Irritable Bowel Syndrome or “IBS” is an increasingly common condition. The integrative and functional medicine approach, which seeks to identify and address the root causes of diseases, is very well suited to dealing with IBS and IBS-like symptoms. This post covers my top 5 treatable conditions that can mimic IBS. According to the American College of Gastroenterology, IBS affects between 25 and 45 million people in the United States. If you have IBS, you may be experiencing the following symptoms over a period of 3 or more months:
- Abdominal pain or cramping that can happen randomly or soon after eating. Pain is often relieved or partially relieved by having a bowel movement.
- Bloating and excessive gas.
- Diarrhea, constipation, or both.
- Mucus in the stool.
IBS is debilitating – Studies indicate that up to forty percent of patients diagnosed with IBS have impaired ability to work and are forced to avoid social events or cancel travel. IBS is one of the “Functional Gastrointestinal Disorders” in which the communication network between the gut and the brain is altered. Other related functional GI disorders include GERD (gastroesophageal reflux disorder) and Functional Dyspepsia.
What is IBS?
When I was a medical resident in the 1990’s, there were many jokes about IBS being a “wastebasket diagnosis.” In other words, if someone had disrupted digestion with pain and gas and had a negative work up for other conditions, they would be diagnosed with IBS. The treatment would be symptom suppression with pharmaceuticals: anti-diarrheal medications were given for diarrhea and laxatives for constipation. Thankfully, now we have a much deeper understanding of the complex interplay between the gut-brain axis, diet, and gut microbiome when it comes to IBS – but therapies are still lacking. For example, the low FODMAP diet (LFD), aka “the reduced fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet” is a well-known method of treating IBS symptoms. Unfortunately, this diet only works in about 2/3 of IBS patients. So if you have IBS or are suspecting it, you want to be 100% sure you have had a comprehensive work up for other conditions that could be responsible for your symptoms.
IBS Diagnosis – These conditions need to be ruled out
A combination of endoscopy, blood, stool and breath testing are needed to make sure you do not have any of these conditions.
- Celiac disease
- Crohn’s Disease and Ulcerative Colitis (Inflammatory Bowel Syndrome)
- GI cancer, particularly colorectal cancer.
- An underlying gut infection (bacterial)
- Underlying parasitic issue
Other possible explanations that should be considered include:
- Chronic pancreatitis
- Endometriosis
- Conditions causing poor bowel motility such as hypothyroidism or hypercalcemia.
- Drugs effects
- Lactase deficiency
- SIBO (Small Intestinal Bacterial Overgrowth)
Things you don’t want to miss:
Things you don’t want to miss:- Community acquired clostridium difficile infection (also known as c diff) In past years, this type of infection would be an obvious diagnosis, usually associated with a recent hospital stay, medical procedure or antibiotics. Also, it would nearly always present with diarrhea. Thangs have changed, and in the past 2 years I have personally diagnosed several cases of c diff infection where the only sign was a change in the stool odor and form, but no diarrhea. The patients all had “IBS like” symptoms for many months that resolved when c diff was treated. ** Make 100% sure you have been tested for this treatable condition appropriately before any IBS diagnosis is made**
- Dysbiotic bacterial infection of the gut Certain bacteria, when they overgrow in the gut, can lead to pain, gas and changes in bowel movements. Diagnosis is made with a functional stool evaluation.
- Parasites The standard ova and parasite exam performed by conventional labs has a very low yield in the USA. To detect certain organisms such as giardia, the correct test needs to be ordered to avoid missing a treatable condition.
- Food Sensitivities Removing certain foods from the diet can lead to major improvements in gut health. Testing is also available to guide elimination diets if/when needed.
- Biotoxin illness – specifically mold Last, but not least, is mold illness. This is not commonly considered in the work up an IBS, but mold produces toxins that can irritate and cause inflammation in all tissues they come in contact with – Think watery eyes/nose, sinus issues, lungs, bladder and gut inflammation.
** If you have ongoing or past exposure to a water damaged building, consider mold illness as a potential cause of gut issues**
Take Home Message
IBS can be a debilitating condition to live with. If you’ve been diagnosed with IBS, it is important to know that all the potentially reversible conditions causing IBS like symptoms have been ruled out, as not all people diagnosed with IBS actually have IBS. If you’re struggling with IBS or IBS-like symptoms don’t hesitate to reach out for a consultation. An integrative and functional approach addresses the root causes of illness and is a powerful step towards regaining control over your health.
If you have any concerns or questions about IBS and your health, don’t hesitate to reach out for a consultation.
The information provided on this site www.drsharongoldberg.com is for informational purposes only. Dr. Sharon Goldberg and Glow Health, PA assume no responsibility and make no claims in treatment or cure of any disease or illness. The information provided by www.drsharongoldberg.com is not intended to substitute for medical advice from your physician or healthcare professional and is intended to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. If you have/suspect you might have a health problem, you should consult your medical doctor. Supplements can interact with prescription medications. Be sure to consult with a healthcare professional before starting any diet, exercise, or supplement.
[1] https://gi.org/topics/irritable-bowel-syndrome/
[2] Huang, Kai-Yue, et al. “Irritable bowel syndrome: Epidemiology, overlap disorders, pathophysiology and treatment.” World Journal of Gastroenterology 29.26 (2023): 4120.
[3] https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts
