IBS is quite literally a pain in the butt. The scary part? It affects 20 per cent of our population. Here’s what to do about it.
Stomach issues make for some seriously awkward social situations. The gas, pain and constant need to be near a washroom can be debilitating. But it’s one thing to be down with an episode of food poisoning for a few days, and quite another altogether if this sounds like a normal day in your life. Suffering from continuous bouts of diarrhoea, bloating, cramping, indigestion or constipation is not normal, and may be an indication that you have irritable bowel syndrome (IBS).
A 2016 study published in the Journal of Neurogastroenterology and Motility found that one in five Singaporeans suffers from IBS, and that figure has been steadily rising through the years. Dr Reuben Wong, gastroenterologist at Gleneagles Hospital, attributes the increase in prevalence to greater awareness about the condition. “Previously, patients with IBS were often diagnosed as simply having gastric problems. Some patients then did not seek further medical attention as they were told that their symptoms were ‘normal’ or ‘stress-induced’ when they were really suffering from IBS.”
So how is IBS different from occasional tummy discomfort? According to Dr Wong, IBS is a chronic, functional gut disorder. This means that the symptoms have to be present for at least the last six months on a regular basis – unlike that of a normal stomach ache that comes and goes – and functional in the sense that all your organs are physically healthy, yet things still aren’t quite right when it comes to your toilet habits. Because of this, IBS can be difficult to diagnose. There is no one medical examination or scan that can diagnose it, and the most common symptoms of IBS are abdominal pain or discomfort that’s associated with a change in toilet habits like stool consistency or frequency. In order for your doctor to make an accurate diagnosis, he or she will usually take a closer look at your medical history, personal profile (like your age and lifestyle habits) and symptoms. Your doctor may also send you for further tests in order to rule out any underlying conditions like inflammation, cancer or stomach ulcers.
Common causes of IBS
Now that you know what IBS is, the next thing to figure out is why it happens. Unfortunately, nothing is really straightforward when it comes to IBS. Though it is so common, there isn’t a clear-cut cause of the disease. Dr Wong explains that IBS is caused by multiple factors and can afflict patients of any age. Furthermore, the causes affect every individual differently. “Whether someone develops IBS depends on one’s genes and personal and environmental factors. It does not occur overnight or solely because of a single factor.”
IBS can be caused and worsened by the following: severe gut infections like a bad case of food poisoning, an imbalance in gut microflora, mental health issues like uncontrolled stress or anxiety, certain medications like antibiotics, and even food. “Certain foods like chilli and FODMAPs foods – short-chain carbohydrates that some people have trouble digesting – can trigger symptoms in IBS patients,” says Dr Wong. When foods high in FODMAPs cannot be digested properly, they ferment in the intestines and produce excess gas that causes discomfort. As for chilli, a study previously published in the journal Neurogastroenterology has found that IBS patients have a greater number of a special receptor in their gut that reacts to capsaicin, a key active ingredient that gives chilli its spicy taste.
Learning to manage IBS
While IBS isn’t totally curable, the condition can be managed with a proper diagnosis and treatment plan. But first, Dr Wong cautions that it is important to recognise that IBS is a chronic condition. “Failure to do so often results in patients getting unnecessarily worried and seeking unneeded tests and investigations,” he says. “The second thing to note is that the treatment of IBS is unique to each individual. Speaking to your doctor can help determine which aspect of the condition needs to be addressed. For example, he or she may recommend a diet change or medication, depending on the severity of the symptoms.”
For IBS sufferers with milder symptoms, taking the right medicine to manage the condition can be helpful. For example, those who frequently experience loose stools can benefit from taking anti-diarrhoea medication, and those who have constipation can find relief in laxatives. Your doctor might also prescribe probiotics for you to rebuild healthy gut microflora.
Identifying what food your gut reacts to is another key way of managing IBS. In general, it is a good idea to cut down on caffeine, alcohol, oily and processed foods, dairy, and foods like beans and legumes that cause gas and bloating. Many IBS sufferers also benefit from sticking to a low-FODMAPs food diet, and multiple studies have shown that doing so helps to increase the quality of life among patients. Here are some common high- and low-FODMAPs foods.
Common high-FODMAPs foods to avoid
- soft cheese
- cruciferous vegetables
- high-fructose corn syrup
- wheat-based products
- soya milk
- fruit juices
Common low-FODMAPs foods to eat
- macadamia nuts
- most berries
- hard cheeses
- bell peppers
- sweet potatoes
The tricky thing about FODMAPs foods is that many items high in FODMAPs are not actually unhealthy or bad for you. In fact, multiple fruits and vegetables make the list. But don’t worry – you’re not expected to eliminate them from your diet forever. Instead, you can start by cutting back on high-FODMAPs foods until your IBS symptoms improve, then slowly reintroducing them into your diet, one at a time. This helps you to better identify your own triggers since everyone reacts differently to different food. Eating smaller but more frequent meals can also help, since it’s less taxing for your body to digest.
Ultimately, there is no one-size-fits-all approach to managing IBS as everyone’s condition is different. Your body is also constantly changing, and certain foods that you had no problem digesting before may suddenly start giving you a lot of bloating and discomfort. Figure out what works best for you by speaking to your doctor and coming up with an individualised treatment plan to best mitigate those pesky IBS symptoms. And above all, listen to your gut!