IBS and SIBO Treatment

Understand Your Digestive Symptoms. Identify Contributing Factors. Build a Personalized Plan.

Chronic bloating, abdominal discomfort, gas, constipation, diarrhea, food sensitivity, and unpredictable bowel habits can significantly affect daily life.

Many patients are told they have irritable bowel syndrome, given general dietary advice, or asked to manage symptoms without a clear understanding of why the symptoms are occurring.

At Integrative Health Solutions, Dr. Bronner takes a comprehensive approach to digestive health. Evaluation may include gastrointestinal function, intestinal motility, microbiome balance, dietary triggers, inflammation, nutrient status, metabolic health, stress, medications, and other factors that may contribute to symptoms.

The goal is not simply to suppress symptoms. It is to identify clinically meaningful contributors and develop an individualized strategy to improve digestive function and long-term gastrointestinal health.

Schedule a Comprehensive Digestive Evaluation

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What Is Irritable Bowel Syndrome?

Irritable bowel syndrome, commonly called IBS, is a disorder involving recurring abdominal pain together with changes in bowel habits.

Depending on the individual, symptoms may involve constipation, diarrhea, or a combination of both. IBS does not typically produce visible structural damage within the digestive tract, but symptoms can still be persistent and significantly affect quality of life. (NIDDK)

Common symptoms may include:

• Abdominal pain or cramping
• Bloating
• Excessive gas
• Constipation
• Diarrhea
• Alternating constipation and diarrhea
• Urgency
• Incomplete bowel movements
• Changes in stool consistency
• Mucus in the stool
• Symptoms that worsen after certain foods
• Digestive symptoms during periods of stress

IBS is not a single disease with one cause.

Symptoms may involve altered intestinal motility, visceral sensitivity, food triggers, changes in gut-brain signaling, previous gastrointestinal infection, stress, microbiome changes, or other physiological factors.

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Types of IBS

IBS may be categorized according to the predominant bowel pattern.

IBS With Constipation

IBS-C is characterized primarily by constipation, often accompanied by:

• Hard or infrequent stools
• Straining
• Incomplete evacuation
• Abdominal pressure
• Bloating

IBS With Diarrhea

IBS-D is characterized primarily by loose or frequent bowel movements and may include:

• Urgency
• Abdominal cramping
• Frequent stools
• Symptoms after meals
• Fear of being far from a restroom

IBS With Mixed Bowel Habits

IBS-M involves periods of both constipation and diarrhea.

Symptoms and bowel patterns may change over time, which is one reason treatment needs to be individualized.

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What Is SIBO?

Small intestinal bacterial overgrowth, commonly called SIBO, refers to an excessive number or altered distribution of microorganisms within the small intestine.

The small intestine normally contains fewer microorganisms than the colon. When excess fermentation occurs in the small intestine, patients may develop symptoms such as bloating, gas, abdominal discomfort, diarrhea, constipation, or altered nutrient absorption.

SIBO is commonly evaluated indirectly using breath testing that measures gases such as hydrogen and methane after ingestion of a testing substrate. (American College of Gastroenterology)

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Common Symptoms of SIBO

Symptoms may include:

• Bloating, particularly after meals
• Excessive gas
• Abdominal distention
• Abdominal discomfort
• Diarrhea
• Constipation
• Alternating bowel habits
• Food intolerance
• Nausea
• Early fullness
• Reflux
• Fatigue
• Nutrient deficiencies in some cases

SIBO symptoms can overlap significantly with IBS and several other gastrointestinal conditions.

Symptoms alone cannot determine whether SIBO is present.

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Hydrogen, Methane, and Different Symptom Patterns

Breath testing may measure hydrogen and methane production.

Different gas patterns may be associated with different bowel symptoms.

Hydrogen-Predominant Patterns

Higher hydrogen production is more commonly associated with:

• Bloating
• Gas
• Loose stools
• Diarrhea

Methane-Associated Intestinal Overgrowth

Methane production is generally associated more strongly with slowed intestinal transit and constipation.

Because methane is produced by microorganisms known as archaea rather than bacteria, the term intestinal methanogen overgrowth, or IMO, is increasingly used.

Patients may experience:

• Chronic constipation
• Hard stools
• Slow bowel transit
• Abdominal distention
• Persistent bloating

Treatment strategies may differ depending on the breath-test pattern, symptoms, medical history, and contributing factors.

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IBS and SIBO Are Not the Same Condition

IBS and SIBO may overlap, but they are not interchangeable diagnoses.

IBS is defined by a pattern of abdominal pain and altered bowel function.

SIBO describes suspected or demonstrated microbial overgrowth within the small intestine.

Some individuals with IBS may have abnormal breath testing, while many do not. Likewise, symptoms that resemble SIBO may result from other conditions.

This distinction matters because treatment should be guided by the individual clinical picture rather than symptoms alone.

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Why SIBO May Develop

SIBO often involves more than simply the presence of excess microorganisms.

Factors that may contribute include:

• Impaired intestinal motility
• Previous gastrointestinal infection
• Abdominal or intestinal surgery
• Structural changes within the digestive tract
• Chronic constipation
• Reduced digestive function
• Certain medications
• Diabetes or metabolic dysfunction
• Neurological conditions affecting motility
• Connective-tissue disorders
• Intestinal inflammation
• Other underlying gastrointestinal disorders

Identifying contributing factors may be important because treatment directed only at reducing microorganisms may not address why the problem developed.

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Why Symptoms May Return

Recurrence is a common concern among patients treated for SIBO.

Symptoms may return when underlying contributors remain unaddressed.

Potential factors may include:

• Slow intestinal motility
• Persistent constipation
• Incomplete treatment
• Structural gastrointestinal factors
• Recurrent dietary triggers
• Medication effects
• Inadequate meal spacing
• Ongoing metabolic dysfunction
• Poor sleep
• Chronic stress
• Lack of a maintenance strategy

A comprehensive treatment plan therefore considers both immediate symptom improvement and longer-term digestive function.

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A Comprehensive Digestive Evaluation

Evaluation begins with a detailed review of:

• Digestive symptoms
• Stool frequency and consistency
• Timing of symptoms
• Dietary patterns
• Previous gastrointestinal infections
• Medication use
• Supplement use
• Previous antibiotic treatment
• Surgical history
• Stress
• Sleep
• Metabolic health
• Existing laboratory and imaging results

Depending on the individual, additional testing may be considered.

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Breath Testing

Hydrogen and methane breath testing may be used when symptoms and clinical history suggest possible SIBO or intestinal methanogen overgrowth. (American College of Gastroenterology)

Breath testing may provide information regarding:

• Hydrogen production
• Methane production
• Timing of gas production
• Possible fermentation patterns

Results should be interpreted together with symptoms and medical history.

Breath testing is not a perfect test and should not be interpreted in isolation.

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Comprehensive Stool and Microbiome Testing

In selected patients, advanced stool testing may provide additional information about the large-intestinal microbiome and gastrointestinal function.

Testing may evaluate:

• Beneficial bacteria
• Opportunistic microorganisms
• Potential pathogens
• Parasites
• Yeast or fungal organisms
• Digestive enzyme function
• Intestinal inflammation
• Immune activity within the gastrointestinal tract
• Markers of intestinal health

Stool microbiome testing and SIBO breath testing evaluate different areas of gastrointestinal function and should not be considered interchangeable.

Explore Microbiome Testing →

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Looking Beyond the Microbiome

Digestive symptoms are not always caused by bacterial imbalance.

A broader evaluation may consider:

• Celiac disease
• Food intolerance
• Lactose intolerance
• Fructose intolerance
• Inflammatory bowel disease
• Pancreatic insufficiency
• Gallbladder or bile-related disorders
• Thyroid dysfunction
• Hormone changes
• Medication effects
• Pelvic-floor dysfunction
• Metabolic disease
• Gastrointestinal motility disorders

Appropriate evaluation helps reduce the risk of attributing every gastrointestinal symptom to SIBO or dysbiosis.

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Personalized Nutrition

Nutrition can play an important role in symptom management, but there is no single IBS or SIBO diet that works for everyone.

Recommendations may depend on:

• Constipation versus diarrhea
• Food triggers
• Nutritional status
• Breath-test findings
• Metabolic health
• Weight goals
• Food preferences
• Other medical conditions

Dietary strategies may include:

• Adjusting fermentable carbohydrates
• Increasing or modifying fiber
• Improving meal timing
• Supporting adequate protein intake
• Reducing highly processed foods
• Identifying individual food triggers

A low-FODMAP diet may improve symptoms in some people with IBS, but it is generally best viewed as a structured, limited trial followed by food reintroduction rather than a permanently restrictive diet. (webfiles.gi.org)

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Fiber and Bowel Function

Fiber recommendations should be individualized.

Some individuals benefit from increased soluble fiber, while others experience increased bloating or discomfort when fiber is increased too rapidly.

Soluble fiber such as psyllium may improve overall IBS symptoms in some patients, while certain forms of insoluble fiber may be less helpful. (webfiles.gi.org)

Recommendations depend on:

• Stool pattern
• Intestinal motility
• Fluid intake
• Current dietary fiber
• Degree of bloating
• Individual tolerance

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Treatment Options

Treatment depends on symptoms, testing, bowel patterns, medical history, and suspected contributing factors.

An individualized plan may include:

• Targeted dietary changes
• Treatment of constipation or diarrhea
• Support for intestinal motility
• Prescription therapy when appropriate
• Targeted antimicrobial treatment
• Digestive enzymes when indicated
• Selected probiotics or prebiotics
• Nutrient replacement
• Support for gastrointestinal function
• Stress-management strategies
• Sleep optimization
• Gradual food reintroduction
• Long-term recurrence prevention

No single protocol is appropriate for every patient.

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Supporting Intestinal Motility

Healthy intestinal movement is an important part of digestive function.

When motility is impaired, food and intestinal contents may remain in the digestive tract longer than expected.

Strategies may include:

• Treating constipation
• Improving hydration
• Increasing physical activity
• Adjusting meal timing
• Supporting normal bowel patterns
• Reviewing medications that may affect motility
• Addressing thyroid or metabolic dysfunction
• Using motility-supportive therapies when clinically appropriate

Addressing motility may be particularly important for reducing recurrence in selected patients.

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The Gut-Brain Connection

The digestive system and nervous system communicate continuously.

Stress does not mean that digestive symptoms are imaginary.

Changes in the nervous system may affect:

• Intestinal motility
• Pain perception
• Visceral sensitivity
• Digestive secretions
• Bowel urgency
• Symptom severity

Gut-directed behavioral therapies may improve overall IBS symptoms for some patients and can be used alongside dietary and medical treatment. (webfiles.gi.org)

Treatment may include:

• Stress-management strategies
• Breathing exercises
• Mindfulness
• Cognitive behavioral approaches
• Gut-directed hypnotherapy
• Sleep optimization
• Regular exercise

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From Testing to a Personalized Plan

Testing is only useful when the findings lead to meaningful clinical decisions.

After completing an evaluation, Dr. Bronner develops an individualized plan based on:

• Symptoms
• Bowel patterns
• Medical history
• Dietary factors
• Breath-test findings when appropriate
• Microbiome and digestive testing when indicated
• Metabolic and hormone factors
• Nutritional status
• Previous treatment response

The goal is to turn complex gastrointestinal information into clear, practical steps.

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Restore Digestive Function and Improve Quality of Life

IBS and SIBO are complex conditions, and persistent digestive symptoms rarely have a single explanation.

By evaluating bowel function, intestinal motility, diet, microbiome balance, nutrient status, metabolic health, stress, and other potential contributors, Dr. Bronner develops a personalized approach designed to improve symptoms and support long-term gastrointestinal health.

Schedule a Comprehensive Digestive Evaluation