Irritable Bowel Syndrome

Irritable bowel syndrome, commonly referred to as IBS affects approximately 20% of Singaporeans. It is a chronic functional gastrointestinal condition, which means there is a problem with the gut-brain interaction, thus leading to a hypersensitive digestive system and abnormal contractions of the large intestines (colon). 

There are three main types of irritable bowel syndrome, these are:

• Irritable bowel syndrome with diarrhoea (IBS-D): typical symptoms of IBS are accompanied by frequent but small amounts of watery and loose stools and sudden urges to go to the toilet. 
• Irritable bowel syndrome with constipation (IBS-C): typical symptoms of IBS accompanied by hard and lumpy stools that are difficult to pass. Bowel movements may also be restricted to once a week.
• Irritable bowel syndrome with mixed bowel habits (IBS-M): also known as IBS-A or alternating IBS. Typical symptoms of IBS are accompanied by a mixture of both diarrhoea and constipation. Stools alternate between watery and loose or hard and lumpy.

The symptoms of irritable bowel syndrome vary among individuals, but typical symptoms are:

• Abdominal/stomach cramping or pain: most individuals with IBS experience abdominal/stomach pain or cramping. These stomach pains may be alleviated or aggravated by a bowel movement.
• Bloating and swelling: bloating and having a distended abdomen are common symptoms of IBS. Gassiness or flatulence tends to accompany the bloating and swelling and can be triggered by certain foods.
• Change in bowel movements/habits: depending on the type of IBS an individual has, symptoms include constipation and diarrhoea or alternating episodes of both. Furthermore, individuals may also have a feeling of not being able to empty their bowels completely.
• Urgent need for the toilet: some individuals with IBS experience an occasional urgent need to use the toilet. 
• Mucus in stools: mucus is commonly secreted by the bowel in small amounts; however, individuals with IBS can sometimes produce large amounts of mucus, which can be visible during a bowel movement.

Although these symptoms are common in other gastrointestinal conditions, such as gastroenteritis, they are usually short-term and will resolve eventually. However, individuals with IBS experience long-term symptoms that do not resolve permanently. Additionally, women with IBS often experience a flare-up of symptoms during their periods.

If you are experiencing any of the symptoms stated above, book an appointment with Alpine Surgical Practice today.

The causes of irritable bowel syndrome are still relatively unknown. However, several factors can contribute to a flare-up of IBS symptoms. These factors are:

• Altered gastrointestinal motility: characterised by a change in the contraction of the gastrointestinal tract, thus leading to constipation (weak and slow contractions) or diarrhoea (strong and fast contractions). This change in gastrointestinal motility is caused by muscle and nerve dysfunction. 
• Visceral hypersensitivity: this occurs when the nerves between the gastrointestinal tract and the brain malfunction. Resulting in increased sensitivity of the digestive tract, which is characterised by stomach pain and cramping.
• Infection: sometimes, a severe infection such as gastroenteritis can trigger irritable bowel syndrome. 
• Imbalanced gut microbiome: our gut naturally contains a mixture of different kinds of microbiomes. When this balance is disrupted, we become prone to various medical conditions. Individuals with IBS have been found to have an imbalanced gut microbiome.
• Stress: stress, particularly early-life stress, has been linked to the development or trigger of irritable bowel syndrome. 

Several factors increase the risk of developing irritable bowel syndrome, including:

• Genetics: a family history of IBS will increase your risk of developing the condition.
• Psychological stress: stress or tension from significant events such as trauma or abuse can increase your risk of developing IBS. Individuals with depression, anxiety, and other mental health issues are also at an increased risk.
• Age: IBS is more common in individuals below the age of 50. 
• Gender: females are more likely to develop IBS than males.

There is no definitive test used to diagnose IBS. Therefore, irritable bowel syndrome is diagnosed using the Rome IV criteria – individuals must experience recurrent abdominal pain at least once a week in the last three months accompanied by two or more of the following:

• Defecation
• Change in the frequency of bowel movements
• Change in the appearance or form of bowel movements 

In addition to the Rome IV criteria, other tests may be conducted to rule out certain gastrointestinal conditions, such as colon cancer. 

Additional tests that may be conducted include:

• Colonoscopy: a colonoscopy uses a thin and flexible tube with a light and camera attached to one end. It is then guided slowly through the rectum and into the large intestine/colon to check for signs of abnormalities that may be causing your symptoms.
• Gastroscopy: a gastroscopy involves guiding a thin, flexible tube through the mouth and into the stomach and small intestine to check for abnormalities.
• Imaging tests: imaging tests such as a computed tomography scan (CT-scan) or x-rays may be used to visualise your abdomen to check for causes of abdominal or stomach pains and cramping.
• Stool or blood test: a sample of your stool or blood may be taken to check for infection or other issues.

Diagnosis of IBS is essential for proper management and treatment; make an appointment with Alpine Surgical Practice today!

Irritable bowel syndrome is a chronic condition, and there is no cure for it. Furthermore, there is no standard treatment for IBS that works for everyone. Treatment of irritable bowel syndrome works by alleviating or managing symptoms; this can be done in the following ways:

• Avoid trigger foods
• Avoid foods on the FODMAP list
• Consume a diet that is high in fibre
• Stay hydrated with plenty of fluids
• Reduce stress where possible
• Medications for the treatment of constipation or diarrhoea

Managing or treating irritable bowel syndrome requires patience and trial and error. Individuals should not try to self-medicate or self-diagnose. Seek medical advice from an experienced colorectal specialist.