Often digestive issues gets slapped with the irritable bowel syndrome (IBS) label. It’s as though a one-size-fits-all diagnosis applies for any and all stomach woes.
Stomach pain? IBS.
Alternating between constipation and diarrhoea? IBS.
Feeling bloated or gassy? You guessed it, IBS.
But is this right? Are we truly understanding what’s happening in our digestive systems, or is the IBS diagnosis just an easy answer that some give when they don’t have a clearer explanation?
In a world where we can test for most things, it seems strange that some people are left with vague, umbrella diagnoses, like IBS, when it comes to digestive discomfort. Is it possible that IBS is becoming a catch-all term for undiagnosed digestive problems, and patients aren’t getting the full picture of what might actually be going on inside their bodies?
What is IBS?
IBS is a functional gastrointestinal disorder that affects how the digestive system works but doesn’t cause structural damage to the intestines. It’s defined by a group of symptoms, including:
- Abdominal pain or cramping
- Bloating
- Alternating diarrhoea and constipation
- Excessive gas.
Despite being a common health issue, affecting 10-15% of the population, IBS remains poorly understood. The exact cause of IBS is still unknown, but it's believed to be a combination of factors, including:
- Gut-brain interactions: The gut and brain are connected through the gut-brain axis, and emotional stress, anxiety, or depression can play a role in triggering IBS symptoms.
- Gut motility issues: People with IBS may experience abnormal movements of the intestines, leading to either constipation or diarrhoea.
- Gut microbiota imbalances: An imbalance in the gut’s bacteria, called dysbiosis. It is suspected that either keystone ‘good bacteria’ are lacking or completely missing in the digestive tract, or ‘bad bacteria’ are taking over and multiplying, causing IBS symptoms.
- Visceral hypersensitivity: The intestines of people with IBS may be more sensitive, meaning that normal amounts of gas or bowel movement triggers can cause pain and discomfort.
So, while IBS is a real condition, it’s a mystery in terms of its origins. And because it’s diagnosed based on symptoms rather than a specific test (there are no definitive blood tests or imaging studies for IBS), many people can go years without truly understanding what's going on with their digestive systems.
Assessing IBS
The common method of assessing IBS is the Rome IV criteria. Under the criteria, to be diagnosed with IBS by a medical professional, you must experience abdominal pain or discomfort for at least one day a week in the last three months, along with at least two of:
- Improvement with defecation
- Change in stool frequency
- Change in stool form or appearance.
There’s no blood test or imaging study that confirms IBS. So, the diagnosis is based on ruling out other conditions through medical history, lab tests, and sometimes endoscopic procedures (like a colonoscopy). But it’s important to note that symptoms vary greatly from person to person. Some people might primarily experience diarrhoea (IBS-D), while others have constipation (IBS-C), and still, others may alternate between both (IBS-A).
What happens if it proves not to be IBS?
There’s no denying that IBS is a frustrating diagnosis. While IBS is not dangerous in itself and doesn’t lead to long-term damage, it can significantly impact quality of life. People with IBS often struggle with chronic discomfort, missed workdays, and social anxiety, due to unpredictable symptoms. However, if IBS isn’t the real issue, it’s crucial to figure out what else might be the cause of the symptoms which might need an alternative treatment. Some conditions that can mimic IBS symptoms include:
- Food intolerances: Conditions like lactose intolerance or gluten sensitivity can cause symptoms like IBS, such as bloating, gas, and diarrhoea. A food diary or an elimination diet may help identify if specific foods are triggering your symptoms.
- Coeliac disease: This autoimmune disorder causes inflammation in the small intestine in response to gluten, and it can be misdiagnosed as IBS if proper testing isn’t undertaken.
- Inflammatory Bowel Disease (IBD): Conditions like ulcerative colitis can present with symptoms very similar to IBS, such as abdominal pain and diarrhoea. IBD, however, is an inflammatory condition that can cause long-term damage to the intestines, unlike IBS, which doesn’t cause structural changes.
- Small Intestinal Bacterial Overgrowth (SIBO): A condition where excessive bacteria grow in the small intestine can cause symptoms like bloating, diarrhoea, and abdominal discomfort, symptoms that overlap with IBS.
- Thyroid issues or hormone imbalances: Conditions like hypothyroidism or polycystic ovary syndrome (PCOS) can cause digestive symptoms, including bloating, constipation, and fatigue, which are often misinterpreted as IBS.
- Stress and mental health: Anxiety, depression, and chronic stress can trigger or exacerbate gut symptoms, often leading to a misdiagnosis of IBS when the underlying cause is actually psychological.
- Helicobacter pylori (H. pylori) infection: This bacterial infection can cause symptoms like aching or burning pain in the stomach, especially when the stomach is empty. In addition to discomfort, it may lead to nausea, loss of appetite, and frequent burping. pylori can irritate the stomach lining, leading to conditions such as gastritis or peptic ulcers.
Getting to the truth
The first step towards a better understanding of your digestive symptoms is to take a comprehensive approach. If you’re diagnosed with IBS but your symptoms don’t seem to respond to standard treatments, it’s worth exploring other possibilities.
- Work with a doctor who takes a holistic approach, looking at your full health history, lifestyle, and potential food triggers.
- Consider a functional medicine approach, which may help identify underlying causes such as food intolerances, gut dysbiosis, or nutritional deficiencies.
- Test for SIBO, coeliac disease, or thyroid issues to rule out other conditions.
- Take stress management seriously. Stress can have a huge impact on gut health, and practices like mindfulness, yoga, or cognitive behavioural therapy (CBT) might help address the root of your symptoms.
Herbs to help digestive discomfort
Certain herbs can be helpful in managing digestive discomfort, particularly for conditions like IBS including:
- Peppermint is known for its ability to relax the muscles of the gastrointestinal tract, which can relieve symptoms such as bloating and cramping.
- Ginger is often used for its anti-inflammatory properties, and can soothe the stomach and reduce nausea, bloating, and indigestion.
- Chamomile is used to reduce inflammation and calm the digestive system, helping with conditions like IBS by easing stress-related digestive discomfort.
- Kawakawa is a powerful native herb that has been traditionally used by the Māori people for supporting digestive health. It is known for its anti-inflammatory, antimicrobial, and analgesic properties. Kawakawa is often used to help soothe the stomach, reduce inflammation in the gut, and alleviate symptoms of bloating, cramping, and indigestion.
- Fennel is known for its ability to relieve gas, bloating, and abdominal cramps, making it a great herb for managing IBS symptoms.
Conclusion
IBS is a real condition, but it's often used as a blanket diagnosis when other causes of digestive discomfort aren’t immediately apparent. It’s a frustrating diagnosis because it doesn’t offer a clear-cut answer, and the treatment options are largely symptom-based, rather than targeted toward a specific underlying cause.
If you suspect that IBS isn’t the whole story, don’t be afraid to seek a second opinion or dig deeper into potential root causes. Also, look for ways to introduce digestive friendly herbs into your everyday life.
