Updated: Apr 24
If you struggle with painful and sometimes embarrassing symptoms from IBS, you might be wondering what has caused your digestive distress, and what you can do to get relief. While there are many ways to find short-term relief from your symptoms, uncovering the root cause is essential in being able to find lasting relief or eventual closure of your IBS.
What is IBS?
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder which is actually a diagnosis of exclusion. This means that other problems such as Ulcerative Colitis, Crohn's disease and Coeliac disease have been ruled out. Up to 15% of people are affected by IBS worldwide (1), with more women being affected than men. Some statistics show that 1 in 5 people in the U.K. has IBS, with up to 6 episodes a year (2). Symptoms such as stomach cramps and pain, bloating, diarrhoea, and constipation are most commonly experienced, and recent studies are showing that anxiety and depression can also be closely linked to IBS (3). The symptoms can range from mild to severe and can have a huge negative impact on the quality of life of those affected.
Conventional treatments mostly focus on symptom relief and sufferers are usually told that it is a lifelong condition, with very little that can be done. Pharmaceutical medicines include antispasmodics, laxatives, and antidepressants.
Diet and lifestyle changes might be recommended, and focusing on stress management is a key strategy to help sufferers. You may be referred by your GP for some Cognitive Behavioural Therapy (CBT) or counselling, in order to ascertain the causes of your stress or anxiety.
What causes it?
The exact cause of IBS is incompletely understood and the factors involved are usually different for everyone. As it’s a multi-faceted condition, it’s important to find your root cause or causes in order to find long-term relief.
Extreme stress or a traumatic event is often associated to the onset of symptoms, and gastrointestinal infections or food poisoning are also strongly linked. It’s also thought that taking multiple courses of antibiotics increases the risk of developing IBS.
Food sensitivities or allergies can be a trigger and may need to be avoided over the long-term, however, with the help of a nutritionist, you may be able to reintroduce certain foods and drinks at a later stage.
Other causes include:
Food passing too quickly or too slowly through the gut, due to a faulty ileocecal valve or an inefficient migrating motor complex (MMC)
Hypersensitive nerve endings in the gut
Bacterial or parasitic gastrointestinal infection
Family history of IBS
Caesarian section birth can potentially predispose you to IBS
Abnormal serotonin signalling in the gut
Increased intestinal permeability
Intestinal permeability or ‘Leaky Gut’
Modern living presents us with several causes that can contribute to poor gut health. Among them include increased intestinal permeability, otherwise known as ‘Leaky Gut’, which is altered intestinal barrier function.
In increased intestinal permeability, the abnormally large spaces between the cells in the gut lining allow entry of toxic material into the bloodstream that would, in healthier circumstances, be repelled and eliminated. The gut becomes "leaky" in the sense that bacteria, viruses, fungi, parasites and their toxins, and undigested foods such as proteins, fat, and waste normally not absorbed into the bloodstream in the healthy state, pass through a damaged, porous, or leaky gut. When these foreign substances enter the bloodstream, the immune system goes into reaction mode and begins creating antibodies. Chronic overstimulation of the immune system leads to chronic inflammation and disease (5).
Causes of increased intestinal permeability (leaky gut) are similar to many of the causes of IBS and include:
High sugar and refined carbohydrate diet
Poor nutrient intake or absorption
Excessive alcohol or caffeine
Pharmaceutical drugs such as antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, antacids, proton pump inhibitors (PPIs), contraceptive drugs, and codeine can all have an impact on our gut health. (*Always discuss with your GP first if you are considering reducing or removing medications).
Food poisoning and pathogenic bacteria
Toxins in our environment
What the heck is SIBO?
And just to complicate matters, IBS can also be caused by small intestinal bacterial overgrowth (SIBO), which is implicated in up to 85% of cases. SIBO can be diagnosed by a hydrogen breath test, and is a condition where there is an accumulation of bacteria in the small intestine. This overgrowth of bacteria, which should normally reside in the large intestine, can interfere with our normal digestion and the absorption of our food and nutrients. These bacteria consume our food and then produce gas within our small intestine. This gas can cause abdominal bloating, pain, constipation, diarrhoea, belching and/or flatulence. The main symptoms of SIBO are the same as Irritable Bowel Syndrome (IBS), and it is thought that SIBO is an underlying cause of IBS (5, 6).
How can I get relief from my symptoms?
Some natural ways to find relief from IBS include:
A low FODMAP diet
Avoiding processed foods
Avoiding alcohol and caffeine
What is a low FODMAP diet?
FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols, which are specific short-chain carbohydrates (sugars) that rapidly ferment in the gut and can be poorly absorbed. The FODMAP diet is a 3 step diet used to help manage the symptoms of medically diagnosed IBS (7).
The aim is to uncover which FODMAP foods you can tolerate and which foods trigger your IBS symptoms. The initial stage of the low FODMAP diet should only be followed for 2 - 6 weeks under the guidance of a nutritionist or specially trained health professional. It’s essential to not restrict too many foods for too long as this diet eliminates most of the fibre from the diet, and these fibres are necessary to feed our short-chain fatty acids, which are essential to a healthy microbiome.
Onions, garlic, apples, pulses, wheat and lactose are found to be problem foods for many sufferers of IBS.
How do I get long-term relief?
As mentioned earlier, in order to find long-term, lasting relief from your symptoms it’s essential to uncover your root cause or causes.
Functional microbiome testing looks for infection and inflammation, which may help to pinpoint specific imbalances in the gut, and serves as a good starting point for constructing a personalised protocol. SIBO breath testing may be required at a later stage.
My 4-Step Gut ReSet Plan aims to nourish and support the gut lining in order to assist it back to a healthy state. A robust intestinal lining is an essential first step for finding freedom from frustrating and embarrassing symptoms of IBS (read more here: www.thewelllifelab.com/gut-reset-plan).
Other potential causes will be examined through an extensive health history and dietary analysis. Effective stress management is also key for finding long-term relief of your symptoms.
If the information in this article resonates with you, then please do book in for a free 30 minute discovery call so I can look more deeply into your case, and determine how I can best help you.
About IBS: Statistics. International Foundation for Gastrointestinal Disorders, found at: https://www.aboutibs.org/facts-about-ibs/statistics.html
Irritable Bowel Syndrome found at: https://www.bupa.co.uk/health-information/digestive-gut-health/irritable-bowel-syndrome
Sibelli, A. et al. (2016) 'A systematic review with meta-analysis of the role of anxiety and depression in irritable bowel syndrome onset', Psychological Medicine. doi: 10.1017/S0033291716001987.
Bischoff et al. (2014) ‘Intestinal permeability - a new target for disease prevention and therapy’, BMC Gastroenterology. doi: 10.1186/s12876-014-0189-7.
Small Intestinal Bacterial Overgrowth website by Dr Allison Siebecker found at http://www.siboinfo.com
Dukowicz, A.C., Lacy, B.E. & Levine, G.M., 2007. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterology & hepatology, 3(2), pp.112–22. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21960820%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3099351
Staudacher, H. M. and Whelan, K. (2017) 'The low FODMAP diet: Recent advances in understanding its mechanisms and efficacy in IBS', Gut. doi: 10.1136/gutjnl-2017-313750.