The etiology of the increased colonic motility seen in IBS has been attributed to physiological, psychological, and dietary factors. A diagnostic summary of IBS is described as a functional disorder of the large intestine with no evidence of accompanying structural defect; characterized by some combination of; abdominal pain, altered bowel function (constipation or diarrhoea), hypersecretion of colonic mucus, dyspeptic symptoms (flatulence, nausea, anorexia), varying degrees of anxiety or depression.
 

Conditions which may mimic IBS

- Gastrogenic dietary factors such as excessive tea, coffee, carbonated beaverages, and simple sugars
- Infectious enteritis such as amebiasis and giardiasis
- Inflammatory bowel disease
- Lactose intolerance
- Laxative abuse
- Intestinal candidiasis
- Disturbed bacterial microflora as a result of antibiotic or antacid usage
- Malabsorption diseases such as pancreatic insufficiency and celiac disease
- Metabolic disorders such as adrenal insufficiency, diabetes mellitus, and hyperthyroidism
- Mechanical causes such as fecal impaction
- Diverticular disease
- Neoplasm

Testing methods

The Irish Centre of Integrated Medicine (ICIM) uses various methods to determine the cause of the symptoms experienced by the patient. Both NutritionalBlood Analysis and Bio-resonance pre-diagnostics are used. These tests identify the presence of possible micro-organisms (dysbiosis) as in the case of candidiasis, amebiasis, parasites, and bacteriosis. These tests can also identify malabsorption. Toxicity levels and inflammatory states can also be determined through testing methods carried out at the center. Once the etiology has been determined then an individualized treatment program is created to address the route of the problem. ICIM uses a multi-tasked approach through the prescribing of herbal, homoeopathic, nutritional and dietary support.

Once IBS has been confirmed and all other conditions ruled out, The Irish Centre of Integrated Medicine (ICIM) believe that there appears to be seven major treatments to consider when formulating a therapeutic regimen: increasing dietary fiber, eliminating allergic/intolerant foods, controlling psychological components, treatment of dysbiosis (candidiasis/bacteriosis/parsites), treatment of gut permeability (healing the lining of the gut), restoring correct flora to the bowel.

Dietary fiber

The treatment of IBS by increasing dietary has a long, through irregular history. Patients with constipation are much more likely to respond to dietary fiber than those with diarrhoea. One problem that has not been addressed is the role of food allergy. The type of fiber often used in both research and clinical practice is wheat bran. As wheat and other grains are among the most commonly implicated foods in malabsorptive and allergic conditions, the use of wheat bran is usually contraindicated since food allergy is a significant etiological factor in this condition. Increasing dietary fiber from fruit and vegetable sources rather than cereal sources may offer more benefit in some individuals. In certain cases fiber may aggravate diarrhoea and is therefore contraindicated.

Food allergy

According to double-blind challenge methodologies, the majority of patients with IBS (approximately two-thirds) have at least one food intolerance, and some have multiple intolerances. The most common allergens are dairy products (40-44%) and grains (40-60%). Many sensitivities may still be undetectable by current available laboratory procedures. Many patients have noted marked clinical improvement when using elimination diets. It is interesting to note that many IBS patients have associated symptoms suggestive of vasomotor instability (such as palpitation, hyperventilation, fatigue, excessive sweating, and headaches), which is consistent with food allergy/intolerance reactions.

Sugar

Meals high in refined sugar can contribute to IBS as well as small intestinal bacterial overgrowth by decreasing intestinal motility. When blood sugar levels rise too rapidly, a gastrointestinal tract peristalis slows down.

Psychological factors

Mental/Emotional problems e.g. anxiety, fatigue, hostile feelings, depression, and sleep disturbances, are reported by almost all patients with IBS. However, many psychological symptoms may be either secondary to the bowel disturbances (particularly malabsorption) or the result of a common etiological factor, e.g. stress, food allergy, or dysbiosis from candidiasis (yeast overgrowth).

Dysbiosis

This is a state of disordered microbial ecology that causes disease. It may exist in the oral cavity, gastrointestinal cavity or vaginal cavity. In dysbiosis, organisms of low intrinsic virulence, including bacteria, yeasts, and protozoa, induce disease by altering the nutritional or immune responses of their host. The concept of intestinal flora having a major impact on human health has increasingly gained support, particularly as the widespread use of antibiotics has been observed to disrupt the normal flora. Published research has implicated intestinal dysbiosis as contributing to IBS, vitamin B12 deficiency, steatorrhea, inflammatory bowel disease, autoimmune arthropathies, colon and breast cancer, psoriasis, eczema, cystic acne and chronic fatigue. In the last few years yeast infections have attracted attention and controversy as a possible cause of chronic complex illness. Many investigaters suggest that an intestinal overgrowth of Candida albicans (and other intestinal yeast) may be involved in several diseases as listed: IBS, food allergy, migraine headache, asthma, indigestion and gas, depression related to PMS, vaginitis and chronic fatigue. The major causes of dysbiosis include: poor diet/nutritional status (high fat, simple carbohydrates), stress, antibiotic/drug therapy, decreased immune status, decreased gut motility, maldigestion, presence of xenobiotics (toxicity), increased intestinal pH.

Gut permeability

More commonly known as leaky gut syndrome. The small intestine has a paradoxical dual function of being a digestive/absorptive organ as well as a barrier to permeation of toxic compounds and macromolecules. Either one of these functions may be disrupted by various mechanisms, resulting in local as well as systemic problems. Diseases associated with leaky gut include IBS, eczema, food sensitivities, psoriasis, skin rashes, asthma, acne, chronic fatigue, liver disease, rheumatoid arthritis, fibromyalgia, celiac disease, cystic fibrosis. Causes of leaky gut syndrome include overuse and misuse of antibiotics, a poor diet high in carbohydrates, sugar, alcohol and caffeine, a deficiency of enzymes, non-steroidal anti-inflammatory drugs (they contain ibuprofin) also found in neurofin, aspirin, ASA, indomethiacin and naproxen sodium, other contributors include chemicals, heavy metals, pesticides etc.  

Bowel flora

The role of altered microbial flora in IBS appears to be indicated. Once dysbiosis has been treated and the gut repaired, restoration of the natural flora of the bowel is suggested through the use of Acidophilus.

The ICIM believe that as a multi-factorial disease, the approach to the patient with IBS requires the consideration and integration of many factors:

- dietary fiber
- determination and elimination of food
allergies/intolerances
- stress reduction
- exercise
- treatment of dysbiosis
- treatment of gut permeability
- restoration of the bowel flora