Functional Medicine for Irritable Bowel Syndrome (IBS)

What is IBS?

IBS is a group of symptoms that occur together, including repeated pain in the belly and changes in bowel movements. These changes may be diarrhea, constipation, or both. With IBS, you have these symptoms without any visible signs of damage or disease in the digestive tract.¹

Doctors now call IBS a disorder of gut-brain interaction. This means it is related to problems with how your brain and your gut work together. The gut and the brain are linked by many nerves and share chemical messengers, such as serotonin. Nerve and hormone signals go back and forth between them and affect how the bowel works.^{1, 2, 3}

In IBS, these problems can make the gut more sensitive and change how the muscles in the bowel contract. A more sensitive gut can lead to more belly pain and bloating. Changes in how the muscles contract lead to diarrhea, constipation, or both. The nerves can also become more active during stress.^{1, 3}

There are three types of IBS. They are based on your stools on days when you have abnormal bowel movements: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), and IBS with mixed bowel habits (IBS-M).¹

Studies suggest that about 12 percent of people in the United States have IBS. Women are up to two times more likely than men to develop it, and people younger than 50 are more likely to develop it than people older than 50. Having a family member with IBS, stressful or difficult events in childhood, or a severe infection in the digestive tract can also raise your chance of having IBS.¹

Doctors aren't sure what causes IBS, and different factors may cause it in different people. Certain problems are more common in people with IBS, and experts think they may play a role. These include stressful early life events, depression or anxiety, bacterial infections in the gut, and food intolerances. Another is small intestinal bacterial overgrowth (SIBO), an increase in the number or a change in the type of bacteria in the small intestine. IBS that starts after a gut infection is called postinfectious IBS. Genes may also make some people more likely to develop IBS.^{1, 3}

IBS can be painful, but it doesn't damage your digestive tract or lead to other health problems such as cancer. IBS is also not the same as inflammatory bowel disease (IBD).^{1, 2, 3}

Common symptoms of IBS

The most common symptoms are belly pain, often related to bowel movements, and changes in bowel movements. IBS is a chronic (long-lasting) disorder, often lasting years, but symptoms may come and go. Symptoms range from mild to severe, and most people have mild symptoms. Women with IBS often have more symptoms during their periods.^{1, 3}

People with IBS often have other health problems too, such as conditions that involve chronic pain (including fibromyalgia), anxiety or depression. Common IBS symptoms include:¹

• Belly pain or cramps, often related to bowel movements^{1, 3}
• Diarrhea, constipation, or both¹
• Bloating, gas or a feeling of fullness^{1, 3}
• The feeling that you haven't finished a bowel movement¹
• Whitish mucus in your stool¹
• With IBS-D, frequent, loose, watery stools and an urgent need to go that may be hard to control³
• With IBS-C, straining and cramps, and passing only a small amount of stool or none at all³
• Loss of appetite, in some people³

How IBS is diagnosed and treated

There is no single test that proves someone has IBS. Doctors diagnose it by reviewing your symptoms and your medical and family history, and by doing a physical exam. They look for belly pain along with two or more of these: pain related to bowel movements, a change in how often you go, or a change in how your stools look. Your doctor will also ask how long you've had symptoms.^{1, 2}

Tests are mainly used to rule out other health problems. If you have no warning signs, your doctor may order blood work for celiac disease (a digestive disease) and inflammation, and stool tests. A breath test may check for SIBO or for problems digesting certain carbohydrates. Most people can be diagnosed with IBS by their history, a physical exam and limited testing. This helps avoid unnecessary tests. Normal test results do not mean your symptoms are "all in your head."^{1, 2, 3}

Some symptoms, listed under "When to get urgent care" below, may point to a different health problem and call for more tests, such as a colonoscopy.^{1, 2}

There is no single treatment that works for everyone, and you may need to try a few. Your doctor may suggest changes in what you eat, such as adding soluble fiber, avoiding gluten, or trying a low FODMAP diet for a few weeks. FODMAPs are carbohydrates that are hard to digest. A dietitian is often helpful, because these diets can be complicated.^{1, 2}

Other lifestyle changes may help IBS symptoms, such as more physical activity, reducing stress as much as possible, and getting enough sleep.^{1, 2}

Your doctor may recommend medicines for diarrhea, constipation or belly pain. Some medicines also used for anxiety or depression are usually given at much lower doses to calm nerve signals between the gut and the brain. Therapies that target the gut-brain connection, such as cognitive behavioral therapy and gut-directed hypnotherapy, may also help. Researchers are still studying the use of probiotics for IBS.^{1, 2}

IBS is the most common intestinal problem that leads to a referral to a gastroenterologist. Your doctor can help you find the right treatment plan.^{1, 3}

How our care fits alongside your gastroenterologist

Avicenna Functional Medicine does not replace your gastroenterologist or the treatment they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may contribute, such as stress, sleep, physical activity, food intolerances, past gut infections and the gut microbiome, alongside the care you already receive. Research links each of these to IBS, and different factors may matter for different people.^{1, 2}

There is no single test that proves you have IBS, so any testing we suggest looks for possible contributors. It does not diagnose IBS or replace the tests your doctor uses to rule out other conditions.^{1, 2}

Please do not stop or change any prescribed medication without talking to the doctor who prescribed it. To be safe, talk with your doctor before using probiotics or any other complementary products.¹

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Blood in the stool and weight loss you didn't intend are not part of IBS. Tell your doctor promptly if you have bleeding from your rectum, bloody stools or stools that are black and tarry, or weight loss. Also tell them if you have anemia (a low blood count) or low iron, symptoms that began at age 50 or over, or a family history of colon cancer. These may be signs of another health problem. Contact your doctor, too, if you notice changes in your bowel habits that do not go away.^{1, 2, 3}

Get medical help right away or call 911 if you are unable to pass stool, especially if you are also vomiting. Do the same if you have sudden, sharp belly pain, or if your belly is rigid and hard to the touch.⁴

Telehealth visits with our team are not for emergencies. Call 911 right away if you have warning signs of a medical emergency, such as:⁵

• Chest pain or pressure that lasts two minutes or more⁵
• Trouble breathing or shortness of breath⁵
• Sudden confusion, unusual behavior or trouble waking up⁵
• Fainting or passing out⁵
• Sudden dizziness, weakness or changes in vision⁵
• Being unable to speak⁵
• Severe belly pain, or sudden severe pain anywhere in the body⁵
• Coughing up or vomiting blood⁵
• Thoughts of suicide or of harming someone else (you can also call or text 988)^{5, 6}