Abdominal Pain with SIBO and What You Can Do About It
Content
1.Types of Abdominal Pain
2. Red Flag Symptoms
3. Abdominal Pain with SIBO
3.1 Abdominal Pain Due to Gas Production
3.2 From Mild Discomfort to Severe Cramps
4. Abdominal Pain with Irritable Bowel Syndrome (IBS)
5. Visceral Hypersensitivity
6. What helps against Abdominal Pain
6.1 Peppermint Oil
6.2 Stress Management
6.3 Avoiding Chili-Based Meals
6.4 Soft Diet and Nutrition for Abdominal Pain
6.5 Individual Therapy
Abdominal pain can be a significant barrier to daily life, especially when it occurs chronically. Many SIBO (Small Intestinal Bacterial Overgrowth) patients experience recurrent, debilitating abdominal pain. But what causes this, and what can be done about it?
1.Types of Abdominal Pain
Abdominal pain is categorized into upper and lower abdominal pain, with the belly button being the dividing line. Abdominal pain can have various causes, as it can originate from different abdominal organs. Therefore, it can indicate a wide range of illnesses, making abdominal pain one of the so called red flag symptoms.
2. Red Flag Symptoms
Red flag symptoms include all symptoms whose occurrence is considered a warning sign of more serious illnesses. Red flag symptoms should therefore always be investigated further. These include sudden onset of chest pain, shortness of breath, blood or tarry stools, vomiting blood, paralysis on one side and unconsciousness, as well as fever, no bowel movements for 5 days, severe headaches and abdominal pain and several others.
Severe abdominal pain can indicate appendicitis, for example.
3. Abdominal Pain with SIBO
Abdominal pain is generally a warning signal for a variety of gastrointestinal disorders. In addition to small intestinal bacterial overgrowth (SIBO), this also includes irritable bowel syndrome and visceral hypersensitivity.
SIBO is the abbreviation for “small intestinal bacterial overgrowth”. It describes the pathological proliferation of bacteria in the small intestine. The human large intestine is richly colonized with bacteria. This accumulation of bacteria is referred to as the human intestinal microbiome. Normally, however, the small intestine is only sparsely colonized with bacteria compared to the large intestine. However, various causes can lead to more bacteria colonizing the small intestine. These causes include impaired intestinal motility, reduced digestion or an impeded flow of food through the intestine. This bacterial overgrowth can lead to various symptoms. Other classic symptoms besides abdominal pain are flatulence, nausea and constipation.
3.1 Abdominal Pain Due to Gas Production
In SIBO, excessive bacteria in the small intestinal tract produce gases as metabolic by-products, which can cause pain in the abdominal area. There are three main forms of SIBO, categorized based on the predominant gas produced by the bacteria: hydrogen (H₂), methane (CH₄), and hydrogen sulfide (H₂S).
3.2 From Mild Discomfort to Severe Cramps
The abdominal pain associated with SIBO can vary, ranging from mild discomfort to intense cramps that significantly affect daily life.
4. Abdominal Pain with Irritable Bowel Syndrome (IBS)
Patients with IBS also often experience abdominal pain. IBS is characterized by recurring abdominal pain and altered bowel habits without an organic cause. Bloating, diarrhea, constipation, and abdominal pain are classic symptoms of IBS, although not all conditions are required for an IBS diagnosis.
5. Visceral Hypersensitivity
Visceral hypersensitivity refers to an abnormally heightened response to pain in the abdominal area compared to the general population. This means that patients with visceral hypersensitivity may experience normal organ movements as painful. Visceral hypersensitivity can occur in IBS or other functional disorders. About 40% of IBS patients suffer from visceral hypersensitivity (1). However, SIBO patients also often experience a hypersensitive gut.
6. What helps against Abdominal Pain
In addition to classic home remedies like heat and massage, painkillers can also help with abdominal pain. However, there are other options as well.
6.1 Peppermint Oil
Peppermint oil is particularly effective against abdominal pain. It has a spasmolytic (cramp-relieving) effect and can help alleviate symptoms (2).
6.2 Stress Management
Stress management techniques like meditation, yoga, or deep breathing can also help reduce symptoms. Stress can exacerbate symptoms like abdominal pain, constipation, or diarrhea. Reducing stress is often a first step toward improvement.
6.3 Avoiding Chili-Based Meals
It is advisable to avoid spicy meals containing chili, as the capsaicin in chili can increase visceral pain. (3)
6.4 Soft Diet and Nutrition for Abdominal Pain
To avoid further strain on the stomach, a soft diet can be beneficial for abdominal pain. This involves focusing on easily digestible foods, while avoiding bloating foods and those that are high in fat or sugar. Foods that are generally well tolerated include white bread, oatmeal, and traditional rusks. Bananas, carrot soup, and grated apples can also be tolerable. However, this soft diet is only for symptom relief and should not be followed long-term. In general, it’s worth reviewing personal eating habits to identify potentially hard-to-digest foods that may cause abdominal pain.
6.5 Individual Therapy
It is important to note that the treatment of SIBO and the associated symptoms should be individually tailored, as not all treatments are equally effective for every patient. A holistic approach, incorporating diet, lifestyle changes, and possibly medication, is often most effective. The diagnosis of SIBO can be made through a breath test. If SIBO is diagnosed, there are several treatment options available. Seeing a doctor can help with diagnosis and creating a treatment plan.
References
- Visceral Hypersensitivity; Cleveland Clinic; https://my.clevelandclinic.org/health/diseases/22997-visceral-hypersensitivity; latest check: 11.05.2024
- Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014 Jul;48(6):505-12. doi: 10.1097/MCG.0b013e3182a88357. PMID: 24100754.
- Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM); Juni 2021 – AWMF-Registriernummer: 021/016; Layer et al.; https://www.dgvs.de/wp-content/uploads/2022/02/ZfG_Leitlinie-LL-Reizdarmsyndrom_08.02.22.pdf; latest check 11.05.2024
