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  • Writer's pictureMarissa Mekelburg MS, RDN, CLT, HHP

Is IBS a Real BS Diagnosis You Shouldn’t Settle For?

Sound harsh? Maybe. But I say this from a place of genuine caring and the desire to help you understand what IBS really is (and isn’t).

I get it, you have felt bad for so long, the symptoms that you experience are very real and have a huge impact on your life; they may cause you to miss work or not be as productive while you are there, to miss out on plans with family or friends because you are afraid to leave the house (and the comfort of your own bathroom) or you may not be as active as you once were because let’s face it who wants to get outside on a 5 mile walk, run or hike (or be in the middle of kickboxing class at the gym that you used to love) and risk having diarrhea hit? Right?

You’ve gone to your doctor, you’ve have had probably what seems like an endless number of tests done and finally, you get diagnosed with IBS – irritable bowel syndrome. Yeah! There you have it, the answer you have been seeking, right? Wrong and here’s why. You see IBS while technically is a diagnosis, in reality it is a label, a description of what your symptoms are but it doesn’t tell you WHY you have the symptoms that you do (I mean think about it....WHY is your bowel irritable anyway?) That’s why I’m encouraging you to keep looking, to not accept this diagnosis as the be all, end all because if you do decide to learn to live with this label, then you are making a terrible mistake that’s bound to keep you feeling miserable.

There is much more that you can do, that you can take charge of that your doctor most likely didn’t talk you about and YOU, your health is worth fighting for!

So let’s talk a bit more about IBS and I will show you what I mean......

The Medical Definition of IBS

The technical criteria for diagnosing IBS is set by the Rome Foundation which is “independent not-for-profit organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of functional gastrointestinal disorders (FGIDs)” (1)

New Rome IV criteria for diagnosing IBS states that (2):

Recurrent abdominal pain, “should be present at least 1 day per week during the previous 3 months” and be:

– Related to defecation and/or – Associated with a change in frequency of stool and/or – Associated with a change in form (appearance) of stool

Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.

Even though the new Rome criteria has been updated, it’s still pretty broad and it’s no surprise then how many people will fit these criteria and be diagnosed with IBS. Also, as you can see the Rome criteria describes a set of symptoms but offers no explanation for WHY does someone have abdominal pain at least 1 day per week? WHY might the pain be relieved with defecation? WHY does someone experience a change in the frequency or appearance of stool? These are questions that have to be answered in order for you to get feeling better.

Why you shouldn’t settle for an IBS diagnosis

A “diagnosis” is a label given to a consistent group of symptoms and then the symptoms are treated according to that label. Did you know that IBS is considered to be a diagnosis of exclusion? (3) This means that you go to your doctor with common symptoms like gas/bloating, abdominal pain, diarrhea, constipation (or both) and based upon your history, he or she will typically run a few tests to rule out more serious conditions like inflammatory bowel disease (IBD), colon cancer, celiac disease and possibly common pathogens like giardia. Once these tests come back negative, the digging stops and you are labeled with IBS. From this point, you most likely will be prescribed whatever the most common IBS medication is and sent on your way. The doctor’s work is done. But due to this approach, many times you may be receiving an IBS diagnosis and be prescribed medication too quickly. And while you may find temporary symptom relief from this approach, in reality, if the underlying cause is not addressed most likely you will eventually begin to feel like crap again, old symptoms may return, or new symptoms may arise and the cycle of trial and error begins - going back to the doctor, perhaps trying a new one, desperately trying to get relief from your symptoms.

While there are pros and cons to receiving a medical diagnosis or label; IBS as a label is a particularly problematic one because it implies that you have found the problem, that there is no reason to continue to look for a specific root cause yet it provides no real guidance on what your next steps should be beyond taking the latest prescription or just living with it. Let me be clear, I am not against medication, prescription or otherwise to provide some temporary symptom relief. I get it. If taking some anti-diarrhea medicine allows you to have a life, to do fun things with friends and family, I’m all for it but please don’t stop there.

Remember IBS is not a cause but rather it is a description of your symptoms and having a label for your symptoms or taking a medication that temporarily alleviates those symptoms doesn’t help you get better. For example, your symptoms may be abdominal pain, bloating and diarrhea but the underlying root cause could be food intolerances, bacterial or yeast overgrowth or malabsorption issues just to name a few. If you are unable to stop a medication without symptoms returning, then your root cause has not been identified or properly addressed.

Symptoms are our bodies way of telling us something is wrong, is out of balance. When we try to only manage symptoms, and don’t look for and address the root cause for why we have them, it can have an impact on our health in the long term. Think of it like this – if you have a campfire that looks like it has been put out unless you stir it up to make sure, it’s possible that there are still embers burning below the top ash that could set off a forest fire. The same goes for only addressing your IBS symptoms and not addressing the underlying root cause that is still “burning”.

Final Thoughts

At the end of the day, ultimately, I don’t mind someone being told or labeled as having IBS. By receiving this diagnosis, it tells me that they have been checked for more serious conditions by a physician and that they have gut issues that requires more investigative work, which is something for me to work with. What I do mind is people who are still suffering and don’t know where to turn or what to do because receiving an IBS diagnosis seems so final and there isn’t a treatment for IBS, only for the root causes for IBS.

If you have received an IBS diagnosis, I would recommend finding a functional practitioner to work with that can help identify and address your specific underlying causes because there is always a reason for a symptom.

If you would like to learn more about how I can help, you can get started by scheduling an initial visit.

References: 1. Rome Foundation.

2. J Neurogastroenterol Motil. 2017 Apr; 23(2): 151–163. Published online 2017 Apr 1. doi: 10.5056/jnm16214

3. Camilleri, M. (2012). Irritable bowel syndrome: how useful is the term and the “diagnosis”? Therapeutic Advances in Gastroenterology, 5(6), 381–386 Camilleri, M. (2012).


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