You don't have IBS

If you have been diagnosed with irritable bowel syndrome (IBS), there are a few things you need to know. First of all, IBS isn’t real. This leads to my second point: you don’t have IBS (because you can’t have something that isn’t real).

IBS isn’t real

What do I mean that IBS isn’t real?

Irritable bowel syndrome is simply a term used to describe a collection of symptoms. It is nothing more than a label. It is not a disease. A disease has a known cause that produces a known pathophysiology (changes in normal cellular function) that results in known damage to cells and organs, which results in known symptoms. When it comes to IBS, all we have are symptoms.

Here is what this means. If you were to tell me you have IBS, all I would know is that you have digestive issues. I wouldn’t even know exactly what your symptoms are. And I certainly would not know what is causing your symptoms and what is going wrong in your body, so I would not know how to fix it.

A diagnosis of exclusion

You see, IBS is what we call a diagnosis of exclusion. When you have been tested and evaluated for every possible other condition and you still don’t know what is wrong with you, that is when you're labeled with a diagnosis of exclusion. It basically means, “We don’t know what is wrong with you, but we have to call it something, so we’re calling it IBS.”

But it seems like the medical profession has forgotten that IBS is a diagnosis of exclusion. The majority of patients who were diagnosed with IBS have never been evaluated for any of the other conditions that could be causing their digestive symptoms. It seems like doctors skipped step 1, which is to rule out other diseases and went straight to step 2, the diagnostic criteria. Well, to meet the Rome III diagnostic criteria for IBS you need to be experiencing recurrent abdominal pain or discomfort at least 3 days per month for the last 3 months with your symptoms having started 6 months ago. You also need to meet 2 or more of the following criteria: symptoms improve with defecation; the onset of symptoms associated with a change in stool frequency; and the onset of symptoms associated with a change in stool appearance.

When you think about it, the criteria seems rather arbitrary. What if you only experience symptoms 2 days per week? Or what if your symptoms started 5 months ago? When you think about it some more, you realize that you could probably diagnose most people with IBS if you really wanted to.

Hopefully, you are starting to realize that to be diagnosed with IBS is meaningless. In the medical world, we, as doctors and as patients, often get hung up on the “diagnosis”. We believe that the diagnosis has some sort of power, whether that is to explain what is wrong or to help you get better. Sometimes, this is true, but often a diagnosis is just a label doctors need to use to get reimbursed by the insurance company. The diagnosis of IBS does not explain what is going wrong with your physiology, it does not explain what is causing your symptoms, and therefore, it has no role in helping you get better.

When your goal as a doctor is to treat the cause, to restore normal physiology, to heal and not just suppress symptoms, IBS becomes a useless medical construct that distracts from the real problem and the real solution.

What to do if you’ve been diagnosed with IBS

If you have been diagnosed with IBS, the first thing you need to do is find a doctor who won’t settle for a diagnosis of exclusion but who will work to actually figure what is going wrong and fix it.

You also need to make sure that you rule out other conditions that may be causing or contributing to your symptoms. Conditions include celiac disease, inflammatory bowel disease, thyroid problems, colon cancer, gastrointestinal infections, MTHFR genetic defects, intestinal dysbiosis, and disrupted brain-gut axis.

Make sure that your doctor considers SIBO, small intestine bacterial overgrowth. Recent research shows a strong correlation between the diagnosis of IBS and SIBO. In fact, up to 84% of people diagnosed with IBS may actually have SIBO. You can test for SIBO using a lactulose breath test so be sure to ask your doctor about this procedure.

Dealing with digestive issues can be painful, frustrating, time-consuming, and even embarrassing. It can affect your work and your social life, decreasing your quality of life. But don't settle for a diagnosis of IBS. Look for the real cause of your symptoms so that you can finally fix the problem and get back to living.

References

• Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2003 Feb;98(2):412-9. doi: 10.1111/j.1572-0241.2003.07234.x. PMID: 12591062.

• Ghoshal UC, Shukla R, Ghoshal U. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut Liver. 2017 Mar 15;11(2):196-208. doi: 10.5009/gnl16126. PMID: 28274108; PMCID: PMC5347643.