Digestive Problems: Understanding Bloating, IBS and Persistent Gut Symptoms

Digestive symptoms are not limited to the colon or the stomach. They can involve different parts and different functions of the gastrointestinal tract, from swallowing to bowel habit, as well as the way the nervous system perceives signals coming from the abdomen.

The same symptom can have different explanations. Bloating does not automatically mean SIBO, loose stools do not automatically mean food intolerance, and constipation does not automatically mean a microbiome problem.

Bloating is a subjective sensation of abdominal fullness, pressure or trapped gas. Distension is a visible or measurable increase in abdominal size. The two often occur together, but they are not exactly the same thing and they do not always share the same mechanism.

Contributors can include constipation, fermentation of dietary carbohydrates, carbohydrate intolerance or malabsorption in selected patients, a disorder of gut-brain interaction, altered visceral sensitivity, pelvic-floor dysfunction, coeliac disease, selected motility disorders, SIBO in an appropriate clinical context, or other gastrointestinal disease.

Irritable bowel syndrome is understood as a disorder of gut-brain interaction. It is characterised by recurring abdominal pain or discomfort associated with altered bowel habits. Depending on the pattern, it may present with constipation, with diarrhoea, in a mixed form or in other patterns.

There is no single structural abnormality and no biomarker that explains every case. Different mechanisms may contribute in different patients: altered intestinal motility, visceral hypersensitivity, gut-brain signalling, diet, bowel habits, previous gastrointestinal infection, stress-related influences and potentially microbiome-related mechanisms.

IBS can often be diagnosed positively from a characteristic clinical pattern after appropriate assessment, rather than only after every imaginable disease has been excluded. At the same time, certain symptoms or clinical circumstances justify further investigation.

The gastrointestinal tract and the nervous system communicate in both directions, through the enteric nervous system, autonomic pathways, neuroendocrine signalling, immune signalling and microbial metabolites.

Stress can influence digestive symptoms, and digestive symptoms can influence wellbeing and stress in return. This does not mean that stress causes IBS, and it does not mean the symptoms are psychological.

It is also why sleep, stress regulation and a person's broader health context form part of our assessment, without the condition being psychologised.

Food can influence symptoms through different mechanisms: lactose intolerance, fructose-related symptoms in selected patients, fermentable carbohydrates, coeliac disease, food-related symptoms outside coeliac disease, meal size and composition, and individual tolerance.

A food allergy is a defined immunological reaction documented by specific testing. A food intolerance involves other mechanisms, for example an enzyme deficiency as in lactose intolerance. Food sensitivity is a less precise term that covers very different situations.

Symptom improvement after avoiding a food does not prove an allergy. We do not recommend broad IgG food antibody panels as diagnostic tests: their diagnostic value is not established and they often lead to unnecessary restriction.

If coeliac disease is suspected, testing should generally take place before a gluten-free diet makes the results harder to interpret.

A limited, supervised low-FODMAP approach can improve symptoms in some people with irritable bowel syndrome.

It is not meant to be permanent. Foods should generally be reintroduced systematically where possible, unnecessary long-term restriction should be avoided, and nutritional adequacy matters. It is one tool, not a philosophy of care.

The gut microbiome is an important part of digestive biology. It contributes to the fermentation of dietary substrates, the production of microbial metabolites, intestinal-barrier function, interactions with the immune system, colonisation resistance and various metabolic functions. That biology is established.

However, there is currently no single definition of an ideal microbiome and no universally accepted stool profile that explains persistent digestive symptoms. Changes in microbial composition are described in conditions such as IBS, but this does not mean that every patient with IBS has one identifiable form of dysbiosis, or that a microbiome test can automatically determine the right treatment.

Dysbiosis broadly refers to changes in the composition or function of microbial communities. It is not one universally defined clinical diagnosis with one accepted diagnostic threshold.

A stool result labelled dysbiosis should therefore not automatically be treated as the explanation for a person's symptoms. Microbial diversity in particular is not a simple health score.

At Centre Algos we can prescribe stool tests. They do not all carry the same clinical meaning.

Some questions are well established: faecal calprotectin when intestinal inflammation or inflammatory bowel disease is a relevant differential, selected pathogen testing when clinically indicated, and other specific stool investigations according to the clinical question.

Broader functional stool assessment may be considered in selected situations where it could add useful information to the overall clinical picture. That does not mean every commercial microbiome marker has established diagnostic meaning.

We review blood tests that have already been done and can, where clinically appropriate, prescribe additional targeted blood testing.

Possible questions include anaemia and iron status, inflammatory markers, nutritional status, coeliac screening where the presentation warrants it, and other biological questions suggested by the history.

This is not a universal panel, and we do not claim that routine tests miss everything. We may look beyond a standard primary-care panel when there is a specific clinical reason to do so.

SIBO means small intestinal bacterial overgrowth. It can cause bloating, abdominal discomfort and altered bowel habits in some patients. Those symptoms are nonspecific.

Symptoms alone therefore do not diagnose SIBO. Not everyone with IBS has SIBO, breath testing has limitations, and routine testing for every patient with digestive symptoms is not appropriate.

Testing may be considered when the history and risk factors make it clinically plausible. We do not offer repeated antimicrobial or herbal protocols aimed at a presumed SIBO.

The intestinal barrier is real, and intestinal permeability is measurable in research. Increased intestinal permeability is described in certain gastrointestinal and inflammatory diseases. This is a legitimate area of biomedical research.

The popular term leaky gut syndrome is often used commercially as a broad explanation for bloating, fatigue, brain fog, food reactions, autoimmune symptoms and many unrelated complaints. Current evidence does not justify diagnosing a universal leaky gut syndrome from those symptoms alone, and a commercial stool zonulin test does not establish such a diagnosis.

When someone asks us about leaky gut, we translate the question into something clinically useful: are there digestive symptoms, signs of intestinal inflammation, a recognised gastrointestinal disorder, nutritional consequences or another reason to investigate intestinal function more closely?

Depending on the presentation, other conditions may be involved and deserve consideration:

These possibilities cannot be sorted out online. They indicate when medical or gastroenterological assessment should be considered.

Some medicines and supplements can contribute to constipation, diarrhoea, nausea, reflux or abdominal discomfort. This is often overlooked in content about gut health.

During assessment we review prescription medication, over-the-counter medication, supplements and, where relevant, recent antibiotics.

We do not ask patients to stop prescribed medication without appropriate clinical discussion, and we do not frame medicines as toxic or inherently damaging to the gut.

Some situations call for prompt medical evaluation, and sometimes urgent care, rather than a supportive consultation:

If these apply, contact your doctor, an emergency service or a gastroenterologist. Appropriate medical assessment takes priority.

More testing is not automatically better testing. We use laboratory investigations when the result could help clarify the clinical picture or influence the next step. Depending on the situation, this may involve selected blood tests, stool investigations or other targeted assessments. Some patients need further investigation; others do not.

We can also prescribe selected blood or stool investigations beyond the tests a patient may already have had in routine care, when the clinical history provides a reason to look further.

We distinguish established clinical markers from newer functional or microbiome measurements whose interpretation is less certain. Results are considered alongside symptoms and medical history rather than treated as diagnoses in isolation.

Treatment depends on what the assessment suggests. It may combine nutrition, meal pattern, fibre depending on the presentation, hydration, movement, sleep, stress regulation, bowel habits, targeted correction of a demonstrated nutritional issue, phytotherapy where appropriate, and conventional medical treatment or gastroenterology input where indicated.

Naturopathy provides the framework for looking at digestive symptoms in context: diet, digestion, bowel habits, sleep, stress, medication, previous diagnoses, lifestyle and laboratory information. We then build an individual strategy.

Our Knowledge Centre article on digestive problems and naturopathy develops this in more depth.

Functional Biology & Micronutrition may be relevant where nutritional status needs clarification, where digestive symptoms may be affecting intake or absorption, where the clinical history raises broader biological questions, where existing laboratory results need interpretation, or where targeted further testing may influence management.

Targeted supplementation can form part of an individual plan, but it follows the clinical picture. We do not work from a standard supplement list and not everyone needs one.

Medicinal plants may be considered as part of an individual digestive strategy depending on the symptom pattern, medical history, medication and overall treatment plan. Possible aims relate to specific symptoms such as digestive discomfort, bowel spasm or nausea.

We do not claim that phytotherapy heals the gut lining, eliminates dysbiosis, cures SIBO or IBS, or restores an ideal microbiome. Interactions between plants and medicines must be considered.

Probiotics are not one treatment. Different products contain different organisms and strains, and evidence varies according to the condition and outcome being considered. They should not automatically be prescribed simply because someone has bloating or a stool test labelled dysbiosis.

If your digestive symptoms persist, keep coming back or remain unexplained, we assess the whole situation, discuss what is worth investigating and build an individual plan with you.