Many individuals experience a change in stool from time to time – what one has eaten, medications and supplements, and emotional events all may contribute to irregular “pooping” patterns. It may be something that one has a tendency towards and under the correct setting a constellation of triggering factors are aligned such that symptoms occur. Perhaps there is an underlying flora imbalance, perhaps there is an emotional event trigger, perhaps there are abnormalities of the anorectal musculature or sensation, and then the accumulation of factors eventually leads to the symptoms of what is often diagnosed as irritable bowel syndrome.
Irritable bowel syndrome (IBS), a syndrome classification in medicine, is diagnosed as such because there is not a known other problem such as Celiac disease, inflammatory bowel disease (Crohn’s, ulcerative colitis), or other diagnosable abnormalities. However conditions such as Celiac disease are grossly underdiagnosed, and often not assessed for if someone has general gastrointestinal symptoms. Additionally, there are also often food sensitivities, and conditions such as lactose intolerance, fructose malabsorption, and small intestinal bacterial overgrowth (SIBO) which are not assessed for. Appropriate assessment of the cause of IBS should always consider these things as if they are appropriately treated patients often find they are finally free of their gastrointestinal and related symptoms.
Altered bowel habits commonly coexist in individuals with anxiety and depression. Looking at a recent study, state (ie current) anxiety coexisted in 84.1% of individuals with gastrointestinal disorders, most commonly related to food allergies (p < 0.001), small intestinal bacterial overgrowth (SIBO) (p = 0.001), Helicobacter pylori (Hp) infection (p = 0.01) and ulcerative colitis in active phase (p = 0.03). Trait (ie overall tendency toward) anxiety was found to be related to similar issues as well, with the addition of irritable bowel syndrome. These relationships do not directly imply causation, but indicate that there is a mental/emotional relationship with bowel issues which also should be addressed.
· Addolorato G, et al. State and trait anxiety and depression in patients affected by gastrointestinal diseases: psychometric evaluation of 1641 patients referred to an internal medicine outpatient setting. Int J Clin Pract. 2008 Jul;62(7):1063-9. http://tinyurl.com/lp8thou
Common foods which may be problems include disaccharides, fructose, lactose, cellulose, and gluten. It may be that there are certain foods within this which are the primary triggers. The primary trigger food (and stress as well) may lead to altered mucosal health and a condition called leaky gut (medically referred to as intestinal permeability). This may be accompanied by problems at the brush border of the intestines where many of the enzymes for digestion also exist and are activated. Collectively this creates an inflammatory state and digestion problems of a variety of foods such as individuals with IBS often experience.
Autoimmune diseases such as Celiac and ulcerative colitis have increased symptoms when under stress or with anxiety, and may have flares in symptoms. Celiac disease has an increased frequency in individuals with other autoimmune diseases and a family history of Celiac disease. With small intestinal bacterial overgrowth (SIBO) there are digestive problems with a wide range of foods; with symptoms being improved with a dietary focus on proteins and fats and utilizing guidelines of a Paleolithic diet, a FODMAPs diet, the Specific Carbohydrate Diet, or a GAPS diet. Discussion of these diets are beyond the scope of this dialog, however many good references can be found online. Foods and supplements such as mucilaginous gels from aloe vera and soluble fiber also may promote symptoms of SIBO in a sensitive individual. Food sensitivity testing also may help to isolate which foods are the primary triggers causing problems.
Motor abnormalities of the gastrointestinal tract such as abnormal frequency and irregularity of luminal contractions are present in some patients with IBS. Additionally, it has been shown that motor disturbances are also provoked with stress.
· Simrén M, Castedal M, Svedlund J, Abrahamsson H, Björnsson E. Abnormal propagation pattern of duodenal pressure waves in the irritable bowel syndrome (IBS). Dig Dis Sci. 2000 Nov;45(11):2151-61. http://tinyurl.com/luqt5fs
· Kumar D, Wingate DL. The irritable bowel syndrome: a paroxysmal motor disorder. Lancet. 1985 Nov 2;2(8462):973-7. http://tinyurl.com/lkh4evf
· Schmidt T, Hackelsberger N, Widmer R, Meisel C, Pfeiffer A, Kaess H. Ambulatory 24-hour jejunal motility in diarrhea-predominant irritable bowel syndrome. Scand J Gastroenterol. 1996 Jun;31(6):581-9. http://tinyurl.com/qja5kjn
Intestinal secretory IgA (sIgA) is a critical and synergistic part of the mucosal immune system; as the only non inflammatory protein, essential for establishing and maintaining gastrointestinal and other mucosal tissues bacterial eubiosis. Levels of sIgA can be affected by acute and chronic stress states, and are something I often test for in conjunction with adrenal cortisol levels or stool analysis. Saccharomyces boulardii (S. boulardii) is one probiotic which is supportive to improving mucosal function and sIgA levels. Healthy levels of sIgA are necessary for normal mucosal health and immunity.
- Rodrigues AC, Cara DC, Fretez SH, Cunha FQ, Vieira EC, Nicoli JR, Vieira LQ. Saccharomyces boulardii stimulates sIgA production and the phagocytic system of gnotobiotic mice. J Appl Microbiol. 2000 Sep;89(3):404-14. http://tinyurl.com/l3euney
- McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010 May 14;16(18):2202-22. http://tinyurl.com/3oxv2e4
The possibility of other flora imbalances also may contribute to gastrointestinal and systemic symptoms. Large intestinal health, flora balance, and digestive function are best assessed with a comprehensive digestive stool analysis with parasitology. In my practice I utilize tests from Doctor’s Data Inc - http://tinyurl.com/q4256rk as well as Quintron - http://tinyurl.com/c5ze8ak- which have been shown to be reliable and duplicable for assessing large and small intestinal issues. Correction of large and small intestinal flora imbalances and appropriately addressing gut health with a restorative phase will often improve systemic symptoms such as low mood, chronic pain, and skin conditions.
In my practice I also utilize botanicals, specific nutritional supplements, counseling, and homeopathy to help address a variety of conditions, and individuals with persistent bowel problems often find long lasting benefits from this. When I work with clients holistically there often are a variety of improvements in overall health – oftentimes even things they did not realize were problems!