What are the common IBS symptoms ?
Distension of the abdomen.
Discomfort or pain in the abdomen.
Diarrhoea and/or constipation.
How common is IBS?
It affects up to 20% of the population over the age of 18.
What is IBS?
The diagnosis of IBS is often used when traditional gastroenterological approaches have failed to find an obvious cause for the symptoms listed above.
‘IBS’ should in fact be understood as an umbrella term that regroups different but often interconnected abnormalities or imbalances in the gut:
– Imbalances in gut microorganisms (gut dysbiosis), particularly bacteria but also yeasts and viruses.
– Parasitic infections, most commonly Blastocystis hominis subtypes 1 and 3, and Dientamoeba fragilis.
– Poor digestion, malabsorption and fermentation of FODMAPs (small sugars such as lactose leading to lactose intolerance).
– Food intolerances/sensitivity (for example gluten, other wheat proteins, nuts, food preservatives).
– Insufficient production of digestive enzymes and/or bicarbonate by the pancreas (exocrine pancreatic insufficiency).
– Hypersensitivity of the nerve endings in the gut, often triggered by the abnormalities listed above.
– Mind-body factors often complicate the picture, worsening gut symptoms when these remain unresolved for years.
Most people with ‘IBS’ have a combination of two or more of the above abnormalities or imbalances, emphasising the importance of an integrated and individualised approach to achieve significant improvements in symptoms and wellbeing. This explains as well why current pharmaceutical, dietary and one-size-fits-all probiotic approaches to managing gut problems have remained mostly unsatisfactory.
A number of ‘common denominator’ factors that lead to the different gut abnormalities listed above include alcohol, some aspects of the Western diet, past heavy antibiotic use and chlorine in drinking water.
What is my approach to IBS treatment?
I look for and then address each potential abnormality listed above. The assessment starts with taking a history of your symptoms, and a medical, surgical and family history (to save time, you will be sent a questionnaire prior to your first consultation). A detailed physical examination is very important.
Which tests and procedures and in which order to do them will be discussed with you at your first appointment. These generally include advanced faecal parasite and microbial (bacteria and yeasts) analyses, blood and urine tests. Occasionally additional tests are indicated, for example food intolerance/sensitivity testing and hydrogen/methane breath tests. And sometimes a gastroscopy or colonoscopy may be warranted prior to commencing IBS treatment.
Ultimately management of IBS and many other gut problems involves identifying and then addressing each potential abnormality or imbalance listed in the section above. This then enables an individualised approach to management, which will usually involve a unique combination of the following:
– Treating any significant parasitic infection.
– Correcting the Imbalances in gut microorganisms, by targeting any harmful overgrowth of bacteria and correcting any deficiencies using specific probiotics and dietary changes.
– Low FODMAP diet.
– Temporarily removing certain foods from the diet.
– Adding digestive enzymes, with or without bicarbonate.
– Addressing any mind-body factors.
Book an appointment for your IBS assessment.