Latest / The Gastro Truth with Dr. Mel Ona / Before You Accept an IBS Diagnosis, Watch This

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Before You Accept an IBS Diagnosis, Watch This · The Gastro Truth with Dr. Mel Ona

• 0:00
  SPEAKER_00: If you've recently been told you have IBS or irritable bowel syndrome, or you've carried that IBS diagnosis for years with no real improvement, there's a conversation worth having before you move forward.
• 0:12
  SPEAKER_00: IBS is a diagnosis of exclusion.
• 0:15
  SPEAKER_00: It's supposed to be the label you get after other conditions have been ruled out.
• 0:19
  SPEAKER_00: The problem is that what gets ruled out varies enormously from one workup to the next.
• 0:24
  SPEAKER_00: And the conditions most likely to be missed are the ones with real specific treatments.
• 0:28
  SPEAKER_00: I'm Dr.
• 0:29
  SPEAKER_00: Mel Ona, a board certified gastroenterologist in Hawaii.
• 0:32
  SPEAKER_00: I have a master's degree in nutritional biochemistry, and I've worked with over 10,000 patients with digestive conditions.
• 0:38
  SPEAKER_00: Now in this video, I'll show you what a complete IBS workup actually looks like.
• 0:43
  SPEAKER_00: I'll cover which conditions get missed most often under that label and the specific questions to ask before you accept IBS as your final answer.
• 0:52
  SPEAKER_00: Now, why the workup varies.
• 0:54
  SPEAKER_00: IBS is diagnosed using what's called the ROM 4 criteria.
• 0:58
  SPEAKER_00: Now these are symptom-based criteria, recurrent abdominal pain, at least one day per week for the last three months, associated with changes in stool frequency or form.
• 1:07
  SPEAKER_00: Now, if your symptoms fit that pattern and your doctor has ruled out a few obvious things, you can receive an IBS diagnosis.
• 1:14
  SPEAKER_00: The criteria don't specify which tests have to come back negative first.
• 1:18
  SPEAKER_00: Now that gap matters.
• 1:19
  SPEAKER_00: A gastroenterologist doing a thorough workup and a primary care physician doing a brief one can both technically issue the same diagnosis.
• 1:26
  SPEAKER_00: What's different is what they looked for before issuing it.
• 1:29
  SPEAKER_00: Now there's also a time pressure built into the appointment structure.
• 1:33
  SPEAKER_00: Running a complete exclusionary workup requires ordering multiple tests, following up on results, and sometimes referring to specialists.
• 1:41
  SPEAKER_00: Most of that happens across several appointments over weeks or months.
• 1:45
  SPEAKER_00: In a busy practice, the symptom pattern gets recognized, the obvious causes get excluded, and the label goes on the chart.
• 1:52
  SPEAKER_00: The patient leaves with a diagnosis and a management plan.
• 1:55
  SPEAKER_00: The investigation stops.
• 1:57
  SPEAKER_00: The patients I see who've carried an IBS diagnosis for years and still have daily symptoms have often not had the full investigation.
• 2:04
  SPEAKER_00: The label arrived early and nothing pushed it forward.
• 2:07
  SPEAKER_00: Now what a complete workup looks like.
• 2:10
  SPEAKER_00: Before IBS is the right label, several specific conditions should be ruled out.
• 2:14
  SPEAKER_00: They are treatable and they look exactly like IBS until they're tested for.
• 2:19
  SPEAKER_00: A bacterial overgrowth in the small intestine, or SIBO, SIBO, is the most commonly missed.
• 2:25
  SPEAKER_00: Bacteria in the small intestine ferment food and produce bloating, gas, cramping, and bowel changes that are indistinguishable from IBS on symptoms alone.
• 2:33
  SPEAKER_00: SIBO requires a specific test, a hydrogen breath test or a lactulose breath test.
• 2:38
  SPEAKER_00: Neither is part of a standard IBS workup.
• 2:40
  SPEAKER_00: A patient can have a colonoscopy, blood work, and a negative celiac panel and still have untreated SIBO.
• 2:46
  SPEAKER_00: Without the breath test, the diagnosis stays as IBS and the bacteria stay untreated.
• 2:51
  SPEAKER_00: Now microscopic colitis is the condition most often missed on colonoscopy.
• 2:56
  SPEAKER_00: It's an inflammatory condition of the colon that causes chronic watery diarrhea.
• 3:00
  SPEAKER_00: The colon lining looks completely normal on visual inspection.
• 3:04
  SPEAKER_00: The only way to find it is through biopsies taken during the colonoscopy.
• 3:08
  SPEAKER_00: Now, if biopsies weren't taken or the colonoscopy wasn't done at all, microscopic colitis won't be found.
• 3:14
  SPEAKER_00: It's actually a common cause of chronic diarrhea in adults over age 50, particularly women, and it responds well to treatment once identified.
• 3:22
  SPEAKER_00: Inflammatory bowel disease, or IBD, is more subtle than most people expect.
• 3:26
  SPEAKER_00: IBD, or Crohn's disease and ulceritis, can present with symptoms that look like IBS for years before a diagnosis is made.
• 3:34
  SPEAKER_00: Fecal calprotectin test measures inflammation in the gut lining.
• 3:37
  SPEAKER_00: If that stool marker is elevated, a scope is the next step.
• 3:41
  SPEAKER_00: If fecal caprotectin hasn't been ordered, IBD hasn't been excluded.
• 3:45
  SPEAKER_00: A normal blood panel isn't enough.
• 3:47
  SPEAKER_00: Inflammation in the gut doesn't always show up in standard blood markers until the disease is further along.
• 3:52
  SPEAKER_00: Thyroid function affects gut motility directly.
• 3:56
  SPEAKER_00: An underactive thyroid slows the digestive tract and causes constipation, bloating, and discomfort that can look like constipation dominant IBS.
• 4:04
  SPEAKER_00: An overactive thyroid speeds motility and can produce urgent, loose stools that look like diarrhea-dominant IBS.
• 4:10
  SPEAKER_00: A basic TSH panel rules this out quickly, but it isn't always ordered as part of a gut symptom workup.
• 4:16
  SPEAKER_00: Now I'm curious about something.
• 4:17
  SPEAKER_00: How long have you had your IBS diagnosis?
• 4:20
  SPEAKER_00: And how many of these tests were part of your original workup?
• 4:23
  SPEAKER_00: Drop it in the comments below.
• 4:25
  SPEAKER_00: It helps me understand what's actually happening out there and it might be useful for other people watching.
• 4:30
  SPEAKER_00: A pelvic floor connection.
• 4:32
  SPEAKER_00: Now there's a fifth category worth knowing about for people with constipation-dominant symptoms.
• 4:37
  SPEAKER_00: Pelvic floor dysfunction is a condition where the muscles of the pelvic floor don't coordinate properly during a bowel movement.
• 4:44
  SPEAKER_00: Instead of relaxing to allow stool to pass, they contract.
• 4:47
  SPEAKER_00: The result is straining, incomplete evacuation, and chronic constipation that doesn't respond to fiber, laxatives, or dietary changes.
• 4:55
  SPEAKER_00: It's diagnosed through a test called anorectal manometry, which measures the pressure and coordination of the rectal muscles.
• 5:01
  SPEAKER_00: It isn't part of a standard IBS workout.
• 5:04
  SPEAKER_00: Many patients with pelvic floor dysfunction have been told for years they have IBSC or constipation-dominant IBS.
• 5:11
  SPEAKER_00: The actual cause is a coordination problem in the pelvic floor muscles.
• 5:15
  SPEAKER_00: Now it responds well to pelvic floor physical therapy, and no supplement or dietary change will fix a mechanical coordination issue.
• 5:22
  SPEAKER_00: The questions to ask.
• 5:23
  SPEAKER_00: Now, if you have an IBS diagnosis and your symptoms haven't improved, these are the specific questions worth bringing to your next appointment.
• 5:31
  SPEAKER_00: Start with SIBO.
• 5:32
  SPEAKER_00: Ask by name.
• 5:33
  SPEAKER_00: Have I been tested for SIBO with a hydrogen breath test or a lactulose breath test?
• 5:38
  SPEAKER_00: If your doctor isn't familiar with the test, ask for a referral to a gastroenterologist who is.
• 5:43
  SPEAKER_00: The test takes about two hours.
• 5:45
  SPEAKER_00: You drink a sugar solution and breathe into a tube at set intervals.
• 5:49
  SPEAKER_00: It's one of the most commonly skipped steps in a gut workup.
• 5:52
  SPEAKER_00: Ask about fecal calprotectin.
• 5:55
  SPEAKER_00: Now, this is a stool test that shows whether there's active inflammation in the gut lining.
• 5:59
  SPEAKER_00: It's inexpensive and non-invasive.
• 6:01
  SPEAKER_00: If it comes back elevated, a scope is the next step.
• 6:05
  SPEAKER_00: Now, if it's never been ordered, you don't know whether you have active gut inflammation.
• 6:09
  SPEAKER_00: Now, if you've had a colonoscopy that came back normal, ask whether biopsies were collected.
• 6:14
  SPEAKER_00: A normal-looking colon tissue can have microscopic colitis.
• 6:18
  SPEAKER_00: Now, without biopsies, that finding isn't available.
• 6:21
  SPEAKER_00: Now, if biopsies weren't taken and you have chronic diarrhea, ask whether the scope should be repeated with biopsies this time.
• 6:28
  SPEAKER_00: Check on your thyroid.
• 6:30
  SPEAKER_00: A TSH test is basic and widely available.
• 6:33
  SPEAKER_00: If yours hasn't been run recently or it was run before your gut symptom started, it's worth updating in the context of what you're currently experiencing.
• 6:41
  SPEAKER_00: For anyone with constipation-dominant symptoms that haven't responded to standard interventions, ask whether anal rectal manometry has been considered.
• 6:50
  SPEAKER_00: Most gastroenterologists can order this or refer you to someone who can.
• 6:54
  SPEAKER_00: If pelvic floor dysfunction is found, the treatment is pelvic floor physical therapy, done by trained specialists separate from general pelvic floor PT.
• 7:04
  SPEAKER_00: Now, what to bring to the appointment?
• 7:06
  SPEAKER_00: You don't need to walk in asking for all these tests at once.
• 7:09
  SPEAKER_00: The most useful framing is this.
• 7:12
  SPEAKER_00: I've had an IBS diagnosis for X years and my symptoms haven't improved with standard management.
• 7:17
  SPEAKER_00: I'd like to make sure the workup has been complete before we continue managing it as IBS.
• 7:22
  SPEAKER_00: Now that framing does two things.
• 7:25
  SPEAKER_00: It keeps the conversation collaborative and it opens the door for the doctor to review what's been done and what hasn't without feeling questioned.
• 7:33
  SPEAKER_00: If your doctor is open to the conversation, bring your previous test results.
• 7:38
  SPEAKER_00: Note what tests you've had and when.
• 7:40
  SPEAKER_00: The key is whether specific tests were ordered.
• 7:43
  SPEAKER_00: A normal complete blood count doesn't rule out SIBO.
• 7:46
  SPEAKER_00: A normal colonoscopy without biopsies doesn't rule out microscopic colitis.
• 7:50
  SPEAKER_00: Knowing what's been tested and what hasn't is the difference between a complete workup and one that's stopped early.
• 7:56
  SPEAKER_00: Now an IBS diagnosis is a starting point for investigation.
• 8:00
  SPEAKER_00: The patients who find their real diagnosis, SIBO, microscopic colitis, IBD, pelvic floor dysfunction, are almost always the ones who asked what else could be causing this before accepting the label.
• 8:12
  SPEAKER_00: The investigation was still open.
• 8:15
  SPEAKER_00: They just needed to push it forward.
• 8:17
  SPEAKER_00: Now, if you want to understand what happens when the root cause of gut symptoms isn't found and diet becomes the only tool people reach for, there's a video on this channel that covers exactly that.
• 8:27
  SPEAKER_00: It's called How Eating Clean Can Make Your Gut Worse.
• 8:30
  SPEAKER_00: Watch that one next.