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The Rome Criteria For IBS

By 7th February 2023March 20th, 2023IBS
Woman With IBS

What is IBS?

IBS (irritable bowel syndrome) is a common digestive issue that impacts a high percentage of the global population.

This syndrome describes a range of digestive and gut symptoms that include:

  • bloating
  • abdominal pain
  • diarrhoea or constipation

While these symptoms can be common, there is a range of causes for these gut symptoms appearing. This means that a diagnosis of IBS is generally given once other causes of these gut symptoms have been excluded.

These can be gut conditions such as coeliac disease, inflammatory bowel disease, microscopic colitis and bile acid diarrhoea. All of these gut conditions can have symptoms that overlap with IBS symptoms.

This has led to the development of a set of criteria that are used in diagnosing IBS. [Source: Pubmed]

What are the ROME IV criteria for IBS?

The ROME criteria were originally created in the 1990s to assist in the diagnosis of IBS. Since the first version, they have been updated with the most recent version, ROME IV, in 2016.

These criteria state that for a diagnosis of IBS to be given certain factors need to be met. These include:

Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:

  1. Related to defecation
  2. Associated with a change in frequency of stool
  3. Associated with a change in form (appearance) of stool [Source: The Rome Foundation]

This set of criteria for IBS is only taking the symptoms the IBS patient is experiencing into consideration. However, further testing may be carried out to rule out gut conditions with similar symptoms of bloating, abdominal pain or altered bowel patterns (e.g constipation or diarrhoea). [Source: Pubmed]

NICE guideliens within the UK also offer further symptoms that may be considered when diagnosis IBS. These are not officially within the ROME IV criteria for IBS.

These gut symptoms include:

  • a change in the passing of stools – eg, needing to strain, feeling a sense of ‘urgency’ or feeling that the bowels haven’t fully emptied
  • bloating, tension or hardness in the abdomen
  • a feeling that IBS symptoms are worse after eating
  • the passing of mucus from the rectum [Source: NICE]

Diagnosing IBS

If a doctor suspects that IBS is present, then further gut health tests may be offered to rule out certain conditions.

These may be initial blood tests for levels of inflammation (which may help to differentiate between IBS and IBD) as well as to rule out other gut conditions such as coeliac disease.

The NICE guidelines within the UK do state that further tests are not nessesearcy to diagnose IBS. These include:

  • ultrasound
  • rigid or flexible sigmoidoscopy
  • colonoscopy or barium enema

There may however be a referral to a specialist if other symptoms are present. These symptoms can include:

  • unintentional and unexplained weight loss
  • bleeding from the rectum
  • a family history of bowel or ovarian cancer.

Additionally, in the over 60’s, a sudden change in bowel patterns lasting for over 6 weeks. These factors may then influence the decision to see a specialist and further tests. [Source: NICE]

Are there different types of IBS?

There are 4 different subtypes of IBS which can be made. This type of subtype given to the patient referred to the predominant types of bowel movements they are experiencing.

The 4 types of IBS include:

  1. IBS-D (IBS with diarrhoea)
  2. IBS-C (IBS with constipation)
  3. IBS-M (IBS with mixed symptoms of constipation and diarrhoea)
  4. IBS-U (IBS but their bowel habits cannot be accurately categorized as IBS-D, IBS-C, or IBS-M)

These can be defined as follows:

The IBS-D Subtype

  • More than 25% of bowel movements using the Bristol Stool Chart are type 6 or 7
  • Less than 25% of bowel movements are type 1 or 2.

The IBS-C Subtype

  • More than 25% of bowel movements are type 1 or 2 using the Bristol Stool Chart.
  • Less than 25% are type 6 or 7.

The IBS-M Subtype

More than 25% of bowel movements using the Bristol Stool Chart are types 1 and 2.

More than 25% are types 6 and 7.

The IBS-U Subtype

Patients who have the IBS-U subtype meet the diagnostic requirement for IBS, but their bowel habits cannot be accurately categorized as IBS-D, IBS-C, or IBS-M. [Source: AMJC]

Bristol Stool Chart[Image Credit: Health Partners]

How to Cure IBS

IBS describes certain symptoms such as bloating, abdominal pain and alterations in bowel patterns. However, the diagnosis of IBS does not indicate what the underlying issue or root cause of these symptoms is.

To resolve the symptoms of IBS, the underlying issue should be examined and addressed.

The underlying cause of IBS does vary from patient to patient, but common causes include the following:

  • Food sensitivities
  • Gut microbiome imbalances
  • SIBO
  • Pancreatic insufficiency
  • Low-grade inflammation
  • Gut-brain axis dysfunction
  • Carbohydrate intolerances
  • Stress
  • Circadian disruption
  • Vitamin D deficiency
  • Non-celiac gluten sensitivity [Source: MDPI]

To address and resolve the symptoms seen in IBS, the underlying cause should be addressed.

Read More: Can IBS Be Cured?

How long does it take for probiotics to work for IBS?

Probiotics have been shown to provide benefits in IBS patients to improve gut symptoms. Various types of probiotic bacterial supplements have been studied in those with IBS.

While some probiotics may provide improvements in overall symptoms, others have more specific benefits such as improving bloating, flatulence or abdominal pain.

With this in mind, using the right type of probiotic bacterial supplement for specific symptoms is a crucial part of the selection process.

Probiotics rarely provide an immediate benefit and will need to be taken for a period of time before assessing how much benefit they’ve provided. Most studies into the use of probiotics are over a time frame of between 4-8 weeks. In some cases, studies last as long as 6 months. [Source: Pubmed]

How long does it take for peppermint oil to work for IBS?

Peppermint oil has been found to be helpful for the symptoms of IBS. The main compound in peppermint oil is L-menthol which has an antispasmodic effect on the muscles in the gut.

Peppermint oil also has other properties which can help in IBS in other ways. This is due to the peppermint oil also working in a way that is:

  • Antimicrobial
  • Anti-inflammatory
  • Antioxidant
  • Anaesthetic

All of which can be relevant in the treatment of IBS. [Source: Pubmed]

While studies into the use of peppermint oil for IBS can vary in length, many are within the 4-week time frame. Some of these do however note that an improvement in symptoms is seen in as little as 24-hour hours. [Source: Pubmed]

Can IBS be Cured?

Along with IBS supplements and diets for IBS, a central part of the process of resolving these symptoms is dependent on the underlying issue. This root cause of IBS can vary from person to person.

Working with a registered gut health nutritional therapist can guide you through this process with a personalised plan.