Irritable Bowel Syndrome
IBS can feel quite isolating at times.
What is Irritable Bowel Syndrome?
Irritable Bowel Syndrome (IBS) is the name given to a collection of digestive symptoms that don’t have any other known cause. Some call it a throw away diagnosis, but I think of it more as a diagnosis that rules out other digestive disorders.
People with IBS frequently experience changes in their bowel movements often alternating between diarrhea, constipation, and normal healthy bowel movements. They also often have abdominal bloating, gas, stomach cramping, nausea, and oftentimes low back pain which feel much better after a bowel movement. Symptoms are often increased during times of stress and sometimes after eating.
Sound familiar?
How is IBS diagnosed?
As mentioned above, IBS is diagnosed by ruling out other digestive system disorders and by meeting a few criteria. First let’s talk about the other conditions that need to be ruled out.
A good workup is key to diagnosing any condition, and IBS is no different. First, IBS is not an inflammatory disorder, so we can look at markers of inflammation in the blood like C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR). We also want to rule out celiac disease by looking at blood markers or performing a biopsy of the small intestine to look for cellular changes. Colitis and colon cancer will need to be screened for as well by looking for blood in the stool and if found performing a colonoscopy. Small Intestinal Bacterial Overgrowth (SIBO) also shares the same symptoms picture as IBS, so a breath test can be done to look for this. Other malabsorption conditions should also be investigated such as fructose, fat, lactose, and insufficiencies of digestive enzyme production.
As you can see, it’s not quite as simple as fitting a diagnosis to a set of symptoms. It’s also hopeful; because, we can always back up and do some more investigation if our treatments just aren’t helping.
Once other disease processes have been ruled out, IBS can be diagnosed by meeting certain criteria. The frustrating thing is that there are many different criteria to turn to, but the most commonly used criteria are the Rome II Criteria (1):
Abdominal pain or discomfort for at least 12 weeks in the past 12 months
AND 2 of the following:
Pain relieved with defecation
Onset associated with a change in the frequency of stool
Onset associated with a change in the form/appearance of stool
What are the different types of IBS?
IBS comes in three different flavors:
IBS-D - predominantly diarrhea type
IBS-C - predominantly constipation type
IBS-M - mixed type
How is IBS treated?
In the pharmaceutical-based medical world, IBS is often treated with symptom management: antidiarrheal drugs like Imodium and, for constipation, stool softeners, laxatives, and fiber supplements. Antispasmodic drugs have also been used for IBS-D and antidepressants have been used for IBS-C.
In the Naturopathic and Functional Medicine world, we approach things a bit differently. First, we like to work with your diet and herbs or supplements that will bring relief from your symptoms such as carminatives (anti-gas) and antispasmodic herbs. Then we like to work with herbs or supplements that help improve your digestion such as bitters and anxiolytics. Then we are going to recommend probiotics and fermented foods to improve your gut microbiome (microbial balance). Finally, we may recommend additional therapies such as hydrotherapy, acupuncture, craniosacral therapy, hypnosis, counseling, neurofeedback, or other therapies that we use as practitioners and that seem indicated for you specifically.
When we look at your diet, we will work with you to identify any foods that seem to be triggering or worsening your symptoms as well as increasing foods that are high in fiber and essential nutrients. An elimination and re-challenge diet is pretty much my gold standard for IBS, but we can also discuss different blood tests as a jumping off point.
What can I do to reduce my IBS symptoms?
First, if you suspect IBS, but haven’t gotten a workup, this is your first step. You need to treat what you have, not what you think you have. All the great IBS treatment plans in the world won’t treat SIBO, celiac disease, Crohn’s disease, or cancer. We need to be smart about getting a good and accurate diagnosis first.
If you have been diagnosed with IBS but didn’t have a workup, you will want to back up and have that done.
If you have been diagnosed with IBS after a good workup, congratulations, you made it over the first hurdle in getting relief. I highly suggest you find a Naturopathic physician or Functional medicine doctor to work with. In the mean-time, you can try an elimination and re-challenge diet such as the Whole30, an autoimmune paleo diet, a whole foods vegetarian diet, the SCD diet, the GAPS diet, or others. If you need suggestions, please ask your doctor vs Dr. Google. If your doctor has no suggestions, I suggest you consult with another doctor who focuses on nutrition in the treatment of their patients.
A good quality probiotic can also go a long way in helping with symptoms. There are specific formulas with more research behind them that you won’t find in your grocery store, but you can start with a product that you find refrigerated that contains both Lactobacillus and Bifidobacter species and has at least 5 billion CFU (colony forming units) per dose.
Gentle herbs that can help with the bloating, gas, and cramping of IBS include our friends Chamomile, Catnip, Fennel, Flax seed, Calendula, Peppermint, Anise, Ginger, and Cardamom.
Gentle herbs that can help with constipation include: Marshmallow, Flax seeds, and Chia seeds to soften stools and Artichoke leaf, Dandelion root, Turmeric, Gentian, and Skullcap to increase digestive secretions and movement.
Teas and foods are the most gentle and often effective way to take herbs especially for the treatment of digestive complaints. Tinctures while a great way to preserve herbal medicine for years aren’t the best route for the treatment of digestive complaints. When it comes to herbs in capsule form, always check with your medical provider before taking herbs in this form as they tend to be much stronger when prepared correctly and can often contain harmful additives if you aren’t purchasing from a company who has strict third party quality control measures.
You will want to be sure to work with a medical provider who understands you, your condition, any other conditions you may have or are at an increased risk for developing, any medications you are taking, and both pharmaceutical and non-pharmaceutical options for your treatment. This is why I will always suggest working with a Naturopathic Physician who graduated from an AANMC accredited school and is licensed by their state board if they are practicing in a licensed state. If your state doesn’t license Naturopathic Physicians, you may find a doctor licensed to practice in another state, and you can always check to see if they went to an AANMC accredited school.
As someone who has lived with IBS since childhood, I truly empathize with you and understand how this condition can change your life when it flares up. I also understand the relief that is possible when using natural medicines correctly! Please feel free to add to the conversation in the comments section below. Healing most often doesn’t happen in isolation but in community.
To our health!
