IBS or Something Else?
IBS is very common, but I also don’t like to assume that every patient with bloating, constipation or diarrhea simply has IBS.
Sometimes there are additional factors that need to be considered—especially when symptoms are persistent or have not responded to the usual approaches.
Did Your Symptoms Start After Food Poisoning?
This is a question I often find useful.
Some patients can pinpoint the beginning of their digestive problems to an episode of food poisoning or a gastrointestinal infection.
Even after the infection has resolved, changes in intestinal motility, sensitivity and immune signaling can persist. This is known as post-infectious IBS.
So when someone tells me, “My digestion was completely normal until I got sick,” that history matters.
Constipation Is Not Always About Fiber
Sometimes that works.
Sometimes it does not.
One reason is that constipation can have different causes. In some people, stool simply moves too slowly through the colon. In others, the problem may be the coordination of the pelvic-floor muscles needed to have a bowel movement.
Signs that make me think about this include significant straining, a sensation that stool is stuck or feeling that the bowel movement is never complete.
In that situation, adding more and more fiber may not solve the problem—and in some people may make bloating worse.
Not All Diarrhea Is IBS-D
The same applies to chronic diarrhea.
Several conditions can produce symptoms that look very similar to IBS-D.
Depending on the history, we may need to consider things such as:
- Celiac disease
- Lactose or other carbohydrate intolerance
- Bile-acid diarrhea
- Medication effects
- Microscopic colitis
- Inflammatory bowel disease
- Certain intestinal infections
This does not mean that everyone needs extensive testing.
Testing should be guided by the person’s symptoms and history rather than ordering every possible test.
Hormones Can Affect the Gut Too
Women frequently tell me that their digestive symptoms change around their menstrual cycle.
This is not unusual.
Hormonal changes can affect intestinal motility, fluid retention, pain perception and bloating. Some women become more constipated during one part of the cycle and develop looser stools during another.
Recognizing the pattern can provide another useful clue.
When Should We Look Further?
IBS is generally a benign condition, but there are symptoms that should not simply be attributed to IBS.
These include blood in the stool, black stools, unexplained weight loss, anemia, persistent vomiting or a significant change in symptoms.
Family history also matters, particularly a history of inflammatory bowel disease, celiac disease or colorectal cancer.
The point is not to make digestive symptoms more complicated than they need to be.
It is to avoid stopping the evaluation too early.
An IBS diagnosis can be useful, but I see it as a starting point for understanding how the digestive system is functioning and what may be contributing to the symptoms.
At Restore Balance Integrative Medicine, that is the approach we take when evaluating persistent digestive concerns.