What is Irritable Bowel Syndrome?
The short answer is we still don’t know for sure. However, we have learned a lot more about it and its treatment in recent years. According to the U.S. National Library of Medicine irritable bowel syndrome (IBS) is a problem mainly of the large intestine (colon). It causes things like abdominal cramps, bloating and either constipation or diarrhea- and sometimes both. Although IBS can cause a lot of discomfort and distress, it does not harm the intestine.
This is the traditional explanation of IBS, where scientists and researchers have focused on the colon as to where IBS originates. Because of this we have tried treatments with things like probiotics which are rarely helpful. New research indicates that the main problem more likely lies in the small intestine. One of the main causes of this seems to be small intestinal bacterial overgrowth (SIBO). When SIBO occurs one has a large amount of bacterial in the small bowel where they don’t belong. Typically the small bowel is relatively sterile and the bacteria are in the colon. When they overgrow in the small intestine they can be very destructive to your digestive health and wellbeing.
What causes IBS?
There are many theories as to the cause of IBS. Reality is many thing can cause what we describe as IBS symptoms. In patients with IBS they develop heightened sensitivity in the intestines and altered motility. Then when they produce gas (which we all do) this causes a distention of the intestine which is felt as pain, bloating and cramps. The altered motility causes constipation or diarrhea which makes the symptoms worse. One of the key players in this process is SIBO. This SIBO can be triggered by an event, like stress, certain foods, antibiotics or different medication. Once the excess bacteria build up in the small intestine they feed off the foods we eat- mainly the carbohydrates. This process of fermentation by the bacteria produces gas which distends the intestine and causes pain. There are also some bacteria, like Archaebacteria, that consume the gas (hydrogen) produced by the other bacteria and produce even more gas in the form of methane. As more of these gasses are produced your small intestine expands more and causes more of the IBS symptoms.
What are the main symptoms of IBS?
The symptoms of IBS can occur frequently (chronic) or on an occasional basis. The most common symptoms of those that suffer from IBS are:
How is IBS Diagnosed?
The first thing to do when diagnosing IBS is to rule out things that can mimic IBS but are treated differently. You should undergo some lab work (blood work) to check liver, kidneys, pancreas and blood counts. You should undergo lab work or an upper endoscopy to rule out Celiac Disease. We do breath testing to look for things like lactose intolerance, fructose malabsorption and SIBO. You should undergo a colonoscopy to rule out ulcerative colitis or Crohn’s as well as microscopic colitis. Typically you would get some type of abdominal imaging like a CT, MRI or ultrasound.
What is the recommended treatment for IBS?
Treatment for IBS is patient specific and aimed at the main triggers for your symptoms. There are several options we have available for treatment. We focus on diet and lifestyle triggers and frequently sitting down with a dietician is helpful. We use antispasmodics that help relieve the distention and discomfort of the small bowel. I use mostly hyoscyamine or Donnatal. Lots of times these are used in conjunction with a tricyclic antidepressant, like amitriptyline or desipramine. These are used not to treat depression but because they effect the neurotransmitters in the abdomen that send the pain signals. Recent data on SIBO as a primary cause has shifted our focus to treatment of the bacteria which seems to help more than anything. There are 2 ways I accomplish this task. One is with GI specific antibiotics for 7-10 days and then retreatment as symptoms occur. The other way is with an all-natural product developed by a gastroenterologist in Dallas called Atrantil. I love this product because it’s not an antibiotic and doesn’t carry the risks of frequent antibiotics, it’s all natural, it’s available online without a prescription and it actually works.
If you suffer from IBS please contact my office or your health care provider. In this day and age there is no reason to continue suffering as there are things we can do to improve you symptoms and your life.