What Are The Different Types of IBS?

One thing you quickly realize working with a nutritionist is that we ask a LOT of details about your poop. Being a new mom, I can say I now talk about poop EVEN more than I did before - though I didn’t even think that was possible haha! So before we get into today’s post, keep in mind we talk a lot about poop in this one!

What is IBS?

Irritable Bowel Syndrome (IBS) is a functional disorder of the large intestine that causes a range of symptoms including diarrhea, constipation, gas, cramping, pain, bloating and even nausea and vomiting for some. It is considered “functional” because it is often diagnosed after all other possibilities have been ruled out first, possibly through a colonoscopy, stool tests or blood tests.

It is a very real and fortunately now well recognized condition, but it is still very misunderstood and often used as a “catch all” term for any type of digestive issue that can’t be explained through diagnostic testing or, in some cases, even before any testing has taken place. For example, someone who has IBS may experience a lot of very real pain or discomfort but diagnostic testing shows no ulcers or even inflammation.

This can be frustrating because it doesn’t really give any concrete answers, but this is because IBS can manifest in various ways for different people as well as for the same person at different points in their life.

If you have a functional GI disorder, you may experience problems with:

  • Motility - how you move food and waste through the GI tract
  • A heightened experience of pain in the GI tract and GI organs (small intestine, colon, stomach, liver, gallbladder etc.)
  • Changes to the immune function in your gut (over 70% of the immune system is located in the gut)
  • Changes to your microbiome, which is the community of bacteria in your gut
  • Changes in how your brain sends and receives information from your gut (the gut is often referred to as the “Second Brain” because the gut and brain communicate!)

While stress is not the cause of IBS, there is often a big link between IBS and stress or anxiety. Generally, people with IBS describe themselves as “feeling their emotions in their stomach”. Feelings of worry, anxiety, depression or even just underlying low-grade stress tend to trigger a flare up for people with IBS.

The Different Subtypes of IBS

Today, many medical professionals are moving towards the Rome IV criteria (previously Rome III) to diagnose IBS and the sub-types. The key distinction between IBS and other digestive issues is the prevalence of abdominal pain, the types of bowel movements and the length of time it has been going on. In people with IBS, the nerves of the intestines may be more sensitive, causing more abdominal pain and discomfort than someone who doesn’t have IBS but who still has constipation, diarrhea, etc. With the new criteria, patients must experience “recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria” (source):

  • Related to going to the bathroom
  • Associated with a change in frequency of bowel movements
  • Associated with a change in form (appearance) of bowel movements

In other words, people who have IBS have chronic pain specifically associated with alterations in bowel movements.

Under the umbrella of IBS are three main subtypes.

IBS-C

This is IBS with predominant constipation. Along with pain and discomfort, someone with IBS-C has more infrequent stools, hard or lumpy stools, may strain to pass stools and feel like their bowels haven’t completely emptied or that their bowels are “blocked”. Generally, the pain and abdominal discomfort improves after a bowel movement.  

With IBS-C, it’s possible that the colon may be absorbing too much fluid from the stool, or the muscles in the colon may be moving too slowly, causing the stool to become dry, hard, and difficult to pass. There may also be a miscommunication between the brain and intestines which may cause more discomfort and a change in bowel movements.

What we’ve seen with clients is that specific food sensitivities can lead to slower transit time and constipation. Anecdotally, in clients that have an egg sensitivity, they often experience constipation when they consume eggs.

IBS-D

This is IBS with predominant diarrhea. Someone with IBS-D usually has very frequent bowel movements, a greater sense of urgency and loose, more watery stools. Unlike IBS-C, in this case the intestine may be contracting rapidly, which can cause both pain and faster movement of stools. The intestine then has less time to absorb water from digested food, which leads to loose or watery stools. Food sensitivities may play a more significant role in IBS-D.

Again, food sensitivities, SIBO and/or parasites can be other root causes at play here. With our clients, an elimination diet helps about 90% of the time and puts almost all symptoms in remission. You can read about two case studies of us helping clients with IBS here:

A Case Study On Curing IBS Naturally

A Case Study on Improving Sleep, Boosting Energy & Relieving IBS

IBS-M

Also, called IBS-A, this is IBS with mixed bowel habits or alternating diarrhea and constipation. People with IBS-M may have to work even harder on developing a routine around eating habits, meal times and when they go to the bathroom.

Keep in mind it’s also possible for someone to switch subtypes later on in life, so how they manage their IBS symptoms can change.

How to Treat IBS

The reason the Rome IV criteria are so important is that they provide a standard definition of IBS, which is needed for credible studies to take place. It’s also tricky though because someone may not fit the criteria but still benefit from similar treatment approaches. This is why at HEAL, regardless of if a client has been formally diagnosed with IBS or presents with symptoms of IBS (or any other digestive issues for that matter), it doesn’t necessarily change our course of action. We always look for the root cause(s) of the issue we are seeking to address and use this to shape a personalized protocol.

When we begin working with clients we have them complete a very detailed intake questionnaire to determine the range of symptoms they may be experiencing. Often, people are surprised by the level of detail but as we work together they begin to understand how different symptoms are linked, and how something they previously thought was normal or didn’t really put any thought into may actually be a symptom, like embarrassing smelling gas, frequent colds or not going to the bathroom every day. Based on individual responses we may focus on a variety of different areas, like:

  • Fiber intake (too little, too much or not the right kind)
  • Consumption of processed foods
  • Hydration levels
  • Vegetable intake (more isn’t always better with IBS)
  • Assessing for food allergies, sensitivities and intolerances
  • Mindful eating practices
  • Assessing for Small Intestinal Bacterial Overgrowth (SIBO)
  • Assessing for gut bacterial imbalances and infections
  • Managing inflammation
  • Stress management
  • Nutritional support
  • And more

Why I Really Dislike An IBS “Diagnosis”

In my experience, when I was diagnosed with IBS I was told I’d just have to live with it. Many clients that come to us at HEAL are either told the same, or put on a medication that results in other, unwanted, side effects.

I really dislike an IBS diagnosis because it usually doesn’t offer solutions. In reality, with the right help, many of our clients are able to overcome it and go back to being relatively symptom-free. The key is to find and address the root cause(s) of your digestive issues and your triggers and take a highly personalized approach to managing it.

Other Sources:

https://www.asge.org/home/for-patients/patient-information/understanding-irritable-bowel-syndrome-with-constipation-ibs-c

https://www.asge.org/home/for-patients/patient-information/understanding-irritable-bowel-syndrome-with-diarrhea-also-known-as-ibs-d

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