Bloating, Constipation, Diarrhea: Is It SIBO?

Gas, bloating, belching, reflux, constipation, and diarrhea

Do you suffer from one or more of these gastrointestinal symptoms? If so, you may want to investigate if the culprit is small intestine bacterial overgrowth, which we call SIBO (see-bo). It is estimated that 16.8% of the United States population have SIBO, which is almost 1/5 of us!

If you have irritable bowel syndrome (IBS), then you may be interested to know that 84% of people with IBS happen to also have SIBO. In these cases, testing for SIBO, and treating it if positive, can be a key part of healing from IBS. Unfortunately, GI specialists do not always test for SIBO in cases of IBS.

SIBO can be simple and straightforward to identify and treat, and it can also be complex, stubborn, and chronic. Each person has a unique presentation.

This blog series is meant to educate you about this condition, in digestible pieces. The entire series is a guide to SIBO symptoms, testing, treatment, and relapse prevention from a functional medicine lens.

SIBO defined in a nutshell

Most of your gut bacteria should be in your large intestine (colon). These helpful bacteria break down fiber that you can’t digest on your own. In the process, they make beneficial vitamins and anti-inflammatory chemicals. Read this post to learn more about what beneficial bacteria do.

Your small intestine should be fairly sterile, with not much bacteria – just a little lactobacillus and enterococcus. When bacteria from your colon back-washes, or translocates up into your small intestine and take up residence, this results in small intestine bacterial overgrowth.

Your small intestine lining is vast – the size of a football field. When bogged down with SIBO, it becomes a bloated, stagnant, fermenting mix of bacteria and their byproducts. Typically, but not always, if the type of bacteria produces hydrogen gas, it causes diarrhea; if it produces methane gas, it causes constipation; and hydrogen sulfide gas producers cause stinky gas. Any type can cause discomfort, bloating, indigestion, and reflux.

SIBO and gut symptoms

SIBO causes gastrointestinal symptoms in most cases, and the classic symptom is bloating. You can feel like you have a giant belly after eating, or at the end of the day. Some women describe it as their “pregnant SIBO belly” – as it feels unnaturally huge and protruding relative to what they ate that day. This bloating is caused by too many bacteria (as well as the wrong types) fermenting in your small intestine.

Other gut symptoms include:

  • Belching and reflux – bacterial fermentation can make gas and fluid rise up to cause these symptoms.
  • Constipation – SIBO damages the nerves of your small intestine, which impairs your motility.
  • Diarrhea – this can result from impaired motility from nerve damage as well. In addition, SIBO affects bile production and flow, so can cause urgency, loose stools, or explosive diarrhea.
  • Gas – Fermentation gases can go down instead of up, and cause odorous gas.

SIBO beyond the gut

SIBO can cause widespread problems outside of your digestive tract. In fact, some people with SIBO are not aware of any digestive problems. The next post digs into the systemic effects of small intestine bacterial overgrowth.

Please post your comments and questions below.

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  1. Great post on SIBO. Do you have any treatment strategies for patients with hydrogen sulfide sibo? I have found that is one of the trickiest cases to treat and it is still relatively unknown.

    Also, what is the best type of body work to get done if someone has motility problems. Does acupuncture, message therapy, or anything related have a good effect for people struggling with this problem?

    It seems like this condition is very challenging to treat and requires a lot of personalization and experimentation.

    1. Hi Josh,

      Thanks for your input! I like targeted abdominal massage. Maya abdominal massage is great and I also like visceral manipulation. You are correct that SIBO does need a personalized treatment, and relapse is unfortunately frequent. That’s why focusing on the causes (if known), and improving the colon microbiome are so important. It’s not just about what will eradicate the bacteria. You are correct that less is known about hydrogen sulfide producers. One strategy is to find out the specific bacteria and go after it, here is a test: http:// Also, garlic tends to not work, and sulphur foods are best avoided. There’s often a fungal correlation, and sometimes mercury. Hope this helps!

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