Having to hurriedly excuse yourself from important office meetings because you have to empty your bowels is not only an unpleasant experience but an embarrassing one as well.

But what exactly is IBS? How does one develop this perplexing condition and how can it be treated?

Dr Shanthi Palaniappan, a consultant gastroenterologist and physician based in Kuala Lumpur, spoke to FMT about this common but often misunderstood bowel condition.

“IBS is characterised by abdominal pain; a change in either the number of times you go to the toilet to pass stool; or a change in the stool consistency,” she said, adding that it was sometimes accompanied by abdominal bloating and pain which can only be relieved by defecation.

The symptoms of IBS can wax or wane, she said, and diagnosis can only take place, at the very least, six months after the onset of symptoms that are present for at least three months.

Diagnosis

Shanthi said that IBS is only diagnosed after excluding other conditions with similar symptoms. The first thing would be to exclude the possibility of an infection because after all, food poisoning, salmonella and e-coli are common in Asia.

“For those above 40 years old, we also want to make sure that we are not dealing with colon cancer as its symptoms such as bloating, a change in bowel habits, and abdominal pain are similar to IBS.”

As such, a blood or stool test would be the basic ways to rule out any other possibilities. “Ultimately, don’t dismiss the symptoms of IBS. If it persists, get it checked,” she cautioned.

Factors

According to Shanthi, one school of thought suggests that IBS can develop due to abnormal contractions of the colon and intestines. Others believe that a heightened sensitivity of the intestines can be another reason.

Additionally, some individuals may develop IBS after experiencing severe gastrointestinal infections such as salmonella, Campylobacter, or other viral infections – although it remains a mystery as to how these infections can lead to IBS. Other factors, she added, include stress and diet.

Taking stress as an example, she revealed that two studies have shown that the prevalence of IBS among medical students in Malaysia is approximately 14.7% and 15.8% respectively – higher than the prevalence in the country’s general population which is at 14%.

“After all, medical students are one of the most highly-stressed individuals,” she shared.

According to Shanthi, women and individuals aged between 20 and 45 have a higher risk of developing IBS.

And why women? “That’s because hormones also have an impact on IBS. Furthermore, women are usually also at a higher risk for depression and anxiety, which could be a result of juggling many things.”

Myths about IBS

She also shared pertinent information regarding several myths about IBS. “People think that IBS is not a big deal and doesn’t cause serious complications, but it does affect a person’s quality of life.”

Sadly, some assume that IBS is “all in the head” – to which, Shanthi stressed that it is a “true condition that affects the gastrointestinal tract.”

She also shared that IBS differs from “inflammatory bowel disease” (IBD) which is a chronic inflammatory condition of the bowel with ulceration that could result in different complications from IBS.

Treatment options

“For those experiencing diarrhoea, the usual treatment is antispasmodics, which is a medication to relax the bowel. Meanwhile, for constipation, laxatives are prescribed.

“When it comes to diet, I would suggest the ‘FODMAP diet’,” she shared. A FODMAP diet is low in certain sugars that may cause intestinal distress.

“If there is any food on the FODMAP chart that they frequently consume, I would advise my patients to eliminate it one by one over at least ten days,” she said, adding that taking probiotics and prebiotics helped.

And because food tolerances differ between individuals, keeping a food diary is a good way for a person to detect what triggers IBS. Additionally, psychosocial therapies such as counselling and hypnotherapy are beneficial.

Lastly, to reduce the risk of developing IBS, Shanthi recommended eating a healthy diet with sufficient portions of fruits and vegetables. Drinking water and getting adequate exercise are equally important.

“Also, take a ‘chill pill’ – try to relax and don’t get stressed,” she concluded. Time-tested principles, indeed!