Irritable bowel syndrome (IBS) has been a recognized gastrointestinal disorder for more than 150 years . Today, IBS continues to challenge healthcare professionals, as many individuals struggle with digestive discomfort in their daily lives.
Functional medicine can provide effective approaches in managing IBS symptoms, including IBS pain. Unlike some standard medicine approaches, functional medicine targets the root causes of IBS, of which poor gut health plays a part, to manage its symptoms more effectively.
In this article, we will explain IBS and its symptoms. Then, we’ll talk about what causes IBS and how functional healthcare helps alleviate IBS pain.
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that reduces your quality of life. Historically referred to as a spastic colon, the core symptoms of IBS are abdominal pain, bloating, and abnormal bowel movements . IBS symptoms most often occur in episodes that can last 1-5 days.
Based on the stool pattern, IBS is sub-categorized into:
- IBS-C: Constipation-predominant
- IBS-D: Diarrhea-predominant
- IBS-M: A mix of constipation and diarrhea
- IBS-U: Unspecified IBS
Common symptoms of IBS include:
- Bloating and distension 
- Gas, flatulence, and cramping 
- Constipation and/or diarrhea
- Indigestion, heartburn, and reflux 
While IBS primarily affects your digestive system and appears as gut-related symptoms, IBS is more than just abdominal pain. This gastrointestinal disorder also causes non-digestive pain symptoms such as fatigue, joint pain, and headaches [6, 7, 8, 9, 10, 11, 12, 13]. It’s also linked to women’s chronic pelvic pain and fibromyalgia .
Besides that, IBS alters gut-brain interaction . At one time, IBS was mistakenly considered to be a psychological condition. While stress can play a role in triggering IBS pain, it’s now known that anxiety and depression, two common conditions in IBS patients, is more likely a by-product of this condition.
What Causes IBS?
IBS is a complex medical condition with multiple root causes:
- Gut dysbiosis: Gut bacterial imbalance, like small intestinal bacterial overgrowth (SIBO), affects at least a third of IBS patients [18, 19, 20, 21]. Dysbiosis leads to bacterial fermentation of food in the intestinal tract, which overproduces gas and causes digestive symptoms .
- Food poisoning: Gastroenteritis (food poisoning) causes about 5-32% of IBS cases. It multiplies the risk of IBS by four .
- Non-IBS digestive diseases: Intestinal inflammation and irritation caused by IBD and celiac disease are possible causes of IBS pain.
- Leaky gut: Increased intestinal permeability, also known as leaky gut, is present in IBS-D patients, leading to more severe IBS pain symptoms [24, 25].
- Food intolerances and hypersensitivity: Gluten, wheat, dairy products, artificial additives, and high FODMAP foods are common triggers of IBS [26, 27, 28, 29, 30].
- Constipation: While constipation is a common symptom of IBS, it’s also a likely root cause . Slow gut motility heightens the risk of gut dysbiosis, inducing IBS pain .
To rule out non-IBS digestive diseases, gastroenterologists have traditionally used invasive procedures like colonoscopy and biopsy. However, a new blood test for IBS-D and IBS-M patients is available, which means that for many patients, IBS can now be diagnosed directly.
While IBS cannot be cured, it’s possible to ease IBS pain, prevent IBS episodes, and experience a better quality of life.
Where Conventional IBS Therapies Fall Short
Doctors employ advanced testing and treatments to effectively manage IBS pain in countless cases. But while some patients see improvement with conventional therapies, others still struggle with this gastrointestinal disorder.
This is partly due to the one-size-fits-all approach most standard practitioners employ. Since symptoms differ widely from patient to patient, a blanketed approach may be less adept at identifying IBS triggers.
Some doctors may only focus on IBS symptoms rather than its root causes. Laxatives and antispasmodics provide pain relief from diarrhea and cramping, respectively, and may be sufficient in mild cases.
But these medications only offer temporary relief and may not resolve chronic IBS pain completely. At the same time, they can lead to unwanted side effects — a meta-analysis found that antispasmodics are associated with a dry mouth, dizziness, and blurred vision .
The bottom line is, while conventional IBS therapies work in many cases, they are not a universal solution for everyone.
Functional Remedies for IBS Pain
Where standard medicine has failed to manage IBS pain successfully, functional medicine can help.
The functional healthcare approach understands different things can contribute to IBS. This means it’s important to pinpoint the exact triggers. Functional medicine doctors recognize each patient as a unique individual, hence the meticulous care in reviewing their family history and current symptoms.
If you’ve visited a gastroenterologist, your functional medicine physician may also review your colonoscopy and blood test reports. Where necessary, your functional doctor may suggest IBS blood testing, stool testing, and/or SIBO breath testing for a more accurate diagnosis of the reasons for your symptoms
Functional medicine also employs therapeutic diets, dietary supplements, stress management techniques, and treatment for gut imbalances as the first line of treatment for IBS pain. Prescription or over-the-counter drugs may be used as secondary approaches. However, the primary goal in functional medicine is to restore balance and function to the digestive system.
Twenty to 65% of IBS patients view food hypersensitivity as the reason for their symptoms . As such, functional treatment for IBS pain often starts with an anti-inflammatory diet which eliminates the most common food triggers.
If IBS pain still continues, your doctor may then transition you to the low FODMAP diet. For best results, try each therapeutic diet for 2-3 weeks. A food diary can also help identify which foods cause IBS symptom flare-ups.
An anti-inflammatory diet focuses on whole, healthy foods such as fresh vegetables, lean meat, and healthy fats. It excludes inflammatory foods, like sugar and trans fats, to reduce and eliminate gut inflammation .
One case study shows promising evidence for the use of the anti-inflammatory diet in IBS patients . After following the diet for more than four weeks, IBS symptoms improved in addition to less medication usage.
Low FODMAP Diet
Although more restrictive than the anti-inflammatory diet, the low FODMAP diet is the most researched diet for IBS pain.
Fermentable carbohydrates in high FODMAP foods feed harmful bacteria in the digestive tract. Switching to a low FODMAP diet deprives the bad bacteria of their food source. This improves bloating and abdominal pain in IBS patients [37, 38] and normalizes bowel habits [39, 40, 41]. The low FODMAP diet may also address joint pain  and fibromyalgia .
Healthy Lifestyle Changes
Healthy lifestyle changes are another important cornerstone of any IBS treatment plan. Simple yet effective changes, such as sleeping 7-8 hours every night and exercising regularly, do wonders for your gut health.
As IBS is a stress-sensitive disorder, research supports the use of stress management techniques like meditation, yoga , and hypnotherapy [45, 46]. Cognitive-behavioral therapy also plays a significant role in addressing IBS pain through the positive management of stress, anxiety, and depression .
Dietary supplements — probiotics and fiber (for some) — rebalance the gut microbiome, soothe intestinal inflammation, and minimize food sensitivities. A healthier digestive system is then better equipped to alleviate IBS pain.
Probiotics help correct bacterial imbalance and inflammation in the digestive tract in order to tackle gut dysbiosis. This causes IBS pain to improve, which relieves bloating, flatulence, gas, and abdominal pain [48, 49, 50, 51, 52, 53].
For best results in restoring gastrointestinal balance, try a triple probiotic therapy for 2-3 weeks that consists of:
- Lactobacillus and Bifidobacteria blends
- Saccharomyces boulardii
- Soil-based probiotics (for example, the Bacillus species)
Unfortunately, fiber can be a double-edged sword as it can feed the bacteria that cause gut symptoms. Some IBS patients have reported worsened bloating, gas, and abdominal pain  after taking fiber supplements.
Low FODMAP fiber sources such as ground flaxseed and chia seeds are well tolerated by most IBS patients.
In some cases, you may need more assistance in addressing IBS pain. That’s where digestive aids like betaine hydrochloride (or betaine HCL) and digestive enzymes come in.
Betaine HCL is an over-the-counter digestive aid for IBS patients with hypochlorhydria (low stomach acid). A case study shows that betaine HCL reduces bloating, reflux, and abdominal fullness, key symptoms of low stomach acid .
Incomplete digestion of certain foods, such as lactose, and dietary fats, can also lead to IBS discomfort like bloating, flatulence, and abdominal fullness. For example, lactose-intolerant individuals with gastrointestinal symptoms usually lack the enzyme lactase  to help break down dairy products.
In more recalcitrant cases of IBS pain, antibacterial treatments may be used to eliminate harmful bacteria and rebalance your gut flora.
Anti-microbial herbs are effective treatments against bacterial and fungal infections. They also disrupt the biofilm on harmful gut microbes, a protective layer that helps these microorganisms evade your immune system. Herbal antimicrobial treatments have been shown to be as effective as antibiotics for treating gut infections.
There are many botanical formulations available. Consult your functional doctor on the right antimicrobial herbs to add to your treatment plan.
The elemental diet is a highly restrictive diet that is best suited for patients with stubborn gut infections. It effectively resolves bacterial overgrowths by starving bacterial populations of their food sources. One study discovered that 65% of IBS patients on a two-week elemental diet showed improvement in their symptoms .
Anecdotal evidence also shows the elemental diet helped resolve chronic IBS pain that manifested as bloating, premenstrual cramps, and abdominal pain.
The elemental diet restricts all normal foods and patients consume elemental meal replacement shakes. The elemental diet has a reputation for being challenging, However, new, better tasting formulas make this an easier choice than in the past. At Austin Functional Medicine, our in-house health coach can provide the knowledge, guidance, and motivation to adhere to an elemental diet successfully.
Relieve IBS Pain for Better Quality of Life
Even though IBS is a challenging GI disorder, you can take steps to manage and eliminate its painful symptoms for a better quality of life. At Austin Functional Medicine, we teach you how to do just that. Our team of experienced functional physicians will identify your IBS triggers and create an effective treatment protocol.
If you’re ready to take the first step towards stopping IBS pain, book an appointment with us today.