By Sarah Ellison, PT, DPT
What is SIBO?
SIBO, or small intestine bacterial overgrowth, is a condition defined by an overabundance of bacteria, typically found in other parts of the gastrointestinal tract, in the small intestine. The increased presence of bacteria in this area can lead to a variety of symptoms, including:
Food sensitivities
Diarrhea
Constipation
Abdominal bloating or cramping
Brain fog and fatigue
Aside from wanting to address SIBO to improve symptoms, it is important to treat SIBO to prevent nutrient malabsorption, which can occur in more severe cases of SIBO.
How is SIBO diagnosed and treated?
SIBO is typically diagnosed with a carbohydrate breath test. This test uses exhale breath samples to measure hydrogen and methane, the gasses produced by the bacteria suspected to be present in SIBO.
Treating SIBO
Treating SIBO is important to reduce the amount of bacteria growing inappropriately in the small intestine. SIBO is typically treated with a short round of antibiotics to eliminate the bacterial overgrowth. SIBO can also be treated with antimicrobials or a dietary regimen called the “elemental diet” to starve out the bacteria. These other treatment options require more time but are alternatives to antibiotic treatment.
Unfortunately, the recurrence of SIBO is quite high. Working with a provider who understands the treatment options is important due to the concern of antibiotic resistance with repeated use of antibiotics.
Why SIBO is likely to recur
As mentioned earlier, SIBO unfortunately has a tendency to recur. This is likely because the underlying cause is not being addressed. There are many possible contributors to SIBO, including poor gut-brain connectivity associated with irritable bowel syndrome, slowed gut motility, adhesions from prior abdominal surgeries, and inflammation associated with conditions such as celiac disease and inflammatory bowel disease. Through improving gut functioning, the hope is to not only provide relief from the symptoms associated with SIBO but to also better manage the common causes leading to SIBO recurrence.
What is Wellest’s Approach to SIBO?
Addressing the muscle contributors to bowel symptoms, bloating, and cramping
People typically hold muscle tension when they are uncomfortable. Pelvic floor therapists can help a person relax muscle tension in the abs, pelvic floor, and nearby muscles that might be leading to difficulty having quality bowel movements. This can include massage, stretches, or looking at muscle activation with daily and exercise routines. Pelvic floor therapists are also trained to teach patients how to coordinate their pelvic floor muscles to properly empty bowel movements.
Visceral mobilization
Pelvic floor therapists are trained to break up scar tissue, or adhesions, that often result from prior abdominal surgeries and can make a person more prone to SIBO. SIBO is also often associated with poor functioning of the ileocecal valve that connects the small intestine to the large intestine. All pelvic floor therapists at Wellest are also trained in visceral mobilization techniques, including working on myofascial restrictions affecting proper functioning of the ileocecal valve, to help with gut motility. Visceral manipulation is also the most effective tool to reduce discomfort from bloating within the small intestine.
Review of lifestyle habits
A daily routine, including how a person is eating, can have a large impact on food digestion and bowel health. Our pelvic floor therapists can review how a person’s daily habits can be optimized for better abdominal bloating and bowel movements.
Development of a care team
Wellest values the importance of an integrative team to get at the root cause of symptoms. This is particularly valuable when approaching the treatment of SIBO. Seeing a pelvic floor therapist can be helpful both in optimizing muscle functioning for alleviating symptoms and addressing several of the common contributors to SIBO. By having a nurse practitioner on staff, we can also help with ordering the testing and prescribing the direct treatments for SIBO itself.
In taking a holistic approach to care, we also strongly value nutrition support when addressing SIBO. This can be particularly helpful to address the nutrient deficiencies that can result from the presence of bacteria in the small intestine. Dietitians can also help identify food triggers (such as FODMAPs) while an individual is symptomatic and help reintroduce these healthy foods as the person is healing from SIBO. Wellest providers take the time to review a person’s care team, including gastroenterologists and registered dietitians, to ensure that the person is fully supported throughout the SIBO healing journey.
Are you looking to add a physical therapist to your care team? Reach out to us today!
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