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One of the hallmark symptoms of IBS is gut pain. It is often the most distressing symptom for many of my patients.
In the scientific literature, this gut pain has a few different names. More commonly it is described as visceral hypersensitivity and other times you see terms like visceral hyperalgesia and visceral allodynia (these names don’t sound fun, because they are not fun).
Visceral hypersensitivity is a heightened pain response in your internal organs. Visceral hyperalgesia and allodynia are both different flavors of visceral hypersensitivity. Hyperalgesia is increased pain from something that is normally painful. Allodynia is pain from a stimulus that should normally not be painful.
Visceral hypersensitivity means your gut is more reactive to gas, distension after eating, movement of food and stool through the gut, fermentation and inflammation. For instance, someone without hypersensitivity could eat a half cup of beans and may feel some mild bloating, but no pain from the fermentation of the fibers in the beans. Someone with IBS eats the same amount of beans and may even have the same amount of bloating, but has painful cramping from it.
One of my favorite studies showed that IBS patients may not have more gas or distension from eating FODMAPs compared to healthy controls. When the IBS patients and healthy controls consumed inulin and fructose, they produced the same levels of gas. There were also no differences between colon volume, small intestinal fluid levels or breath hydrogen levels. So why do IBS suffers have pain and discomfort when they eat FODMAPs?
The only difference between the two groups was sensitivity to the the changes in the gut. IBS patients may not be more gassy, they may just be more reactive to the gas.
Because I am a mom of 2 toddlers, the IBS gut is similar to an unhinged toddler. If you give them a banana without letting them eat it like a monkey—they will be pissed off. If you force them to share their favorite doll, they will melt into the floor. If you do something for them that they wanted to do themselves, they may run up and slap you.
All bets are off for a pissed off toddler. Like these little unhinged maniacs, a hypersensitive gut just needs a slight shift of gas or pressure to set it off. At least with toddlers you can bet on tantrums being a phase—but IBS can stick around unfortunately.
How does hypersensitivity develop?
The short and simple answer is gut-brain connection confusion drives hypersensitivity. IBS is a disorder of the gut brain interaction.
The gut and brain are constantly relaying messages back and forth to each other. If the signals become crossed, you can start to see an uptick in many gut symptoms, hypersensitivity being one of them.
If we zoom in a bit closer, IBS patients appear to have mucosal immune activation. That sounds like a mouthful (because it is), but basically it means that the immune system is usually overactive in an IBS gut. Your gut becomes like an overprotective mom and starts trying to prevent any perceived bad influences from coming near it’s precious gut lining. If your gut starts labeling more stimuli as threats, your gut will increase attacks which in turn leads to more inflammation.
Higher amounts of immune system mediators like prostaglandins, proteases and histamine have been found in the mucosal layer of IBS patients. These are all important immune molecules meant to keep us safe, but an exaggerated immune response raises levels leading to chronic inflammation at the gut barrier.
Increased immune activation is linked to gut pain (hypersensitivity). Recalibrating the immune system is a key target in the work that I do with my clients.
What drives this immune activation at the gut lining? Nutrition deficiencies, microbial imbalance, psychological/emotional stress, lack of joy/fun, lack of movement, lack of sleep and gut infections are the biggest drivers. Again—the unsexy basics are going to be the key to fortifying your guts lining and keeping your immune system balanced.
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