If you’ve been diagnosed with Irritable Bowel Syndrome (IBS) but still feel like something isn’t adding up, you’re not alone. For so many people—especially women—the IBS label is more of a catch-all than a real answer. You’ve been told it’s stress, you’ve been handed a prescription for anti-anxiety meds, and you’ve probably left your doctor’s office feeling unheard. Sound familiar?

Here’s the truth: IBS is a diagnosis of exclusion. That means you only truly have IBS if every other possible root cause has been ruled out. But for many people, that step never actually happens.

So, before you accept IBS as your final answer, let’s talk about the other conditions that could be at play—and how to check for them.

Conditions That Can Mimic IBS

1. Small Intestinal Bacterial Overgrowth (SIBO)

SIBO is one of the most common underlying causes misdiagnosed as IBS. Up to 80% of people with IBS actually have SIBO. It happens when bacteria that should stay in the large intestine start overpopulating the small intestine, leading to bloating, gas, diarrhea, or constipation.

There are three types of SIBO, each requiring a different treatment approach:

Hydrogen-dominant SIBO—Often linked to diarrhea and treated with specific antibiotics or herbal antimicrobials.
Methane-dominant SIBO (now called IMO—intestinal methanogen overgrowth) typically causes constipation and may require a combination of antibiotics and prokinetics.
Hydrogen sulfide SIBO can cause a mix of symptoms and often requires a different dietary approach and antimicrobial treatment.

Test for it: A simple breath test (lactulose or glucose) can check for excess hydrogen, methane, or hydrogen sulfide gases, which indicate bacterial overgrowth.

SIBO is a multifactorial condition, meaning it requires a comprehensive approach with dietary adjustments, gut motility support, and sometimes even nervous system regulation to prevent relapses. A low-FODMAP diet is often used short-term to help manage symptoms, but it’s not a cure. Working with a practitioner is key!

2. Small Intestinal Fungal Overgrowth (SIFO)

Similar to SIBO, but instead of bacteria, an overgrowth of yeast or fungi (like Candida) takes over the small intestine. This can cause bloating, brain fog, sugar cravings, and fatigue.

Test for it: A stool test or organic acids test can help identify fungal overgrowth.

Dietary Support: While antifungal treatments are key, reducing refined sugar and incorporating antifungal foods can help support recovery.

3. Food Intolerances & Sensitivities

We know that feeling bloated all the time is frustrating, but before you start eliminating foods randomly, it’s important to rule out other conditions like SIBO, SIFO, celiac disease, and others.

Once we have a solid understanding of what’s really happening, we can create the right nutritional strategy.

Why you shouldn’t cut out too many foods without a plan:
Eliminating too many foods without proper replacements can lead to nutrient deficiencies, and your body needs those nutrients to repair and recover from gut imbalances. Without a thoughtful strategy, we can actually create more problems while trying to solve them. In fact, when we over-eliminate without proper evaluation and gut support, we may accidentally create new food intolerances along the way. The goal isn’t to shrink your plate—it’s to expand your healing.

🔍 Test for it: An elimination diet with guidance or a food sensitivity panel can help identify problematic foods while keeping your nutrition (and healing) on track.

4. Celiac Disease

Celiac is not just a gluten sensitivity—it’s an autoimmune disease. Eating gluten triggers an immune response that damages the gut lining, leading to diarrhea, bloating, nutrient deficiencies, and long-term health issues if undiagnosed.

💡 Test for it: A blood test for anti-tTG antibodies is the first step, but a gut biopsy via endoscopy is the gold standard for diagnosis.

5. Endometriosis (Yes, Really)

Endometriosis isn’t just about painful periods. When it affects the bowel, it can cause IBS-like symptoms—bloating, diarrhea, constipation, and pain—especially around menstruation.

Although laparoscopy is the definitive diagnostic tool, an endo-mapping protocol that includes high-resolution MRI can provide valuable insights before opting for surgery. One of the best options we’ve found so far is Prenuvo, a whole-body MRI that gives an incredibly comprehensive analysis of your health, head to toe. Their locations are expanding at an impressive rate (we think due to the demand people are having for bio-individual and root-cause answers) and are available in many states in the U.S. as well as in Canada, England, Sweden, and Australia.

💡 Test for it (and journal): Tracking symptoms around your cycle and consulting a specialist can help determine the next steps.

6. Hypothyroidism (or Hyperthyroidism)

Your thyroid directly affects digestion, so when it’s out of balance, your gut feels it. Hypothyroidism slows digestion (hello, constipation), while hyperthyroidism speeds things up (diarrhea, anyone?).

Test for it: A full thyroid panel (not just TSH) that includes Free T3, Free T4, Reverse T3, and antibodies is crucial for an accurate assessment.

Chronic Stress & Nervous System Dysfunction

Yes, stress does play a substantial role in gut health—but not in the "it’s all in your head" way you may have been told. Chronic stress dysregulates the gut-brain axis, leading to real, physiological changes in digestion, motility, inflammation, and even gut permeability! Your vagus nerve (cranial nerve ten) comes from your brainstem and travels down to your heart, lungs, and GUT; among many other organs.

This nerve directly transmits signals and affects the operating state of our entire autonomic nervous system, helping us switch and balance from the stress state (“fight or flight”) to the calm, growth, and repair state (literally nicknamed “rest & digest”). The more stress we experience, the more we live in fight or flight, and the more downstream negative effects are levied on our entire digestive system!”

💡 Test for it: Heart Rate Variability (HRV) tracking, cortisol testing, and nervous system assessments can reveal if stress is the root cause (as well as help provide actionable steps to shift your stress and benefit the health of your entire body)!

Women, IBS & The "Anxiety" Diagnosis

Here’s a not-so-fun fact: Women are more likely than men to be prescribed anti-anxiety or antidepressant medications when presenting with IBS symptoms.

Absolutely, mental health and gut health are connected, but too often, women’s digestive symptoms are written off as anxiety rather than properly investigated. If you’ve been given a psych prescription instead of real testing, it’s time to advocate for yourself.

Dr. K, this is a lot. What can I do next?

Let’s look at the bright side: there are HIGH chances that you’ll get to the root cause. You just need the right approach and help. If you suspect your IBS might not actually be IBS at the core of the matter, here’s where to start:

✔️ Request proper testing—blood work, stool tests, breath tests, and functional gut assessments can provide real answers.
✔️ Track your symptoms—note patterns related to food, stress, and your cycle.
✔️ Work with a practitioner who listens—someone who will help you uncover root causes, not just mask symptoms.
✔️ Trust your gut (literally)—if something feels off, keep pushing for answers.

You Deserve More Than a Catch-All Diagnosis

If IBS has felt like a dead end rather than a real solution, it’s time to dig deeper. There’s a reason for your symptoms—and the right testing and approach can help you find it.

At Navigate Wellness, we specialize in hormones, PCOS, and fertility, but gut health is the foundation of everything. If your body isn’t properly absorbing nutrients, every other system suffers in a cascade effect. Aristotle said it best: “All disease begins in the gut.”

The good news? You don’t have to navigate this alone. Consulting with a professional can be the most empowering (and least overwhelming) step you take.
👉 Book a complimentary strategy session with Dr. K and her team to start uncovering your root causes today.

The IBS Label: A Diagnosis or a Dismissal?