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Understanding Irritable Bowel Syndrome (IBS)

Unresolved stomach issues? Dr Gwee Kok Ann, a senior gastroenterologist specialising in IBS, explains this common, curable, but often poorly managed problem.


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Do you experience ongoing bouts of stomach pain, bloating, indigestion, diarrhoea or constipation? Have you seen doctors, gone for tests and taken medication, yet have not received satisfactory answers and still live with the symptoms?


Chances are you might be suffering from irritable bowel syndrome (IBS) – a common but complex problem that takes time, expertise and dedication to diagnose and treat.


Unfortunately, many doctors seek quick and blanket solutions for IBS-related issues, and when they fail, patients are told that they have to live with the symptoms. However, this need not be the case. When you seek the right help, you may possibly be cured of your digestive problems for life.


IBS – Might it be the cause of my tummy issues?

IBS, along with other functional disorders of the digestive system, is the most common cause of symptoms such as abdominal pain, bloating, indigestion, burping, gas, constipation, diarrhoea, incomplete bowel movements or changes in stool consistency.


It is estimated that close to a million people in Singapore have these symptoms. Patients and doctors often worry that these symptoms could be due to diseases like infections, gallstones, ulcers or cancers. However, every year, the number of people with functional disorders such as IBS outnumber the people with gastrointestinal cancers by 500 times.


How do I confirm if I have IBS?

IBS is not a condition that is diagnosed simply by doing blood or stool tests, x-rays, ultrasound scan or even endoscopy. Instead, IBS can be diagnosed when the doctor carefully listens to the patient’s history.


Tests can serve to exclude possible causes of the bowel irritation, which can range from irritable bowel to infection to even cancer. However, many patients are unwilling to go for tests, and sometimes tests are not only unnecessary, but can make a patient’s IBS worse. Therefore, the doctor must consider various factors regarding the patient’s personal profile, symptoms and history, to decide if further tests are required. It is also important to remember that a person can have IBS along with some other disease like ulcers or cancers.


Why can’t many doctors, even highly regarded specialists, effectively cure IBS?

Each doctor has their specialty interests and area of expertise. While gastroenterologists are experts at performing procedures to diagnose and treat diseases of the digestive tract, many are not experts in solving IBS.


IBS needs expert treatment from a specialist in IBS who has the knowledge, experience, tools and dedication to understand their patients and customise a unique treatment plan for each individual. Unfortunately, many doctors seek quick and blanket solutions, and patients often end up stuck living with the symptoms. However, this need not be the case.


So how can IBS be effectively treated?

Treating IBS always requires a multi-faceted and customised approach. There is no ‘one size fits all’ treatment plan. It is not enough just to know that a patient has IBS. It is important also to define and determine as many as possible of the factors that contribute to the disturbed functions. The combination of factors that are present in any given IBS patient varies from individual to individual. Therefore, treating IBS requires a vastly different and personalised plan for every individual.


To achieve this, the doctor will have to ask detailed and probing questions, sometimes accompanied by a carefully selected set of tests, and listen carefully to the patient to get an understanding of the patient’s problem. The doctor also needs to help the patient develop a clear understanding of the condition, paying particular attention to lifestyle and psychological factors. Some patients will also benefit from medications, but these have to be carefully selected. Unnecessary surgery should be avoided.


Is there any general diet advice? Are popular detox diets helpful?

The short answer is no, there is no single right diet for IBS patients. The diet that helps one person may actually make another feel worse.


For example, a widespread idea is to eat a high-fibre diet. However, this is unhelpful for many people – a diet high in fibre can further disturb the digestive system. Other popular health fads promote the idea of clearing toxins from the body. However, mainstream science does not support the concept of detoxification except in very limited circumstances such as liver cirrhosis or liver failure.


Many herbal detox teas contain a laxative ingredient known as senna, which forms the basis for the over the counter laxative known as Senokot. While senna is generally safe, unsupervised use by patients may give rise to tolerance, whereby progressively higher doses are required. Senna will also stain the colon lining an abnormal brown colour.


Can IBS be cured?

Yes. There is clear evidence that the issues caused by IBS can be largely resolved with proper diagnosis and treatment. Studies report that, with a confident diagnosis of IBS, a clear explanation and time spent working with the patient on an individualised treatment plan over a period of up to 6 months, as many as 85% of patients become largely symptom free.


 


Dr Gwee Kok Ann

Article with contribution from Dr Gwee Kok Ann, Consultant Gastroenterologist at Gleneagles Hospital. Dr Gwee specialises in the management of irritable bowel syndrome, chronic constipation, persistent diarrhoea, Helicobacter pylori infection and reflux oesophagitis.


For more information, call the Gleneagles Patient Assistance Centre 24-hour hotline at +65 6575 7575 or contact us online to get a specialist appointment. 

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