UNLIKE POPULAR OPINION, IRRITABLE BOWEL SYNDROME - COMMONLY KNOWN AS IBS - IS NOT A SINGLE DISEASE entity but rather a combination of a variety of symptoms including abdominal pain, bloatedness, frequent diarrhoea and/or constipation. One of the most common afflictions around the world, it had been suggested that up to one in ten Singaporeans may have some form of IBS. Many people frequently experience bloatedness of the abdomen along with diarrhea but this particular combination of symptoms may be triggered by a variety of external factors and always pose a diagnostic problem. Stress, lactose intolerance, intestinal gas producing bacterial overload, spicy foods, excessive dietary fibre and usage of antibiotics can all lead to IBS.

It is sometimes difficult to actually pin down what exactly is causing the bowels to become irritable so frequently, as there are many potential causes and factors to take into consideration.

Furthermore IBS is always diagnosed only when all other “real”diseases have been ruled out. This means that numerous tests and investigations have to be performed before IBS can be blamed.

The abdominal pain that so many IBS sufferers experience is generally due to a buildup of excessive gas that causes the gut and gut wall to distend, resulting in a bursting-like sensation in the tummy. Overactive contraction of the intestines or intestinal spasms; causes the patient to experience pain. This distension is frequently worse in the evenings as opposed to the mornings, and the patient may experience the symptoms of IBS more sharply after eating certain foods.

While constipation is not often thought of as a symptom of IBS - and, in and of itself, it probably is not - it can sometimes be associated with the excess buildup of gas in the intestines. For this reason, sufferers of frequent constipation is sometimes thought to have a subtype of IBS. On the flipside, most patients with IBS experience frequent diarrhoea. This is often due to indigestion, where the resultant hyper-osmolar mixture rushes through the gut, leading to a feeling of urgency and the need to use the toilet. In some particularly serious cases, this feeling is so strong that faecal incontinence may result!

Because there are so many causes of IBS, I treat and manage this syndrome from an etiological point of view. Infective and inflammatory intestinal diseases have to be excluded by appropriate tests. Stress and food sensitivities should also be assessed. Lactose intolerance, for instance, is a common cause of IBS. It has been shown that up to 95 per cent of Singaporean Chinese adults are actually lactose intolerant and therefore unable to digest anything with lactose including: milk, cheese, butter and many other diary products. A trial of avoiding milk and lactose containing foods is sensible. Gastroenteritis or taking a course of antibiotics may have led to bacterial overgrowth which causes the IBS. These gas producing bacteria acts on undigestible fibre resulting in excessive gas ion the gut. Therefore, my flow of treatment regimen thereafter; is to ask patients to initiate a trial of no dietary fibre for two or three weeks together with a replacement regime of medical grade probiotics. Using this treatment flow many instances of IBS can be cured.

However, if none of the above methods work, the patient may have a more resistant and endogenous IBS and may need to be treated with drugs designed to stabilise the gut contraction, decrease the amount of gas produced and lower the associated diarrhoea.