Irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) are two common gut conditions that often cause confusion and frustration. While they share similar symptoms like bloating, abdominal pain, and diarrhoea, they are different conditions with differing underlying causes. If you have IBS and SIBO, understanding the difference and finding relief can be crucial for managing your symptoms and to stop it affecting your everyday life.

What is IBS?

IBS is unique to sufferers. It’s not a one-size-fits-all condition. It can be categorized into different types based on the predominant symptoms:

1. IBS-D (diarrhoea-predominant): Individuals with IBS-D experience frequent episodes of diarrhoea. This can be accompanied by urgency and a constant need to use the toilet
2. IBS-C (constipation-predominant): IBS-C is characterized by infrequent bowel movements and hard, lumpy stools. People with this type often struggle with abdominal discomfort and a feeling of incomplete evacuation
3. IBS-M (mixed-type): Some individuals may experience a mix of both diarrhoea and constipation, with their symptoms varying over time
4. IBS-U (unsubtyped): This category is used when the symptoms do not clearly fit into any of the above types

What is SIBO?

SIBO, which stands for Small Intestinal Bacterial Overgrowth, is a condition where an excessive amount of bacteria starts inhabiting the small intestine. This leads to a disruption in the natural balance of gut flora, causing various digestive issues that can significantly impact your well-being. Imagine your small intestine, a long tube responsible for absorbing nutrients from food. Normally, only a small amount of bacteria resides there. However, in SIBO, this balance is disrupted, leading to an excessive overgrowth of bacteria. This overgrowth can trigger various symptoms, often mimicking those of IBS.

SIBO and IBS: The complex connection

While not everyone with IBS has SIBO, and vice versa, there’s a significant overlap. Studies suggest that up to 80% of individuals with IBS may also have SIBO. This raises the question: is SIBO a potential cause of IBS, or simply another symptom?

The answer is complex. While SIBO can undoubtedly contribute to IBS symptoms, it’s not always the sole culprit. Other factors like stress, motility issues and gut sensitivity can also play a role. However, treating SIBO often leads to significant symptom improvement in IBS patients, suggesting a strong link.

How to recognise SIBO symptoms

As many SIBO symptoms overlap with IBS, it can be challenging to differentiate between them. However, some key indicators might suggest SIBO:

• Chronic bloating and gas – even after eating only small amounts
• Excessive burping
• Nutritional deficiencies despite a healthy diet
• Skin issues like rosacea or acne
• Fatigue and brain fog

Diagnosing SIBO

Diagnosing SIBO can be tricky due to the lack of any current single definitive test. However, several methods can help identify its presence:

• Breath tests: These measure hydrogen or methane gas produced by bacteria in the small intestine
• Small intestinal aspirate and culture: This direct sampling of the small intestine content is considered the gold standard but is more invasive
• Blood tests: While not directly diagnosing SIBO, they can help rule out other conditions

Treating SIBO and IBS

If SIBO is confirmed, treatment usually involves a course of antibiotics specifically chosen to target the overgrowth. Additionally, dietary changes and lifestyle modifications should be recommended to support gut health and prevent future overgrowth. The changes to the diet suggested for SIBO, are similar to those recommended for IBS:

• Reduce FODMAPs: These are short-chain carbohydrates which are poorly absorbed and exacerbate symptoms. Consider trying a low-FODMAP diet under the guidance of an IBS dietitian trained in FODMAPs
• Probiotics: These live bacteria can help restore gut balance and improve digestion. Read my blog for more information on the best probiotics for you
• Stay hydrated: Adequate water intake is crucial for gut health and digestion

Can a FODMAP Dietitian help improve my symptoms?

An IBS Dietitian trained in FODMAPs can use knowledge and experience to help with the low FODMAP diet. It’s tricky to do alone though, but with support, sufferers can identify their triggers and improve management of SIBO and IBS symptoms. A FODMAP dietitian will provide practical ways to help fit the low FODMAP diet into your lifestyle and ensure that you still get a balanced diet. I’m and IBS Dietitian based in Cardiff, but work across the UK. I offer a free initial telephone consultation, so why not arrange a call today.

Conclusion

Diagnosing and managing IBS and SIBO is far from straight forward and requires a multi-pronged approach. But, working with an IBS Dietitian and exploring various treatment options, including dietary modifications and stress management techniques, is crucial. Remember, you’re not alone in this journey. With the right support and knowledge, you can find relief and reclaim control of your gut health.

Disclaimer: This blog is for information purposes only and does not substitute for professional medical advice. Please consult your healthcare provider for personalised diagnosis and treatment of IBS and SIBO.