SIBO update

SIBO Updates plus follow up Q&A

In pelvic floor physical therapy, Pelvic Health, SIBO by Emily TranLeave a Comment

Let’s talk SIBO

SIBO stands for Small Intestine Bacterial Overgrowth; bacteria that is an overgrowth of the normal bacteria in your small intestine. 

SIBO

 

How to test for it:⠀

A breath test is typically used either in the clinic or a take-home test is given. The test uses a solution, glucose or lactulose (but usually lactulose), that is consumed and then one would blow into tubes at 20-30 min intervals which are then analyzed for the amount of hydrogen and methane gas that is expelled. If there is a specific amount of either gas at certain time points, the test is positive for overgrowth and there are a number of treatment options available. ⠀

Classic symptoms include:

  • Abdominal bloating 1-2 hrs after eating⠀
  • Gas, belching, feeling of fullness
  • Diarrhea and/or constipation⠀
  • Brain fog
  • Fatigue⠀
  • Food sensitivities and reactions (if intestinal permeability occurs) ⠀
  • Poor nutrient absorption (B12, iron)

These symptoms occur because the overgrown bacteria love certain types of fermented carbohydrates, known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). The “low FODMAP diet” is a nutrition plan SIBO sufferers are regularly recommended to reduce their symptoms. ⠀

 

Did you know that people with pelvic pain syndromes (IC, endo) often also have SIBO and IMO?

Bowel Health⠀

Pelvic floor physical therapy can relieve constipation and improve continence by optimizing pelvic floor muscles function with manual therapy and exercise. If SIBO and IMO are present, treating the gut and the pelvic floor is necessary for improvement. ⠀

Endometriosis⠀

Women with endo are up to 5 times more likely to have gut dysbiosis and report symptoms such as “endo belly.” Surgery will not fix the gut dysbiosis but will allow treatment for SIBO and IMO to be more effective.⠀

Interstitial Cystitis/Painful Bladder Syndrome

One study found 17 out of 21 patients with IC/PBS had a positive breath test for SIBO. SIBO and IMO often coexist with pelvic pain syndromes, we must test for and treat SIBO and IMO to improve outcomes.⠀

 

Q&A 

Q: How is this diagnosed?

 

A: The most common test for SIBO is called a lactulose breath test. A physician can order the lactulose solution, which a patient drinks. The patient will then breathe into collection tubes 2-3 hours later. 

 

Q: How long is Low FODMAP recommended for?

 

A: There is not a specific time frame, and it differs for everyone. Typically though, it is a therapeutic diet that should and should not be a “lifestyle” diet as it restricts many beneficial foods. It should also not be used to treat SIBO, but it can play a role in treatment when it is introduced at the appropriate time. 

 

Q: How does the overgrowth even occur anyway?

 

A: Many reasons including chronic health conditions, stress, poor stomach acid (hypochlorhydria) and a big one is food poisoning, adhesions, slow motility.

 

Q: Is this the same as the H. Pylori test?

 

A: No, it is not the same as testing for H. Pylori.

 

Q: I was diagnosed with methane dominant SIBO 2 years ago finally – after years of digestive issues that would get worse the so called “healthier” I ate. I did not go the antibiotic round bc I can’t swallow large pills and the gastro said usually it’s 50/50 with success rate & high recurrence. I’ve been taking MegaSporeBiotic & putting it into food or drinks for the past 4 months & it def helps with some of my symptoms but I know I’m not absorbing nutrients properly bc of sibo – especially b12 which was on the much lower side of “normal” the last time I checked it 2 years ago. I get overwhelmed as hell with diet protocols – especially having IC & Vulvodynia too – I straight up panic at this point trying to come up with a game plan around food. A lot of people I’ve consulted with said it sounds like I have Candida too but I was only able to get the SIBO Test covered by insurance. I hear that a lot of people that have SIBO also have Vulvodynia & IC, is that accurate? Are there any supplements that help to support the clearance of SIBO in addition to diet? I just ordered a new multivitamin that I was told I can break open the capsule to take so hopefully I can get more of what I’m lacking!

 

A: Well, SIBO and IMO are often overlapping issues with pelvic health disorders when it comes to bowel health (constipation & diarrhea), endometriosis, and interstitial cystitis. This is the classic scenario of SIBO, most people only treat the overgrowth component but not the root cause and that is a common issue of recurrence. There are various supplements used to treat it at the root cause and some of them come in liquid form! This is the classic scenario of SIBO, most people only treat the overgrowth component but not the root cause and that is a common issue of recurrence. There are various supplements used to treat it at the root cause and some of them come in liquid form! 

 

Q: Are prebiotics/probiotics or foods containing such helpful? 

 

A: These are definitely important in addressing gut health and helping to ensure a good gut balance especially in preventing recurrence of SIBO, but need to be introduced at the right time. If introduced while SIBO is still present, this could further flare your symptoms. It is important to remember that SIBO is just an overgrowth of bacteria, not necessarily bad bacteria so introducing more bacteria (probiotics) or feeding all of it (prebiotics) may just make it worse.

 

Q: There is lots of information on how to detect and test it but not much on how to cure it. I have been on a low FODMAP diet for years and still have chronic bloating after eating. I don’t want to try the ‘rifaximin’ antibiotics as that is what I think caused my gut mess in the first place . Years of antibiotics as a teenager . So what are the cures for the bloating?

 

A: There is actually quite a bit of info on treatments, but treatment goes beyond treating just the overgrowth. That is often a “symptom” of something else. It is important to address both. The literature reports that antibiotic use is moderately effective and herbal therapy can be just as effective. IT is important to know which type of SIBO you have because it changes the course of treatment. As far as antibiotic therapy goes, not all antibiotic use is the same. For example, rifaximin is actually a more gentle one, whereas Cipro can wipe out the flora in one dose. But like I mentioned before, if you just treat the overgrowth but not the underlying cause, that is often the reason for failed treatment or recurrence. 

 

Q: I think years of prescription meds have done this, is there anything natural I can do to help?

 

A: There are absolutely natural agents that can be effective for treatment! It is important to work with a provider though to know which ones are the right ones considering all that is going on and helping to also identify and treat the root cause.

 

Q: Hi, I recently found out I was highly positive for SIBO after dealing with issues with food for years and finally it escalated so badly I sought out help. I took the breath test and tested positive but I am methane predominant. I know sibo isn’t widely known so it’s been hard for me to find a GI that knows how to treat it. They put me on Cipro and that made things worse so I stopped. I follow a low FODMAP diet and even was before getting tested. Because I am methane predominant, is there a different way to go about treatment?

 

A: Yes, many conventional providers are not familiar, there are various antibiotics to treat SIBO and cipro is often not one of them and can have significant effects on the gut microbiome. There are natural approaches to treating all the types of SIBO. Although the low FODMAP diet can be used as a part of the treatment if it is used the right way, it is not a treatment for SIBO and caution should be taken for long-term use. 

 

Q: I have thrush that I just cannot get rid of. It’s so painful. I am a vegan and don’t eat much refined sugar.

 

A: Thrush can be a symptom of gut issues, not necessarily SIBO. Certain diets can promote this and there can be other underlying causes other than just refined sugar. It is important to work with a healthcare provider that can help to figure out those underlying causes and help to treat it and address the underlying causes. Working with an integrative practitioner is ideal to work on both diet and can run functional tests and offer treatment options your conventional provider may not be able to do so.

 

Q: How is it treated with antibiotics?

 

A: There are a few different approaches, antibiotics are one and there are natural approaches like antimicrobials that can both be effective to treat SIBO.

 

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Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

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