Navigating IBS and SIBO: Can You Have Both? What to Do Next
If you’ve been diagnosed with IBS (Irritable Bowel Syndrome) or suspect you might have it, you’ve probably heard of SIBO (Small Intestinal Bacterial Overgrowth). These two conditions are closely linked, often with overlapping symptoms, leaving many people wondering: can you have both? The short answer is yes.
In fact, studies suggest that up to 60% of people with IBS may also have SIBO. Let’s break down the connection, how to know if both conditions are impacting you, and what steps to take next.
Understanding IBS and SIBO
What is IBS?
IBS is a functional gastrointestinal disorder characterized by symptoms like abdominal pain, bloating, diarrhea, constipation, or a mix of both. While IBS doesn’t cause structural damage to the gut, it significantly affects quality of life and is often linked to issues like food intolerances, stress, and gut-brain communication problems.
What is SIBO?
SIBO occurs when bacteria that should primarily live in the large intestine start overgrowing in the small intestine. This overgrowth disrupts digestion and absorption, leading to symptoms like bloating, gas, abdominal discomfort, and altered bowel movements (diarrhoea, constipation, or both). SIBO often stems from motility issues, which can slow down the natural process of clearing bacteria out of the small intestine.
How Are They Connected?
The gut is a complex system, and IBS and SIBO can easily overlap. Poor motility—a common issue in IBS—creates the perfect environment for bacteria to accumulate in the small intestine, leading to SIBO. Additionally, SIBO can trigger symptoms that mimic IBS, such as bloating, pain, and irregular bowel habits. This overlap is why many people with IBS find themselves wondering if there’s more going on.
Could You Have Both IBS and SIBO?
It’s entirely possible to have IBS and SIBO simultaneously. In fact, many researchers believe SIBO might be an underlying cause of IBS symptoms in a significant portion of people. Here are some signs that SIBO might be contributing to your IBS:
- Persistent bloating: If your bloating feels extreme, especially after meals, SIBO might be a factor.
- Unpredictable bowel movements: Fluctuating between diarrhoea and constipation could point to SIBO.
- Food intolerances: If seemingly random foods trigger symptoms, SIBO might be disrupting digestion.
- Worsening symptoms with probiotics: Some probiotics can exacerbate SIBO, especially those containing prebiotics that feed bacteria.
If these symptoms resonate with you, it might be worth exploring whether SIBO is contributing to your IBS.
What to Do Next: A Step-By-Step Approach
Get a Proper Diagnosis
The first step is confirming whether SIBO is present. This is typically done with a breath test that measures hydrogen and methane gases produced by bacteria in your small intestine. Discuss your symptoms with a healthcare provider or dietitian who specialises in gut health to determine whether this test is right for you.
Address Both Conditions Holistically
If you have both IBS and SIBO, treating one without addressing the other might not fully resolve your symptoms. Your care plan may include:
- Dietary Changes: A low-FODMAP diet or other elimination diets can reduce fermentable carbohydrates that feed bacteria in SIBO while also easing IBS symptoms.
- Antibiotics or Herbal Antimicrobials: Depending on the type of SIBO (hydrogen or methane dominant), your doctor may prescribe antibiotics like rifaximin or recommend herbal treatments to reduce bacterial overgrowth.
- Motility Support: Prokinetics (medications or supplements that promote gut motility) can help prevent bacteria from building up in the small intestine again.
Focus on Gut Motility
Poor motility is a major player in both IBS and SIBO. Supporting your migrating motor complex (MMC)—the system that sweeps food and bacteria out of your small intestine—is key. Strategies include:
- Eating meals 4–5 hours apart to allow the MMC to activate.
- Avoiding grazing or constant snacking, which can interrupt this process.
- Incorporating gentle movement, like walking, to stimulate motility.
Work on Gut-Brain Health
Stress can worsen both IBS and SIBO by disrupting motility and gut-brain communication. Practices like mindfulness, yoga, and breathing exercises can help calm your nervous system and support better digestion.
Seek Professional Support
Navigating IBS and SIBO together can feel overwhelming, but you don’t have to do it alone. Working with a dietitian experienced in both conditions can help you personalize your diet, identify triggers, and develop a sustainable plan for long-term relief.
Final Thoughts
If you’ve been managing IBS without much improvement, it’s worth exploring whether SIBO might also be contributing to your symptoms. While having both conditions can feel frustrating, the good news is that understanding the connection can lead to more effective treatment.
By addressing SIBO, supporting your gut motility, and taking a holistic approach to IBS management, you can start feeling better and take control of your gut health. Remember, progress takes time, but with the right tools and guidance, relief is absolutely possible.
