Did you know that one of the American College of Gastroenterology’s IBS Management Guidelines points to how important it is to subtype patient’s IBS?

Accurately categorizing those with IBS based on their primary bowel habit is generally recognized to help improve patient therapy – and may help steer patients away from recommendations that may actually worsen symptoms.

No one needs their IBS to get worse right? So let’s chat about the IBS “category” (or “subtype”) a little more.

The “abnormal” bowel movements define someone’s subtype of IBS in term of:

• Form (shape and consistency of your poop), and
• Frequency (number of poops per day)

There are 4 subtypes of IBS:

• IBS-D
• IBS-C
• IBS-M
• IBS-U

IBS-D

IBS-D stands for Irritable Bowel Syndrome with Diarrhea (hellooo...this is my subtype)!

It is a type of IBS in which the individual experiences frequent diarrhea, often accompanied by abdominal pain, cramping, and bloating.

Need some exact numbers, you detail-oriented person? Sure.

IBS-D is defined as MORE than 25% of abnormal bowel movements are loose or watery (Type 6 or 7), and LESS than 25% of abnormal bowel movements are hard or lumpy (Type 1 or 2). Or, IBS-D may be assigned when a person reports that most of their bowel movements are diarrhea.

IBS-D is a chronic condition and can cause significant discomfort and disruption to daily life. In fact, some studies suggest this subtype can have the greatest impact on someone’s mental health and wellness, mainly due to the anxiety surrounding having a “diarrhea episode” while out of their home.

I’ve sure been there.

The exact cause of IBS-D is not known, but it is thought to be related to changes in the way the muscles in the intestines contract and relax, leading to diarrhea and other symptoms.

1 in 10 people, for example, who experience digestive infections such as traveler's diarrhea, or food poisoning may wind up developing IBS-D.

Treatment for IBS-D may include changes in diet (FODMAPs, fibre, certain digestive enzymes, and more) and healing the gut-brain connection, as well as potential medications such as Rifaximin to help manage symptoms.

If you suspect you have IBS-D, it is important to consult with a healthcare professional for an accurate diagnosis and treatment plan, as bloating, diarrhea and abdominal pain may not only occur in IBS-D, but also can overlap with other (some, potentially serious) health issues including but not limited to: Celiac Disease, Inflammatory Bowel Disease (IBD is not to be mistaken with IBS-D!) Microscopic Colitis, and more.

I have a both an IBS-D Program for eligible Canadians in certain provinces, and an IBS-D Ultimate Guide available that may be a great starting point once you have been officially diagnosed with IBS-D, (which usually involves your Doctor and/or Gastroenterologist ruling out the more serious conditions including the above mentioned diseases first).

For much more on IBS-D and tips that I use in my daily practice (and personal life in fact), head on over to my Self Help Resource Page and snag your own free (for now) copy of my IBS-D Mini-Guide.

At the end of the day, I truly believe that booking in with a registered dietitian trained in IBS (such as Monash University IBS Training) can point you in the right direction in your journey to manage your condition (trust me when I say there are a lot of IBS myths, wacky supplements, expensive and non-science based “food sensitivity testing”, and incorrect FODMAP food lists out there)!

IBS-C

IBS-C is the acronym for people with Constipation predominant IBS, or “IBS with Constipation”.

Like most with IBS, folks often experience an individual "constellation" of symptoms unique to them.

In my practice, I often find hard/dry/infrequent bowel movements, bloating, gas, nausea, abdominal pain and getting in enough (less bloating) fibre sources are the primary struggles of IBS-C folks, and thus my recommendations target evidence-based ways to help reduce such symptoms.

What’s the current definition of IBS-C in numbers? Glad you asked:

IBS-C is defined as LESS than 25% of abnormal bowel movements are loose or watery (Type 6 or 7), and MORE than 25% of abnormal bowel movements are hard or lumpy (Type 1 or 2). Or, IBS-C may be assigned when a person reports that most of their bowel movements are constipation.

If you suspect you have IBS-C, it is important to consult with a healthcare professional for an accurate diagnosis and treatment plan, as bloating, constipation and abdominal pain may not only occur in IBS-C, but also can overlap with other, (some more serious than others) health issues including, but not limited to: Cancers of the reproductive system, Endometriosis, Small intestinal bacterial overgrowth (SIBO), Hypothyroidism, Diverticular disease, Cancers of the gastrointestinal system, and more.

I have an IBS-C Ultimate Guide available that may be a great starting point once you have been officially diagnosed with IBS-C (which usually involves your Doctor and/or Gastroenterologist ruling out the more serious conditions including the above mentioned diseases first).

Booking in with a registered dietitian trained in IBS (such as Monash University IBS Training) would always be a worthwhile investment in my opinion, if you have the financial means or extended health coverage to do so, as potential dietary tools (such as the Low FODMAP Diet) can be quite the challenge to navigate without support.

Also, there could be other helpful strategies available that you might not yet know about for your particular IBS type that use tactics beyond what goes on your plate. Check out some more neat IBS-C info in my free IBS-C Mini-Guide.

IBS-M

Folks with Irritable Bowel Syndrome with Mixed Bowel Habits (IBS-M) cycle between hard and loose bowel movements, abdominal pain possibly other symptoms like bloating and gas.

IBS-M is defined as more than 25% of abnormal bowel movements are loose or watery (Type 6 or 7), and more than 25% of abnormal bowel movements are hard or lumpy (Type 1 or 2). Or, IBS-M may be assigned when a person reports that their bowel movements go back and forth between constipation and diarrhea.

In my practice I find clients with IBS-M are challenged with getting a handle on this metaphorical bowel movement “see-saw” so they can return to a consistent and predictable daily toilet routine, as well as getting enough (less bloating) fibre sources are the primary struggles.

Did you know that IBS-M may possibly be more of a constipation issue than one of diarrhea for some folks? I find this is more often the case in my practice.

So, my recommendations for IBS-M usually target potential tools to help disembark this awful roller coaster bowel movement pattern of constipation to diarrhea (and on and on it goes) first, and then make a plan to manage any other symptoms they may be experiencing.

If you suspect you have IBS-M, it is important to consult with a healthcare professional for an accurate diagnosis and treatment plan, as bloating, constipation/diarrhea and abdominal pain may not only occur in IBS-M but also can overlap with other, (some more serious than others) health issues.

Is this your diagnosed subtype?

Unfortunately IBS-M is one of the least researched subtypes, but fret not! Booking in with a registered dietitian trained in IBS (such as Monash University IBS Training) can point you in the right direction in your journey to manage your IBS-M.

If you’d like to sneak a peak at some of my top IBS-M tips I use in my practice, head on over to my Self Help Resource Page and snag your own free copy of my IBS-M Mini-Guide.

IBS-U

Unclassified folks are assigned IBS-U when they meet the Rome IV criteria for IBS in terms of recurrent abdominal pain, yet their bowel habits cannot fit into any of the IBS subtype categories.

In other words, someone may not experience significantly abnormal bowel patterns (more than 25% of the time having constipation, diarrhea, or both) unlike the subtype categories.

People with IBS often experience an individual "constellation" of symptoms unique to them (not so surprising right?).

If you suspect you have IBS-U, it is important to consult with a healthcare professional for an accurate diagnosis and treatment plan, as bloating and abdominal pain may not only occur in IBS-U but also can overlap with other (some more serious than others) health issues such as: Celiac disease, Milk protein intolerance, Lactose intolerance, Food chemical sensitivities, Pelvic floor issues, Endometriosis, Small intestinal bacterial overgrowth (SIBO), Constipation, Hypothyroidism, Inflammatory bowel disease (IBD), Diverticular disease Cancers of the gastrointestinal and/or reproductive system, Pancreatic insufficiency, and others.

In my practice, I often find bloating, gas and abdominal discomfort are the primary struggles of IBS-U folks, and thus my recommendations target evidence-based ways to help reduce such symptoms.

Is IBS-U your diagnosed subtype?

Unfortunately, like IBS-M, IBS-U is the other of the two least researched subtypes, but chin up! Booking in with a registered dietitian trained in IBS (such as Monash University IBS Training) can point you in the right direction in your journey to manage your IBS-U.

If you’d like to sneak a peak at some of my top IBS-U tips I use in my practice, head on over to my Self Help Resource Page and snag your own free copy of my IBS-U Mini-Guide.

WHAT ABOUT SIBO?

You may have heard of SIBO (and been through some successful...or maybe not so successful treatments for SIBO), or this may be a new consideration for you.

Did you know approximately 30-40% of those with IBS may also have SIBO (Small intestinal bacterial overgrowth)?

I can hear your questions already, so let’s dive in a little more.

What is SIBO?

Well, first of all I’ll tell you what it’s not:

SIBO is not an infection, inflammation, or an “imbalance” of our gut bugs, and (surprise!) it does not occur spontaneously, meaning it usually is a symptom of something else.

Let’s back it up a little:

Our large intestine normally has trillions of healthy bacteria, viruses, and fungi that help us digest and ferment our food, feed our gut cells, produce certain vitamins like vitamin K, and more.

If these bacteria sneak past our ileocecal valve (a little sphincter, or band of muscles, that is kind of like the gate where our small intestine connects to our large intestine) and out of the large intestine, and set up camp in the small intestine, this can cause intense bloating, in particular.

Why? The small intestine is great at moving food, but not at moving gas like the large intestine is.

So if these good gut bugs (again, this isn’t an infection) are coming into contact and digesting (fermenting) non-digestible food particles, such as FODMAPs from the diet, the gasses produced may be quite tough to tolerate for the small bowel, and can lead to the person with SIBO experiencing their symptoms.

Always speak to your Doctor if you suspect SIBO, as your practitioner may need to still rule out other (potentially serious) undiagnosed issues first, such as celiac disease, IBD, colorectal cancer, or other gut-related issues before starting any interventions for SIBO. These issues may share overlapping symptoms with SIBO, and may pop up at anytime.

Common questions I come across in my practice with regards to SIBO are:

What might SIBO symptoms look like?

What shape are SIBO poops?

What increases someone’s risk of SIBO?

How is SIBO tested?

Can SIBO be treated naturally?

What is currently the most effective treatment for SIBO?

Can I manage SIBO symptoms through diet?

If interventions for SIBO do not work, tell your Doctor, and consider working with a specially trained Dietitian to identify any possible FODMAP (or other) triggers.

Remember, SIBO is a symptom of something else and may reoccur if the reason someone developed SIBO in the first place remains unidentified.

Whew!

If you are a resident of BC, and if you want help navigating your IBS (or your potential SIBO) book here if you’d like to work with me.

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Always, always consult your health care practitioner prior to starting, stopping, or altering any diet, supplement or lifestyle change!