Always getting the runs? You might have IBS
If you find yourself running to the loo one too many times a day, you may have irritable bowel syndrome, or IBS. A study done in 2016 revealed that around 20% of the Singapore population experience its symptoms which are usually bloating and diarrhoea. While IBS is a lifelong condition, there are many ways to manage it — here's what you need to know.
Stephanie*, 36, has been experiencing frequent bloating accompanied by loose stools daily for the last six months. This could occur up to six times a day, and five to six times a week. She also noticed that the condition worsens during busy periods at work. Upon seeking treatment at Sengkang General Hospital, her physician, Dr Ng Yi Kang, Consultant, Gastroenterology & Hepatology Service diagnosed her with IBS.
According to Dr Ng, IBS is characterised by prolonged abdominal pain that lasts at least three months and altered bowel behaviour such as increased frequency.
He shares, "IBS is known to be affected by the brain-gut connection which means that your brain can affect your gut health and your gut can affect your brain — in short, IBS can be triggered by high levels of stress and anxiety, for instance." He adds that anyone can get IBS although women tend to get it more often, as well as anyone under the age of 50.
Although its exact causes are unknown, there are several factors that can contribute to the development of IBS. These range from the movement of the stomach and intestines (gastrointestinal motility), increased sensitivity of the gastrointestinal nerves (visceral hypersensitivity), intestinal inflammation, and post-infections, to changes in the composition and amount of gut bacteria, food sensitivity and psychosocial dysfunction such as stress and anxiety.
Genetics can also play a part, and IBS has been found to cluster within families, indicating that an individual has a higher risk of IBS if someone in the family has it.
Loose stools do not always mean IBS
Contrary to common perception, having loose stools (diarrhoea) is not indicative of IBS, as IBS can also cause hard stools as well as constipation. While it is a symptom, medical professionals tend to look at the frequency of the bowel movement and if it is accompanied by abdominal pain.
According to Dr Ng, an acute episode of diarrhoea is one that lasts for a week or less and is typically caused by bacterial or viral infections. Most of these cases tend to go away on its own or are easily treated with antimicrobials. However, if someone has diarrhoea a few times a day and it lasts longer than four weeks, this should be considered as an increased stool frequency and a medical check-up is recommended.
Dr Ng also shares some red flags that patients should be aware of as these would require immediate medical attention:
Blood or mucus in stool, or oily stool that is difficult to flush down. Or black stool (malaena) where the stool appears like a black liquid which is a sign of intestinal bleeding.
Diarrhoea that happens at night
Symptoms that occur late in life (50 years old and above)
Severe and progressive symptoms despite treatment
Abrupt unexplained weight loss and loss of appetite
Family history of colon cancer or inflammatory bowel disease, or laboratory abnormalities such as anaemia or low blood count, raised C-reactive protein or inflammatory markers
In cases requiring further investigation, a colonoscopy may be recommended to examine the internal lining of the colon and rectum.
Eating well, having balanced meals, regular exercise, and managing mental health can keep IBS symptoms under control as well as improve overall quality of life. Dr Ng shares that there are various management strategies to treat IBS and they can be a mix of medical and non-medical therapies. He believes that the key lies in devising a treatment plan in partnership with the patient and making shared decisions when it comes to finding the right approach.
Here are some of the treatment options available, which may vary depending on the severity of the case:
Medical
Once diagnosed with IBS, your physician can refer you to a dietitian who will do a full dietary assessment and help you find the best dietary strategy that considers your eating habits, social and environmental factors.
One of the dietary interventions for IBS is the low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols (FODMAP) diet which, in a nutshell, is made up of fermentable carbohydrates which draw water in the large intestines when consumed, creating gas and causing IBS symptoms.
According to Ms Chan Ya Ling, Dietitian at SKH, the low FODMAP diet has been found to relieve symptoms for about 70% of IBS patients. However, not all IBS patients may be suited for it hence a full dietary assessment is important. She adds that the low FODMAP diet is not a straightforward diet and requires long-term commitment as it has a total of three phases which can take up to four to six months to complete. For it to be effective, you need close follow-ups with a dietitian and motivation to make changes to your diet.
As a low FODMAP diet is highly complex, it may not be suitable for everyone. It is recommended that you consult a qualified dietitian to advise a diet that suits your individual needs and tolerance.
Ms Chan also recommends keeping a symptom-food diary. The little things count, too! Mindful eating such as chewing thoroughly and having your meals on time can also help manage IBS symptoms.
You may have heard about some popular diets or supplements that are purported to help with digestion. Ms Chan shares the top three most common misconceptions and separates the facts from the fiction.
Myth 1: Eat fermented foods for good gut health.
Many fermented food products have no evidence that their live microbial component provides health benefits, and the precise microbiological content is rarely defined. But don't let that stop you. You can still enjoy fermented foods in moderation as they help to increase variety and textures of foods.
Myth 2: Avoid gluten.
Current evidence shows there is no need to be on a gluten-free diet unless you have been diagnosed with celiac disease or have been advised to avoid gluten by a doctor or dietitian. Going on a gluten-free diet may cause a lack of intake of prebiotics fibre which is beneficial for gut health, so do not restrict unless necessary.
Myth 3: Over-the-counter digestive supplements, such as digestive enzymes, are good for gut health.
There is currently no substantial evidence to show that digestive enzymes aid digestion, except for lactase enzymes for lactose intolerance. Digestive enzymes are prescribed by doctors for a medical reason, such as for patients with pancreatic insufficiency due to pancreatic cancer, or those undergoing gastrointestinal surgeries.
Myth 4:Probiotic supplements can ease IBS symptoms. Probiotics may work only for some people. At the moment, it is only recommended by the British Society of Gastroenterology Guidelines. For patients with IBS, you are also advised to consider other ingredients that could be added to probiotic products, such as synbiotics (mixtures of prebiotics and probiotics) which can contain FODMAPs, such as inulin or fructooligosaccharides (FOS). These may be poorly tolerated in people with IBS.
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