What does an IBS Diagnosis Mean?
You’re probably on this website because you already have some kind of digestive issue. or received a SIBO or IBS diagnosis. Maybe you have gas, bloating, diarrhea, or constipation. Maybe you have strange stomach pains, or gurgling noises. Maybe certain foods bring on problems for you—or maybe just the act of eating itself.
Is it IBS (irritable bowel syndrome)? And just what is IBS, anyways?
IBS is generally a diagnosis of exclusion.
First of all, an IBS diagnosis is one of exclusion. What this means is that when a doctor diagnoses you with IBS, that doctor couldn’t find anything else wrong with your digestive system to explain your symptoms. In other words, doctors have very little idea what’s wrong with you—just that your digestive system isn’t working properly. Although the medical science surrounding IBS has advanced, it still remains largely true that doctors don’t really know what the problem is (or more importantly, how to fix it!).
But just because doctors can’t explain the reason behind your symptoms doesn’t mean you have IBS. Not all unexplained digestive symptoms meet the technical criteria for an IBS diagnosis. And as recently as 2016, that criteria, known as the Rome Diagnostic Criteria, got an update.
The 2016 Rome IV Diagnostic Criteria set a new definition of functional gastrointestinal disorders.
The new Rome Criteria moved IBS further away from being solely a diagnosis of exclusion. Previously, the Rome Criteria defined a functional gastrointestinal disorder as the “absence of a structural disease.” The 2016 updates to the Rome Criteria changed the definition of a functional gastrointestinal disorder to a disorder of the interaction between the gut and the brain. Functional gastrointestinal disorders may involve symptoms of any combination of:
- Motility disturbance
- Visceral hypersensitivity
- Altered mucosal and immune function
- Altered gut microbiota
- Altered central nervous system (CNS) processing
These disorders include such disorders like Reflux hypersensitivity syndrome, Reflux hypersensitivity syndrome, Opioid-induced constipation, and others.
Rome IV Standards for IBS Diagnosis
The Rome IV standards for a diagnosis of IBS changed only slightly from the previous standards. The new diagnostic standard requires that a patient experience recurrent abdominal pain on average at least one day a week in the past three months, associated with two or more of the following: related to defecation, associated with a change in frequency of stool, and/or associated with a change in the form of stool. The patient must have experienced that pain and changes to bowel habits for the previous three months, with symptoms that began at least six months prior to the diagnosis.
As you can see, that definition merely describes a change in your bathroom habits, but doesn’t offer any explanation of why that change occurred. Practically speaking, this means that what a doctor will usually do is test you for things that have similar symptoms (like celiac disease). If those tests don’t yield anything unusual, the doctor will then declare that you have IBS. Not particularly helpful!
If you’ve gotten to that stage and have received an IBS diagnosis, you should consider whether your doctor ever tested or evaluated for SIBO (small intestinal bacterial overgrowth). Over half of IBS cases actually turn out to be SIBO. Unlike IBS, SIBO can be tested for, usually using a hydrogen and/or methane breath test. Doctors also largely know the causes of SIBO and treatment is possible, although it can be challenging.
