IS IT IBS OR SIBO?
Irritable bowel syndrome (IBS) may not be life-threatening, but anyone who says it’s not life-changing has probably never experienced the gas, bloating, abdominal pain and changes in bathroom habits the condition causes.
Approximately 1 in 7 New Zealanders are affected by Irritable Bowel Syndrome (IBS). IBS is a common gut condition, with symptoms including cramping and pain in the abdomen, bloating, diarrhoea and constipation. Diet and lifestyle changes such as the use of a low-FODMAP diet or managing stress levels can improve your symptoms a lot.
What is IBS?
An “irritable” bowel is one which does not function smoothly. The muscles of the intestine contract as they push food along the colon. In IBS those muscles are not well coordinated, meaning that food may pass too quickly or too slowly through the intestine, resulting in IBS symptoms. The term syndrome refers to the cluster of chronic symptoms experienced. IBS can cause a lot of discomfort and stress.
What are the symptoms of IBS?
· Crampy abdominal pain
· Diarrhoea and/or constipation
· Bloating and gassiness
· Mucus present in the stool
What causes IBS?
It is still not known what causes IBS. What we do know is that people with IBS have poorly coordinated muscle contractions of the colon (peristalsis). This means that the muscles that move food along the intestines are not well coordinated. It is a functional disorder – there is usually no visual sign of the disease when the bowel is examined. The onset of IBS may be triggered by an infection or inflammation of the gut or by injury to the gut. If the gut is irritated then it can produce a vicious cycle of gut irritation.
Any of the following may trigger IBS symptoms:
Certain foods or liquids such as wheat, milk, alcohol, coffee, and artificial sweeteners
Medical conditions such as nerve damage, celiac disease, or infectious diarrhea
Hormonal changes during a woman's monthly period
Abnormal growth of bacteria in your intestines
How is the bowel affected?
If food waste moves too slowly through the colon and if too much water is absorbed as it moves then constipation can occur. If waste moves too fast and not enough water is removed then diarrhoea can occur. Both of these problems can cause the symptoms of IBS.
Can IBS Cause Back Pain?
In addition to bloating and gas, people with IBS often develop extraintestinal symptoms, or symptoms that involve body parts beyond the gut. These may include sleep problems, headaches, urination troubles, fatigue, muscle pain, pain in the pelvis or jaw—and back pain.
Back pain is common among IBS patients, though the exact incidence is unknown. Studies estimate it affects between 28 and 81 percent of people with the disorder. Some experts believe that it may be referred pain, or pain that originates elsewhere in the body and is felt in the back. In research, gastrointestinal symptoms like gas and bloating have been linked to back pain.
Another possibility: People with IBS often have other health conditions at the same time, which are also frequently associated with backaches. These include interstitial cystitis—a chronic illness that causes bladder pressure and pain—and the pain condition fibromyalgia. Studies have found that about 3 in 10 people diagnosed with IBS meet the criteria for fibromyalgia, as well.
In addition, IBS can be associated with other inflammatory conditions, including rheumatoid arthritis, which could lead to back pain.
For those with back pain, there’s good news: Treating your IBS may also help to ease back pain without specifically targeting your back. You won’t need surgery for IBS-related back pain, and you can likely avoid long-term painkiller use by treating the other symptoms of IBS.
Who usually gets IBS?
Anyone can develop IBS, although the symptoms usually begin in early adulthood. IBS is more common in younger people. In New Zealand about 15-20% of the population may have IBS. Women seem to be twice as likely as men to get IBS.
What can make the symptoms worse?
Some people relate flare-ups to specific stressful events or to ongoing everyday stress. You may also notice that certain foods, for example spicy foods or dairy products make your symptoms worse. Certain medications can make constipation worse.
What is SIBO?
SIBO, or Small Intestinal Bacterial Overgrowth, is caused when bacteria that are normally present in the large intestine start to grow in the small intestine. This causes problems because many of these bacteria and other single cell organisms called archaea ferment sugars to produce gases.
The presence of these gases, usually hydrogen and methane, can cause a whole range of symptoms and here are the six most important:
Bloating – a feeling of fullness and discomfort, especially 1-2 hours after eating meals rich in carbohydrates (sugars are a type of carbohydrate).
Abdominal pain – linked to the bloating, as the gases build up in the small intestine, they stretch the intestinal walls, and this can be very painful. In some people this pain can be crippling, really affecting their ability to ordinary daily tasks.
Excessive belching – once the gas has built up in the small intestine it has to go somewhere! Whilst its normal to belch after eating or drinking, especially after drinking something fizzy, SIBO can cause really excessive belching that is uncomfortable and embarrassing.
Reflux – one of the causes of SIBO is thought to be the prolonged use of proton pump inhibitors for reflux symptoms. These medications make the stomach less acidic and let bacteria through to the small intestine. When patients suffer from excessive belching, they can belch acid from the stomach into the gullet, causing symptoms that mimic reflux like heartburn.
Flatulence/wind – again some wind is normal, after all everybody farts! Patient with SIBO are often very windy and the wind can be very smelly. For a SIBO patient this can mean not going out and may cause some relationship difficulties!
Diarrhoea/constipation – often seen as a symptom of irritable bowel syndrome (IBS), alternating diarrhoea and constipation can also be a symptom of SIBO. The mechanism for this symptom is less clear than the others but many doctors think that at least some people who think they have IBS actually have SIBO.
SIBO symptoms mainly affect the gut. It can also lead to malnutrition, as the bacteria start to use up the body’s nutrients.
Why small intestinal bacterial overgrowth (SIBO) develops?
The small intestine is the longest section of your digestive tract, measuring about 20 feet (6.1 meters). The small intestine is where food mixes with digestive juices and nutrients are absorbed into your bloodstream.
Unlike your large intestine (colon), your small intestine normally has relatively few bacteria due to rapid flow of contents and the presence of bile. But in SIBO, stagnant food in the bypassed small intestine becomes an ideal breeding ground for bacteria. The bacteria may produce toxins as well as interfere with the absorption of nutrients. The breakdown products following bacterial digestion of food can also trigger diarrhea.
Small intestinal bacterial overgrowth (SIBO) can cause escalating problems, including:
· Poor absorption of fats, carbohydrates and proteins. Bile salts, which are normally needed to digest fats, are broken down by the excess bacteria in your small intestine, resulting in incomplete digestion of fats and diarrhea. Bacterial products may also harm the mucous lining (mucosa) of the small intestine, resulting in decreased absorption of carbohydrates and proteins.
Bacteria can compete for available food. And compounds produced through the bacterial break-down of stagnant food can also trigger diarrhea. Together, these effects of bacterial overgrowth result in diarrhea, malnutrition and weight loss.
· Vitamin deficiency. As a result of incomplete absorption of fats, your body can't fully absorb the fat-soluble vitamins A, D, E and K. Bacteria in the small intestine synthesize as well as use vitamin B-12, which is essential for the normal functioning of your nervous system and the production of blood cells and DNA.
The overgrowth of bacteria can result in B-12 deficiency that can lead to weakness, fatigue, tingling, and numbness in your hands and feet and, in advanced cases, to mental confusion. Damage to your central nervous system resulting from B-12 deficiency may be irreversible.
· Weakened bones (osteoporosis). Over time, damage to your intestine from abnormal bacterial growth causes poor calcium absorption, and eventually may lead to bone diseases, such as osteoporosis.
· Kidney stones. Poor calcium absorption may also eventually result in kidney stones.
The good news is IBS/SIBO can be diagnosed and treated.
Laboratory tests can include:
· Stool tests. Your stool might be examined for bacteria or parasites, or a digestive liquid produced in your liver (bile acid), if you have chronic diarrhea.
· SIBO Breath test for bacterial overgrowth. A breath test also can determine if you have bacterial overgrowth in your small intestine. Bacterial overgrowth is more common among people who have had bowel surgery or who have diabetes or some other disease that slows down digestion.
Used to evaluate for a Small Intestinal Bacterial Overgrowth (SIBO) which is an underlying cause of Irritable Bowel Syndrome (IBS) in approximately 50% of sufferers.
Other symptoms of SIBO can include:
· Bloating/abdominal distension with associated discomfort, particularly after eating
· Gas and belching
· Food Intolerances
· Constipation (generally associated with methanogenic bacteria)
· Diarrhea (generally associated with hydrogenic bacteria)
· Immune activation (e.g. food sensitivities)
· Nutrient deficiencies i.e. vitamin B12 & Iron
· Weight loss / weight gain
· Fatigue or brain fog
A restricted diet is required for 24 hours in preparation.
Following a collection of a baseline breath sample, either a lactulose
or glucose test substrate is consumed.
The bacteria may ferment the lingering substrate and produce hydrogen and/or methane. These gases are absorbed into the bloodstream and exhaled through the breath. Breath samples are collected every 15-20 minutes (depending on the substrate used) for up to 3 hours and analysed for the amount of Hydrogen, Methane and CO2 produced.
· Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don't produce lactose, you may have problems similar to those caused by IBS, including abdominal pain, gas and diarrhea. Your doctor may order a breath test or ask you to remove milk and milk products from your diet for several weeks. Most popular, but may produce more false positives.
Better able to detect SIBO in distal small intestine.
Not a good option if have rapid intestinal transit.
· Glucose tests Most accurate (sensitivity & specificity) but not suitable for those with diabetes or blood sugar issues or carbohydrate malabsorption.
· There are even more accurate blood tests available for assessing food allergies and sensitivities, that include IgE, all subclasses of IgG and complement markers C3D or C1q
What can I do to prevent or relieve IBS?
· Keep a diary of what you eat and drink. There may be certain foods which trigger your symptoms.
· Slowly increase the fibre in your diet. This helps to keep other food moving through the intestine; it also holds water and softens the stool to make it easier to pass. A rapid increase in your fibre intake can cause bloating and gas.
· Reduce stress. Relaxation training, meditation or stress management may help symptoms.
· Stop Smoking.
· Exercise more (this helps intestinal movement and is stress relieving).
· Respond to the urge to move your bowels. If you delay you may have to strain later.
If you have IBS, SIBO or feel pain in your back, get in touch with Three Lamps Chiropractic today. We can help you learn why you might be feeling uncomfortable, test you for other conditions and start you on treatments to ease your symptoms. The faster you reach out, the faster you can begin feeling better.
Give us a call 09 378 0069 or email: firstname.lastname@example.org today to get to the underlying cause of the problem.