SIBO Relapse: 5 Reasons Why You Don’t Feel Better After Treatment

Small Intestinal Bacterial Overgrowth (SIBO) is a digestive condition where bacteria overgrow in the small intestine, leading to uncomfortable symptoms like:

• Bloating
• Abdominal pain
• Diarrhea
• Constipation

Unfortunately, SIBO is often misunderstood or misdiagnosed. Many people find it challenging to find a knowledgeable practitioner who can help, which leads to self-diagnosing, self-treating, or getting misdiagnosed altogether. I hear stories like “I’ve spent thousands on treatments, but nothing has worked” or “I’ve been struggling with this for years” all too often. And if you’re one of the many people who feel bloated every day with no solution in sight, you’re not alone.

Even once diagnosed, SIBO can be a tough condition to treat. The bacteria causing the issue can persist even after dietary changes or antibiotics, especially if the underlying cause isn’t fully addressed.

If you’re feeling stuck, here are five reasons why your SIBO treatment might not be working—and what you can do to change that.

1) Your Antibiotics or Antimicrobial Protocol Was Too Short

A lot of people expect to feel better after just one round of antibiotics or herbal antimicrobials. The reality? It often takes multiple rounds to fully clear the bacteria. Each round typically reduces gas levels by around 30 ppm. So, if your SIBO test shows gas levels in the 60s, 80s, or higher, you’re likely going to need more than one round of treatment.

• Antibiotics usually last between 10 to 14 days.
• Herbal antimicrobials typically require 4 weeks of treatment.

To clear SIBO completely, you’ll need to follow through with the full treatment plan and give it time.

2) You Haven’t Addressed Constipation

If constipation is your main digestive issue, it’s critical to focus on getting your bowels moving—and keeping them moving—during your SIBO treatment. Poor motility can prevent the bacteria from being fully eradicated.

I often recommend starting with magnesium to ease constipation, but additional support may be needed. You might benefit from:

• Motility agents (herbal or prescription)
• Fiber support
• Pelvic floor exercises or training
• A regular morning toilet routine

Managing constipation is key to successfully treating SIBO, so make sure it’s part of your approach.

3) Your Sympathetic Nervous System Is Overactive

The sympathetic nervous system, also known as the “fight or flight” system, is activated when your body perceives stress or danger. In this state, your body redirects blood flow away from your digestive system and towards your muscles and brain. This inhibits digestion.

If you’re constantly stressed or anxious, your body may remain in this heightened state, making it harder for your SIBO treatment to work. When you’re in “fight or flight” mode, the gut struggles to function properly, which can result in relapse once you finish your antibiotics or antimicrobials.

It can be tough, especially if you’re someone who thrives on staying productive and organized. But, to truly heal, it’s essential to activate your parasympathetic nervous system (the “rest and digest” system). Prioritize relaxation techniques like deep breathing, meditation, and stress management to support your treatment.

4) Your Diet Isn’t Supporting Your SIBO Treatment

While the right diet won’t cure SIBO, it can make a huge difference in reducing symptoms like bloating and discomfort during treatment. Popular diets like low FODMAP or SIBO-specific diets can help ease digestive distress, but diet alone won’t cure SIBO.

What matters most is that your nutrition supports gut motility, as SIBO’s root cause is a motility issue. Here’s how you can support motility through diet:

• Eat consistent meals each day
• Focus on balanced meals that include protein, fat, and fiber
• Allow at least 3 hours between meals to give your digestive system time to rest
• Modify the texture of your food to ensure it moves easily through your GI tract
• Practice good chewing techniques to support digestion

Supporting motility with your diet can help make your SIBO treatment more effective.

5) It’s Not Just SIBO

SIBO is just one type of dysbiosis (an imbalance of gut bacteria). Other imbalances, like insufficient beneficial bacteria, fungal overgrowth, or parasites, could also be contributing to your symptoms. In fact, I’ve never worked with a client who had only SIBO. Most often, they need comprehensive gut microbiome restoration to fully recover.

It’s essential to look at the bigger picture of gut health when treating SIBO. If you’re experiencing stubborn symptoms, it might be time to investigate other underlying issues.

Struggling with Stubborn SIBO? Let’s Talk.

If you’re feeling frustrated with your ongoing battle against SIBO, I’m here to help. Let’s have a conversation about what you’re experiencing and what treatments you’ve tried so far. Together, we’ll figure out if personalized 1:1 coaching could help you get to the root of your SIBO symptoms and finally feel better.

Book a free consultation with me today to take the next step toward your gut health recovery.