Irritable Bowel Syndrome Singapore

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Irritable Bowel Syndrome (IBS) is a gastrointestinal disorder that affects the large intestine (colon). It is characterised by symptoms such as abdominal pain, bloating, and changes in bowel habits, including diarrhoea, constipation, or both.

Unlike other gastrointestinal conditions, IBS does not cause structural damage to the digestive tract. It is classified as a functional disorder, which means it affects how the gut functions rather than its structure. IBS is a chronic condition with symptoms that range from mild to severe.

Causes and Risk Factors

The exact cause of IBS is unknown, but several factors may contribute to its development. These include:

Gastrointestinal Motility Issues

The intestines rely on coordinated muscle contractions to move food smoothly. In IBS, these contractions can become too fast or too slow, resulting in irregular digestion.

Disruptions in Gut-Brain Interaction

IBS may be linked to the way the brain and gut interact. In people with IBS, disruptions in this communication may misinterpret normal digestive activity as painful, leading to altered digestive processes.

Genetic and Environmental Factors

A family history of IBS may increase the risk, suggesting a genetic link. Environmental factors such as infections, food poisoning, or antibiotic use can also trigger symptoms.

Types of IBS

Irritable Bowel Syndrome (IBS) is classified based on the following symptoms that affect bowel habits:

IBS with Constipation (IBS-C)

Involves hard, dry stools and infrequent bowel movements. Individuals may feel the urge to pass stool but often experience difficulty or incomplete evacuation.

IBS with Diarrhoea (IBS-D)

Characterised by frequent, loose stools with a sense of urgency. In some cases, leakage or accidents may occur.

Mixed IBS (IBS-M)

Alternates between constipation and diarrhoea, with unpredictable shifts in bowel patterns.

Unsubtyped IBS (IBS-U)

This applies when the symptoms do not fit into any of the other categories. Bowel habits are inconsistent, but abdominal discomfort may still be present.

Diagnosis of IBS

IBS is diagnosed by identifying symptom patterns and ruling out other gastrointestinal conditions, as there is no specific test that can confirm the condition.

Medical History

The diagnostic process starts with reviewing when symptoms began and how long they have lasted. Any family history of IBS or related gastrointestinal conditions is noted. Recent infections, medication use, and lifestyle or dietary changes are also considered as contributing factors.

Symptom Assessment

This focuses on the frequency and severity of abdominal pain, constipation, diarrhoea, or alternating bowel patterns. For IBS, abdominal pain should occur at least once a week over the past three months, along with changes in bowel habits. Patterns such as symptom relief after bowel movements or worsening with specific foods or stress are also assessed.

Blood Tests

Blood tests are used to detect inflammation, anaemia, and conditions such as coeliac disease, which can mimic IBS symptoms.

Stool Tests

Can be useful to identify infections, detect blood, or find markers of inflammation, which may suggest conditions other than IBS, such as inflammatory bowel disease (IBD).

Colonoscopy

A colonoscopy may be necessary if there are concerning symptoms, such as unexplained weight loss, rectal bleeding, or a family history of colon cancer. This procedure uses a flexible tube with a camera to examine the inside of the colon and rule out other serious conditions. It is not used to confirm IBS but to exclude other potential causes for accurate diagnosis.

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Treatment Options for IBS

IBS is typically managed through lifestyle changes and medications to relieve symptoms. These include:

Antispasmodics

These medications relax the muscles in the intestinal walls, helping to reduce cramps and abdominal pain. They are often taken as needed, especially during flare-ups, to ease discomfort caused by abnormal muscle contractions.

Laxatives

Laxatives help stimulate bowel movements and are used for those with constipation-predominant IBS (IBS-C). Bulk-forming laxatives, such as psyllium husk, are recommended over stimulant laxatives to avoid dependency.

Anti-Diarrhoeals

Medications like loperamide can slow down bowel movements, reducing the frequency of diarrhoea for those with IBS-D (diarrhoea-predominant IBS). They are used as needed to prevent sudden diarrhoea, especially before activities where access to a bathroom is limited.

Probiotics

Probiotics contain beneficial bacteria that may help improve gut health by balancing the bacteria in the intestines. Some people find relief from bloating and diarrhoea after taking probiotics.

Dietary Changes

The low FODMAP diet eliminates fermentable carbohydrates that may trigger bloating, gas, and diarrhoea. For those with constipation, increasing soluble fibre (such as psyllium) can improve stool consistency, but insoluble fibre (like bran) may worsen symptoms for some people.

Managing IBS Flare-Ups

Managing IBS flare-ups focuses on identifying triggers and adjusting habits. Avoiding trigger foods such as high-fat foods, caffeine, and artificial sweeteners can help to reduce symptoms. Staying hydrated and adding soluble fibre can improve bowel regularity for those with constipation. Tracking symptoms through a diary helps identify patterns and guides more effective management strategies over time.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Is IBS the same as IBD (Inflammatory Bowel Disease)?

    No, IBS and IBD are different conditions. IBS is a functional disorder that affects how the gut works without causing visible damage to the intestines. IBD, which includes Crohn’s disease and ulcerative colitis, involves chronic inflammation that damages the gut lining and can lead to serious complications.

    Can IBS lead to more serious health conditions?

    IBS does not cause damage to the intestines or lead to conditions like cancer. However, it can significantly affect the quality of life due to its symptoms. Effective symptom management may help reduce the risk of chronic pain, nutritional deficiencies, or anxiety.

    How is IBS treated in children?

    IBS in children is managed similarly to adults, focusing on diet adjustments, stress management, and, when necessary, medication. A paediatrician may recommend a tailored plan that considers the child’s specific symptoms and lifestyle, including dietary changes and possibly probiotics.

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