Understanding Irritable Bowel Syndrome (IBS): A Gut-Brain Connection

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Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal issues seen in clinical practice - but it's also one of the most misunderstood. If you've experienced symptoms like abdominal pain, bloating, irregular bowel movements, or digestive discomfort that seems to come and go, IBS may be at the root.

Let's break down what IBS actually is, how it's diagnosed, and the therapeutic approaches that can help manage it.

What is IBS?

IBS is now classified as a disorder of gut-brain interaction (DGBI), which is influenced by the microbiota-gut-brain axis.

It is largely driven by dysfunctional communication between the brain and the digestive system and associated visceral hypersensitivity, dysbiosis, disordered intestinal permeability, altered bowel motility and central nervous system processing.

Effective treatment requires addressing the microbiota-gut-brain connection.

IBS is a chronic and complex condition, but it can be effectively managed with the right support.

How Common Is IBS and What Are Some Risk Factors?

IBS is a common condition. It is one of the most common complaints presenting to health professionals, and for most people, tends to follow a relapsing/remitting course, which can significantly affect quality of life - physically, emotionally, and socially.

Irritable bowel syndrome often first presents following a bout of gastro (also known as post-infectious IBS), repeated antibiotic use, high stress, mood disturbances (anxiety and depression), and presents more commonly in females under 50 years of age. IBS also has significant symptom overlap with non-coeliac gluten sensitivity, coeliac disease, endometriosis, IBD, GERD, and functional dyspepsia.

Key IBS Symptoms

The hallmark sign of IBS is abdominal pain related to changes in bowel habits. This can present as pain that improves (or worsens) after going to the toilet.

Other typical signs include:

Irregular bowel movements (diarrhea, constipation, or both)
Urgency or straining during bowel movements
A sensation of incomplete evacuation
Non-bloody mucus in the stool
Bloating or abdominal distension, and/or gas

However, certain symptoms raise a red flag and may suggest the presence of more serious issues. These include:

Onset of symptoms after age 45
Unexplained weight loss
Rectal bleeding
Nighttime Diarrhoea
Family history of colon cancer, inflammatory bowel disease, or coeliac disease.

If you have noticed any red flag symptoms, it is important to have these assessed by your GP

Diagnosing IBS: The Rome IV Criteria

IBS is diagnosed based on the Rome IV criteria, which defines IBS as recurrent abdominal pain occurring at least one day per week over the past three months, accompanied by two or more of the following:

Bowel movements
A change in stool frequency
A change in stool appearance or consistency.

Symptoms must have started at least 6 months before diagnosis

IBS is further classified into four subtypes, based on predominant bowel habits:

IBS-D (diarrhea-predominant)
IBS-C (constipation-predominant)
IBS-M (mixed – both constipation and diarrhea)
IBS-U (unclassified – presentation does not fit other categories)

These subtypes can change over time, making a personalised and adaptable treatment approach essential

Additional Considerations

Multiple interwoven factors can increase the risk of developing IBS, trigger its onset, and sustain or worsen symptoms over time. These include methylation issues, Small Intestinal Bacterial Overgrowth (SIBO), a history of trauma or chronic stress, Intestinal Methanogen Overgrowth (IMO), Intestinal Sulphide Overgrowth (ISO), oxalate overload, and histamine intolerance. While these are too broad and complex an area to dive into in this post, they do represent crucial aspects of understanding and effectively treating IBS - stay tuned for a future post!

Exploring the Microbiome with Functional Pathology

To truly understand what’s going on, functional pathology testing can offer powerful insights - especially when standard testing shows “nothing wrong,” yet symptoms persist.

Useful tests include:

Comprehensive stool and microbiome panels that assess microbiome balance (beneficial vs pathogenic strains), digestive capacity (enzymes, bile acids, short-chain fatty acids), intestinal inflammation or immune markers, yeast and fungal overgrowth, parasites and dysbiosis, and markers of leaky gut (intestinal permeability).
SIBO breath tests
Targeted Blood and Urine Tests

When combined with a detailed health history, screening measures, dietary assessment, and symptom tracking, this data offers a more holistic and functional understanding of the underlying drivers of symptoms. This integrative approach enables more precise and effective interventions, tailored to your individual needs.

How Is IBS Managed?

That depends on the factors driving the issues for an individual. There is no “one size fits all” solution. No two people with IBS present the same or have the same underlying causes, therefore, a highly personalised treatment approach is required.

However, generally speaking, treatment will include:

Dietary changes:

Personalised dietary manipulation to positively influence microbiome (guided by pathology results).
Identify triggering foods (NOTE: Whilst the FODMAP diet is often recommended and helpful, the full FODMAP diet is not designed to be used long-term – undesirable changes to the microbiome can occur in as little as 4 weeks. The FODMAP diet also does not address all possible dietary triggers, and additional testing is required).

Mind-body therapies:

Mindfulness, meditation, and stress-reduction techniques
Cognitive behavioural therapy (CBT)
Gut-directed hypnotherapy
Somatic therapy

Supplements:

Antispasmodics
Neuromodulators for gut sensitivity
Prokinetics and Digestive Aids
Pre and Probiotics
Targeted antimicrobials
Vitamin and mineral therapy

Utilising a combination of these therapeutic approaches provides a more complete approach to addressing the microbiota-gut-brain connection.

IBS: A Journey, not a Quick Fix

Living with IBS can be frustrating, flare-ups are common and expected – but know that you are not alone. By addressing the microbiota-gut-brain connection through lifestyle, nutrition, stress management, and targeted supplements, it is possible to reduce the frequency and severity of symptoms and improve your overall wellbeing.

If you’re unsure where to start, consider working with a Naturopath who can guide you through a personalized and empowering evidence-based plan.

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The information provided above is for general educational purposes only. It is not a substitute for personalised medical or health advice and does not take your individual circumstances into account. The content above is intended to inform and educate, not to promote or advertise any specific service.

Always consult your own qualified healthcare professionals regarding your individual situation before making decisions related to your health.

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Website: www.catherineclark.com.au
Email: catherineclark@groupmail.com

Catherine Clark is a Naturopath, Nutritionist, and Medical Herbalist with a special interest in GIT health, hormones, mental health, and methylation. Catherine consults in person from Logan, Queensland and also online via Telehealth throughout Australia.

If you are looking for tailored solutions that support your digestive system from the inside out - blending natural medicine, nutrition, and mind-body practices – Click the link below to get in touch.

References

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Dinan, T. G., & Cryan, J. F. (2017). Gut-brain axis in 2016: Brain-gut-microbiota axis - mood, metabolism and behaviour. Nature reviews. Gastroenterology & hepatology, 14(2), 69–70. https://doi.org/10.1038/nrgastro.2016.200
Dinan, T. G., & Cryan, J. F. (2017). Brain-Gut-Microbiota Axis and Mental Health. Psychosomatic medicine, 79(8), 920–926. https://doi.org/10.1097/PSY.0000000000000519
Huang KY, Wang FY, Lv M, Ma XX, Tang XD, Lv L. Irritable bowel syndrome: Epidemiology, overlap disorders, pathophysiology and treatment. World J Gastroenterol 2023; 29(26): 4120-4135 DOI: https://doi.10.3748/wjg.v29.i26.4120
Ford, A. C., Sperber, A. D., Corsetti, M., & Camilleri, M. (2020). Irritable bowel syndrome. Lancet, 396(10263), 1675–1688. https://doi.org/10.1016/S0140-6736(20)31548-8
Rej, Anupam; Sanders, David. (2019). The overlap of irritable bowel syndrome and noncoeliac gluten sensitivity. Current Opinion in Gastroenterology 35(3): 199-205, https://doi.10.1097/MOG.0000000000000517
Rome Foundation. (n.d.). Rome IV Criteria. https://theromefoundation.org/rome-iv/rome-iv-criteria/
Vandeputte, D., & Joossens, M. (2020). Effects of Low and High FODMAP Diets on Human Gastrointestinal Microbiota Composition in Adults with Intestinal Diseases: A Systematic Review. Microorganisms, 8(11), 1638. https://doi.org/10.3390/microorganisms8111638
Bennet, S.M.P., Böhn, L., Störsrud, S., Liljebo, T., Collin, L., Lindfors, P., Törnblom, H., Öhman, L., Simrén, M. (2018). Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut, 67, 872-881. http://dx.doi.org/10.1136/gutjnl-2016-313128

Monday, May 19