Stomach Pain, Bloating, Gas & Diarrhoea? Understand IBS

What is irritable bowel syndrome or IBS?

Irritable bowel syndrome (IBS) is a chronic digestive problem that affects the large intestine. Signs and symptoms include abdominal pain and bloating with constipation or diarrhoea. Worldwide, it is more common in women than men.

Having IBS does not increase your risk of colon cancer.

Managing IBS requires a customised approach and there is no 'one size fits all' treatment.

Irritable bowel syndrome symptoms can usually be managed with dietary and lifestyle changes which includes medication and probiotics.

Speak to a gastroenterologist to find an effective solution to relieve your problems.

In 2016, a medical study in Singapore reported that 20.9% of its participants had IBS, a big increase from 8.6% in 2004. The prevalence of IBS in Singapore is rising, possibly due to the food that we eat and an increased level of stress in our lives. 

OK, but what actually causes IBS?

While there are several well-known theories, the actual science behind IBS is still somewhat uncertain.

It is believed that IBS is caused by exceptional sensitivity in the large intestine. Muscular contractions which propel food along the colon lead to abdominal pain. Pain may be experienced even when the large intestine is minimally stretched by gas. 

IBS is also associated with intestines that move food through the system either too quickly (causing diarrhoea) or too slowly (causing constipation).

Some other theories have suggested that IBS is due to a problem of the nerves that connect the brain and gut, immunity of the intestines, or an imbalance of the bacteria in the digestive tract. 

What we do know is that symptoms vary between each case of IBS – some people experience pain and constipation, some experience pain and diarrhoea, while some experience pain and alternating periods of diarrhoea and constipation. The symptoms of IBS are often triggered by a variety of foods, stress, lack of rest and hormonal changes.

What are the symptoms of IBS?

The symptoms of irritable bowel syndrome (IBS) may vary between individuals. Common signs and symptoms include:

• Diarrhoea, constipation, or alternating periods of diarrhoea and constipation
• Abdominal pain and cramps
• Bloating, which is worse after a meal or better after going to the toilet and passing bowel movements
• Harder or looser stools than usual
• A bloated belly
• Mucus in the stool

Technically speaking, there are 4 types of IBS: IBS with constipation (IBS-Constipation), IBS with diarrhoea (IBS-Diarrhoea), IBS with a mixture of constipation and diarrhoea (IBS-Mixed), and IBS that doesn't fit into any of these categories (IBS-Unclassified). The type of IBS that you have depends entirely on your symptoms.

Severe signs and symptoms of IBS

A small number of people may experience severe signs and symptoms of IBS. These may indicate a more serious condition, such as colon cancer.

Consult your doctor immediately if you notice any of these:

• Weight loss
• Diarrhoea at night
• Rectal bleeding
• Iron deficiency anaemia
• Unexplained vomiting
• Difficulty swallowing
• Persistent pain that isn't relieved by passing gas or a bowel movement

How does it feel to have IBS?

Although IBS is not a life-threatening condition, many people do worry that it will be incapacitating. People are often concerned that the pain will be so bad that they cannot leave the house. Others may be anxious about having frequent and sudden episodes of diarrhoea.

If you experience these problems, do not be afraid to seek professional help. You are not alone, and you are not defined by your condition. With proper management and guidance, your IBS can be controlled and you can resume a healthy lifestyle.  

Ultimately, getting stressed over IBS may aggravate your symptoms. See a gastroenterologist if your symptoms are severe or frequent enough to disrupt your lifestyle. You can discuss with your doctor on the next appropriate step.   

Am I at risk of developing IBS?

IBS is more common in women than in men, especially women in their late 20s. 

If you have a family history of IBS, your risk of developing this condition is higher than a person who does not have a history of it. Doctors have also linked IBS to depression, migraines, fibromyalgia (a chronic muscle pain disorder), panic disorders and other psychological conditions. 

Realistically, anyone can develop IBS. If you are concerned, it is best to consult your specialist. They will be able to assess your symptoms properly. 

How do doctors diagnose IBS?

IBS cannot be diagnosed by blood tests, stool tests, x-ray or ultrasound scans. These tests serve to exclude other causes of bowel problems such as inflammatory bowel disease, cancer and infections. To clinch a diagnosis of IBS, a gastroenterologist has to consider various factors such as your medical history, risk factors and symptoms.

Gastroenterologists can recognise the symptoms of IBS pretty quickly. Tests may be performed if there are worrisome signs such as blood in your stool, unintentional weight loss or a family history of cancer. Your doctor may check for conditions that commonly accompany IBS such as depression, anxiety or migraine. 

Tests which are usually performed include blood tests (to check the blood count), stool tests (to check for infections and inflammation), endoscopy (a visual examination of the digestive tract) and a psychological assessment. 

If you are concerned about food intolerance or food allergies, it can be helpful to keep a diary of the foods that you eat, and indicate its relationship to your symptoms. This information can be given to your doctor during the consultation.

How is IBS treated?

After the diagnosis is confirmed, your doctor will map out a treatment plan. This is unique to you as different people have different triggers, such as specific foods or stress.

Managing IBS requires a customised approach and there is no 'one size fits all' treatment. Your doctor will most likely recommend dietary and lifestyle changes as well. These might include (but may not be limited to):

• Eating smaller meals
• Keeping to regular mealtimes
• Reducing the intake of caffeine
• Avoiding dairy products
• Consuming probiotics 
• Minimising stress
• Doing more exercise

Your doctor may also prescribe medicines which are tailored to your specific needs. Regular appointments may be required to check on your progress and to make further modifications to optimise your treatment.

Will alternative therapies help my IBS?

Some people with IBS swear by alternative treatments such as acupuncture. Acupuncture is believed to stimulate the nerves at key acupuncture points in the body. This causes the body to release special hormones that can alleviate the pain that we feel. 

The evidence for using acupuncture to treat IBS is inconclusive, as some studies show a benefit while others don't. If you think that an alternative treatment is working for you, you might want to continue with it as long as it is safe. 

Before starting on an alternative treatment, you should check with your doctor to ensure that it does not interfere with your current medical management.

What foods should I avoid in IBS?

The foods that trigger IBS are often unique to each individual. Hence, the list of foods to avoid is determined by your own experience. Some foods are known to be common triggers. These are:

• Oily foods (due to its high fat content)
• Caffeine (due to its stimulating effect on the intestines) 
• Processed foods (due to the amount of additives and preservatives in them)
• Dairy products (lactose intolerance is common in adults)
• Cabbage, beans, onions and legumes (they increase bloating and flatulence)
• Gluten (some people with IBS are gluten-intolerant)

Do remember that every person with IBS is different. It is possible that you can eat all of these food, without any symptoms. Try keeping a food diary to track what works for you and what doesn't.  

What foods can I eat with IBS?

Instead of focusing on what you can't eat, focus on what you can! Once you have successfully identified the triggers, you should be able to settle into a healthy routine.

Your doctor may recommend a low FODMAP diet. FODMAPs are a group of carbohydrates which are hard to digest. These undigested foods are thought to trigger the symptoms of IBS in the large intestine. Hence, eating a low FODMAP diet can result in less gas, bloating and pain. 

Low FODMAP foods are:

• All meats, fish and eggs
• Most herbs and spices
• Nuts and seeds like almonds, cashews and peanuts 
• Vegetables like bok choy, spinach, tomatoes, carrots, sweet potatoes and zucchini
• Fruits like bananas, honeydew, kiwifruit, grapes and oranges 
• Grains like corn, oats and rice
• Lactose-free milk and hard cheeses 

Diet and lifestyle remedies for IBS

Certain diets can help improve IBS symptoms. A diet rich in soluble fibre helps with bowel movement in those who experience constipation.

For those who frequently have gas and diarrhoea, opt instead for a low-fibre diet. However, before you completely eliminate fibre from your diet, explore consuming small amounts of soluble fibre.

A gluten-free diet may also help those who are gluten-intolerant. The protein, found in most grain products, can damage the intestines of those who are gluten-intolerant.

Cutting down on high-fat foods can help to improve IBS symptoms. Fatty foods are especially bad for those with mixed IBS (both constipation and diarrhoea are present).

A low FODMAP diet is helpful in reducing gas, bloating, and diarrhoea. Keep track of the foods that induce your symptoms and eliminate them from your diet.

Can I drink alcohol if I have IBS?

Alcohol is a common trigger of IBS and an irritant to the digestive tract. However, it is a popular beverage that is often served during celebrations and on special occasions. If you are planning to drink some alcohol, limit your intake to 1 or 2 glasses of wine or beer.

Low FODMAP choices like beer, wine, gin, vodka or whiskey should be consumed in moderate amounts. 

Will stress make my IBS worse?

Up to 30% of people with IBS suffer from either depression or anxiety. Treating these problems will improve the symptoms of IBS. Stress management is equally important. Meditation, exercising, counselling, relaxation therapy and cognitive behavioural therapy are some of the treatments used to manage stress. 

Stress management can alleviate the symptoms of IBS. 

Want to try meditation? Sit comfortably on a chair with your feet on the floor and your knees bent at 90 degrees. Keep your back upright. Close your eyes and focus on the rate and depth of your breathing. Relive a pleasant memory or embrace the sounds around you. Try this for 10 minutes every day.

Do inform your doctor if you think that stress or your emotions are aggravating your symptoms. 

Will IBS increase my risk of developing colon cancer?

Having IBS does not increase your risk of colon cancer. While your doctor may perform tests to exclude a cancer, IBS itself doesn't damage your intestines. Your risk of colon cancer is similar to a healthy individual without IBS.   

You should be aware of the symptoms of colon cancer so that you can differentiate them from the symptoms of IBS. These are the warning signs of a possible cancer:

• Blood in your stools
• Unintentional weight loss
• A new or different kind of abdominal pain
• A sudden change in your bowel pattern

Your risk of colon cancer increases if you are over 50 years old or have a relative with the disease. See a gastroenterologist if you're worried about colon cancer or if your symptoms of IBS have abruptly changed.  

Can you cure my IBS?

IBS can be challenging to treat because triggers vary from person to person and the response to medicines varies. However, it doesn't mean that IBS is a life sentence. With proper diagnosis and an individualised treatment plan, the symptoms of IBS can be successfully controlled.

A gastroenterologist can find an effective solution to your problems, and you can certainly expect to live a normal life free of IBS symptoms.