With Dr. Lara Spector, ND

Constipation is a condition that affects 1 in 4 Canadians and is defined as having a bowel movement fewer than four times per week. Chronic constipation can sometimes be managed with diet and lifestyle including extra fluid intake, exercise, increased dietary fibre and much more. For some of us, these changes either make a small difference or the effect doesn’t last and the constipation returns!

This can make it very frustrating for some, especially when the issue has been longstanding and comes with aggravating symptoms such as abdominal pain, bloating, hemorrhoids and more.

So, what gives? What is causing this chronic constipation/IBS? The amount and type of bacteria in your digestive tract might be to blame, specifically a condition known as Small Intestinal Bacteria Overgrowth (SIBO). Studies shown that up to 80% of people with irritable bowel syndrome (IBS) have SIBO.

What is SIBO?

SIBO, small intestinal bacterial overgrowth, is characterized by an overgrowth of various types of bacteria in the small intestine, bacteria which are normally only found in the colon. SIBO has been shown to interfere with the digestion and absorption of the food we eat and can lead to leaky gut (which causes our intestinal barrier to become permeable, leaking large proteins into our bloodstream). Leaky gut can then cause constipation, inflammation, autoimmune disease and food allergies.

Causes of SIBO:

  • Multiple courses of antibiotics
  • Low stomach acid
  • Moderate alcohol consumption
  • Oral contraceptive pills (OCPs) – present or past use
  • Diabetes mellitis (type 1 and type 2)
  • Crohn’s disease, ulcerative colitis or IBS
  • Celiac disease

Most common symptoms/signs of SIBO:

  • Constipation (caused by the methane gas produced by the bacteria)
  • Bloating
  • Gas
  • Belching
  • Stomach pain
  • Probiotics make digestive symptoms worse
  • Symptoms are better with fasting

How do I test for SIBO?

SIBO is largely under-diagnosed and as mentioned above, up to 80% of people with IBS have SIBO so there is a strong chance, especially if there are symptoms that include more constipation, bloating and gas, that SIBO could be the culprit. SIBO is tested via a breathalyzer test (Quintron – http://www.breathtests.com/#) which measures the amount of methane and hydrogen in the body (which are the gases produced by the bacteria responsible for SIBO).


SIBO can be difficult to treat. Successful treatment of SIBO requires addressing the underlying cause of this imbalance in bacteria in the body. An individualized protocol that includes diet (such as the FODMAPs or SCD diet), anti-microbial herbs (such as berberis, goldenseal) and probiotics can help ameliorate the symptoms in addition to treating the cause. Some studies show that certain antimicrobial herbs have equal or slightly better outcomes to antibiotics, which are typically prescribed by doctors to treat SIBO. Working naturally to support your digestive system and balance the bacteria in your gut can result in a great improvement in your overall health and wellbeing, and healthier trips to the bathroom.


Chehid V, Sameer D. Herbal Therapy is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. Global Advances in Health and Medicine 2004 3(3)

Dukowicz A.C., Lacy B.E. Small Intestine Bacterial Overgrowth. Gastroenterol Hepatol 2007, 3(2): 112-122.

Kresser C. SIBO – What causes it and why it’s so hard to treat.,November 4 2014.