risk for conditions such as bowel cancer later in life, but if your symptoms aren’t in fact driven by IBS and rather, something else, it’s key for you to know.
Step 1: Rule out other possible causes for your symptoms
The symptoms of IBS overlap with other conditions such as colorectal cancer, ovarian cancer, diverticular disease, coeliac disease and irritable bowel diseases (IBD) including Chron’s and colitis. These conditions can be life threatening which means it’s important to rule these out before beginning treatment.
The presence of symptoms such as unexplained weight loss, blood in the stool, mucus in the stool, unexplained anaemia, fever, age of onset (50+), fever, nocturnal bowel motions, recurrent vomiting and/or persistent and daily diarrhoea all warrant immediate investigation.
Prior to speaking with a health professional, take note of when your symptoms began and even develop a “food, mood and symptom diary” to share with them. This will help them to screen you in the appropriate manner and determine what testing may be required. Common testing at this point would include:
- Full blood examination
- C-reactive protein
- Nutritional markers such as iron, ferritin and B12
- Coeliac screening (either genetic or antibody testing)
- Faecal calprotectin
Your health professional will use these results to determine if you meet the criteria for IBS, or not. The most widely accepted criteria is the Rome Criteria. Which states:
Recurrent abdominal pain on at least 1 day per week in the last 3 months, with 2 or more of the following:
- Related to defecation
- Change in consistency of the stool
- Change in the frequency of the stool
Step 2: Determine root cause
Once other possible conditions have been ruled out, determining the driver for IBS is key to achieving symptom resolution. There could be multiple drivers for any given case of IBS and usually, there are. The most typical drivers include:
- Altered microbiome (dysbiosis) either in the large intestine or small intestine (Small Intestinal Bacterial Overgrowth).
- Low grade chronic inflammation, which could be driven by many things including dysbiosis, food intolerance or increased intestinal permeability (often referred to as leaky gut’).
- Visceral hypersensitivity. Studies do confirm that central nervous system dysregulation exists in IBS patients.
- Altered motility which could be driven by psychological factors including stress and anxiety (either increasing or decreasing transit time). It’s also thought that psychology could affect pain threshold and impair the mucosal secretory and barrier functions of the gastrointestinal tract.
Doing the appropriate testing to determine the driver of your IBS is not only important for developing the most efficacious treatment plan, it also saves time and finances in the long run. My clinical experience also indicates that it helps individuals take better ownership of their condition.
Step 3: Find the right team to support you
With symptoms present one day and gone the next, certain foods a trigger one week and not the next, managing IBS can be confusing to say the least. Working with a team of practitioners such as a Dr that you know and trust, a Gastroenterologist (if referred) and your Nutritionist or Naturopath with experience in IBS can really help direct your focus, in turn speeding up the healing process and helping you achieve long lasting symptom resolution.
If you want to hear more about IBS you might find episode 282 of the Health Happiness & Human Kind Podcast, Dissecting IBS, incredibly helpful. If you’re ready to take action on any of the steps above, then please book in for a 15-minute complimentary consultation today for direction. We can discuss whether testing is required, what testing you require and how to best start managing your symptoms.
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Norgaard M et al., 2011. Irritable bowel syndrome and risk of colorectal cancer: a Danish nationwide cohort study. British Journal of Cancer, 104, 7, 1202–1206.
Chey WD et al., 2015. Irritable bowel syndrome: a clinical review. The Journal of the American Medical Association, 313, 9, 949-58.
Tillisch K et al,. 2011. Quantitative meta-analysis identifies brain regions activated during rectal distension in irritable bowel syndrome. Gastroenterology, 140, 1, 91-100.