Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) - What it is

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IB) is a chronic gastrointestinal disorder | SingHealth

Irritable bowel syndrome (IBS) is a prevalent and chronic gastrointestinal disorder characterized by a combination of persistent and recurrent abdominal pain and abnormal bowel habits.

The condition often presents with symptoms such as diarrhoea, constipation, or a fluctuation between the two. The pain associated with IBS typically occurs after meals and may be relieved or exacerbated following a bowel movement. In addition to abdominal discomfort, individuals with IBS may experience bloating, passage of mucus in stools, and a sensation of incomplete emptying after a bowel movement.

Irritable Bowel Syndrome (IBS) - Symptoms

What are the symptoms of irritable bowel syndrome?

The symptoms of IBS are diverse and can significantly impact an individual's quality of life. Common causes of IBS and their associated symptoms include:

Dysmotility, which causes diarrhoea, constipation, or a combination of both at different times, leads to diarrhoea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C), or a mixed stool pattern IBS (IBS-M).
Visceral hypersensitivity results in heightened sensitivity to normal contractions, leading to pain or discomfort during regular activities such as eating or bowel movements. This sensitivity does not indicate bowel damage, but rather increased sensitivity to stimuli in individuals with IBS.
Brain-gut axis dysregulation affects the communication between the brain and the gut, potentially leading to an inability to regulate pain or excessive signals causing diarrhoea in individuals with IBS.
Dysbiosis in IBS occurs when "good" bacteria are replaced by "bad" bacteria, leading to increased sensitivity of intestinal nerves or increased fermentation of food, resulting in symptoms such as bloating and diarrhoea.

The symptoms of IBS are not indicative of structural problems (such as ulcers or cancers), often resulting in normal findings in blood tests, endoscopies, or scans for patients with IBS.

The location of pain may vary among patients due to the involvement of the small intestine and colon (large intestine).

When should you see a doctor?

Be aware that blood in the motion is not a symptom of IBS and you should see your doctor as soon as possible if this happens.

Irritable Bowel Syndrome (IBS) - How to prevent?

Irritable Bowel Syndrome (IBS) - Causes and Risk Factors

What are some common triggers for irritable bowel syndrome?

Common triggers for IBS include:

Food: Many patients identify food as a trigger for their symptoms. While there is no single diet that universally cures IBS, food often plays a role in producing symptoms, particularly in cases where bloating, discomfort, and diarrhoea are the main symptoms.
Medications: Certain medications, such as antibiotics, diabetic medications, and cough medications, can trigger symptoms of IBS, especially if symptoms worsen after starting one of these medications.
Stress: Stress can exacerbate IBS symptoms due to its impact on the brain's ability to reduce the body's reaction to stress.
Infections: Infections that cause symptoms such as diarrhoea and vomiting, such as stomach flu or food poisoning, may also worsen IBS symptoms.

Irritable Bowel Syndrome (IBS) - Diagnosis

How is irritable bowel syndrome diagnosed?

To diagnose IBS, the following steps are typically involved:

Gathering a comprehensive medical history is crucial for making an accurate diagnosis of IBS.
Symptoms should be present at least weekly for about 6 months to confidently diagnose IBS.

It is important to note that the absence of findings on scans or endoscopy does not necessarily indicate the need for further tests to find the cause of the problem.

Depending on age and the presence of alarm symptoms, some patients may require diagnostic testing via blood tests, endoscopies, or scans to exclude the possibility of other medical conditions. Alarm symptoms include loss of appetite, loss of weight, bloody or black stools, progressively worsening symptoms, abnormal physical examination, difficulty swallowing, and a family history of cancer or bowel diseases.

Irritable Bowel Syndrome (IBS) - Treatments

How is irritable bowel syndrome treatment?

As IBS is a lifelong condition with no cure, active self-management is crucial for individuals with IBS. Patients are encouraged to learn how to monitor their symptoms and rely on self-help measures during symptom flares. Identifying specific triggers, such as food, irregular meals, medications, and stress, is essential for managing IBS symptoms. Keeping a symptom diary can help individuals track their symptoms and food intake, enabling them to make informed dietary adjustments.

Some patients with mild symptoms of IBS may not require a specialist for management, and certain medications can be obtained in GP clinics or polyclinics. The following medications may be prescribed:

Anti-diarrhoeal (e.g. loperamide)
Antispasmodics (e.g. meteospasmyl)
Laxatives (e.g. forlax, lactulose)

Your doctor may also prescribe probiotics, antibiotics, and newer laxatives to target specific symptoms.

Additionally, lifestyle modifications, including regular exercise, adequate sleep, well-balanced diet, and proper positioning for opening bowels, can help manage symptoms. Download the document below for more advice about breathing exercises, managing your symptoms with a food diary, step-by-step breathing exercises, and more:

IBS Patient Information.pdf