Struggling with painful bloating and frequent trips to the toilet? Local doctor shares warning signs of IBS and tips for a healthier gut

If you find yourself rushing to the bathroom more often than you should, or struggle with painful bloating and cramps, you might be one of many worldwide who suffer from a functional gastrointestinal disorder known as irritable bowel syndrome (IBS).

With IBS plaguing nearly one in 10 people in Singapore, there's a need to pay greater attention to this frustrating disorder.

According to Dr Wang Yu Tien, senior consultant, gastroenterology and hepatology at Nobel Gastroenterology Centre, Gleneagles Medical Centre, IBS is a disorder that is described by the symptoms that the patient feels. Common symptoms include abdominal pain, bloating and discomfort associated with some change in bowel habit, namely constipation or diarrhoea.

Adding that IBS can be categorised into three main types – the diarrhoea, constipation and mixed type – Dr Wang says it is important to note the symptoms that a patient has so treatment can be directed towards that.

"If a person has diarrhoea, the medication will try to slow down the gut a little, while for a patient with more constipation, it will be to help them pass motion," he says.

In an interview with AsiaOne, Dr Wang shares the 101 of irritable bowel syndrome, including its myriad of complex causes, recommended treatments, as well as how to better manage your general gut health.

In the first place, how do we know if it's IBS or a more severe problem like stomach ulcer or colon cancer?

With no single definitive test to diagnose IBS, it begs the question of how one can find out if they suffer from the syndrome or a more serious gastrointestinal disorder.

Along with identifying common symptoms, Dr Wang says the diagnosis for IBS is made "when there's an absence of any structural or biochemical problem".

This means that the possibility of other gastrointestinal conditions like stomach ulcer and colon cancer, or biochemical problems such as internal organ and hormonal issues, needs to first be ruled out.

"We have excluded these, either because the patient is very low risk or we've done the necessary tests. For example, a scope of the stomach or colon, or a scan of the abdomen to rule out other things," explains Dr Wang.

Due to how common IBS is, tests are also not always necessary. Instead, doctors may ask patients about their family history, or if they are experiencing any danger signs such as unexplained weight loss and blood in the stool.

"If symptoms get better after medication, it's probably just IBS. Otherwise, I think we need to be judicious and check that it's nothing more serious," says Dr Wang.

What actually causes IBS?

The causes of IBS are far-ranging. They include environmental problems such as food, medications, supplements and psychosocial distress, host factors which refer to traits of an individual that affect susceptibility to disease, and luminal factors – the variety of nutrients, secretions and other essential components produced in the lumen of the gastrointestinal tract.

Another common trigger is stress, which can be explained by the gut-brain axis, the two-way communication between your gastrointestinal tract and central nervous system. It is shown that patients who are depressed or anxious can experience abnormal gut movement, says Dr Wang.

"It can cause the nerve of the stomach to be hypersensitive, meaning that a stretching of the stomach which is physiological – normal for everybody – is perceived as being very bloated and uncomfortable for this person," he explains.

That said, Dr Wang shares that oftentimes, doctors will not attempt to diagnose the underlying causes of IBS as some factors cannot be proven clinically or require invasive procedures to be diagnosed.

Instead, doctors will see if there is a predominant cause that can be managed. For instance, whether there's a specific food that patients may want to avoid or a bacterial problem that needs to be addressed.

So how does gut health relate to IBS?

Along with the long list of potential causes of IBS, Dr Wang says gut health is another factor not to be overlooked. Broadly speaking, there are two microbial factors that relate to IBS – small intestinal bacterial overgrowth and dysbiosis.

Just like how there is a different amount of bacteria in every part of our bowel, there is a certain amount of bacteria accepted as normal in the small intestine, says Dr Wang.

"When the amount of bacteria in the small intestine exceeds this threshold, we call it SIBO (small intestinal bacterial overgrowth)," he explains.

When a carbohydrate goes through the intestine, fermentation happens. Having too much bacteria will cause a lot of gas and acid to be released, thereby resulting in symptoms such as bloating and diarrhoea.

The other microbial factor is dysbiosis, which is when the bacterial balance in a person's gut is abnormal.

"When we talk about gut health, one of the things we know is that the gut and bacteria in a healthy person is in a very stable and good homeostasis. The gut helps to preserve the natural barrier of our intestine and control the inflammation so that it's in good harmony," says Dr Wang.

"But when there's disease, either because the gut has caused it or some external stimuli has caused the inflammation, this goes into disarray. The type of bacteria [in the gut] is different, the integrity and inflammation of the barrier are disrupted. This, in a way, is dysbiosis."

Now that we better understand the causes, can IBS be treated?

While the bad news is that there's no cure for IBS, rest easy as symptoms can be managed.

After all necessary tests are out of the way and it is certain that the patient isn't facing a dangerous problem, simple medication will usually be prescribed to tackle specific symptoms like constipation or bloating.

Besides medicine, patients can be more discerning with their food choices. Patients are advised to avoid food that stimulate the intestine or slow down the gut, such as spicy and oily food, food containing caffeine, and alcohol.

One popular diet to manage IBS is the low FODMAP diet.

Short for "fermentable oligo-, di- and monosaccharides, and polyols", this diet refers to restricting certain non-digestible carbohydrates that may not be well-absorbed in the gastrointestinal tract. When these carbohydrates reach the large intestine, fermentation happens, increasing the production of gas and acid that can trigger digestive symptoms.

Patients with mild symptoms can self-monitor for food triggers for their symptoms, whereas those with more severe symptoms are suggested to do this with a dietitian.

As a general rule of thumb, the key to "gut health" is having variety and "a good, healthy population of bacteria in the gut", says Dr Wang.

"In line with that, eating a variety of fruits and vegetables, which are natural prebiotics in a sense, is one way to enhance this population [of bacteria in the gut]. You'll have a spread of food for different types of bacteria which may enhance the population," he explains.

Can supplements containing probiotics or prebiotics help in managing IBS and gut health?

For those looking for off-the-shelf supplements, according to Dr Wang, probiotics are a commonly used remedy these days. This is with the premise that IBS is due to dysbiosis and the probiotics may help to modify this, he adds.

While the exact science behind how probiotics work is still unclear, Dr Wang says what matters in managing IBS is the outcome and whether symptoms can be controlled.

"If you treat a group of patients with this prebiotic and their symptoms have improved at the end of the treatment period, then you have achieved your aim. That's how we look at whether a probiotic is effective," adds Dr Wang.

As for prebiotics, Dr Wang says this can simply be thought of as "food for the bacteria" used to enrich the bacteria in the colon.

But he cautions that prebiotics may not be "selective" in the type of bacteria that they enrich.

"When you take a prebiotic, it may enrich whatever bacteria that is there, not necessarily just the healthy or favourable bacteria. Sometimes the prebiotics may be in the group of FODMAP, so it may not be suitable and may actually trigger IBS symptoms in certain patients."

How can we choose from various probiotics supplements out there?

Dr Wang believes the best way to tell if a probiotic is useful is to see if clinical studies have been done and whether the supplements are made of "good quality ingredients". For the latter, he adds that probiotics registered as medications under the Health Sciences Authority generally tend to have more robust ingredients.

Another way to evaluate the suitability of a probiotic supplement would be to examine the specific population involved in studies, and how closely it aligns with your population or the population to be "treated".

"Many studies have shown that your ethnicity, where you live, your age, your weight, actually all affect the way our gut bacteria works. So similarly, you cannot expect one probiotic to work for everybody," says Dr Wang.

"We are not at that level of tailoring where we can say, I have this probiotic for just you. But we can look at whether this probiotic has been geared towards, for example, a population in Asia, whether it's for males or females, children or adults.

"Then perhaps those that are nearer to your population will be better. Ultimately, there's no guarantee that it would work but it just gives a better chance," he adds.

Above all, just like how Rome wasn't built in a day, it's unrealistic to expect symptoms to completely disappear within a day or week of taking probiotics supplements.

"It's not a cure. It doesn't mean you take this good probiotic for two weeks and [your symptoms] are never going to come back. That's seldom the case. But if it helps control the symptoms, then that's very favourable," says Dr Wang, adding that most people are able to use probiotics for long periods as they have no serious side effects.

"If there was a probiotic that is targeted at a certain disorder, with good evidence, then I think that certainly will be the one to go for."

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This article is brought to you in partnership with GenieBiome Limited (G-NiiB Immunity+).

yukiling@asiaone.com

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