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SINGAPORE - Three years ago, social worker Sivasankeri Sathasivam started having bouts of diarrhoea several times a week.
Gradually, it became worse. She had severe pain in her abdomen, no appetite and diarrhoea up to 10 times a day.
"Taking diarrhoea pills did not work and it was affecting my quality of life because I always had to find a toilet after a meal outside," says the 34-year-old.
She was later diagnosed with irritable bowel syndrome (IBS).
It is a disorder that affects the digestive system, causing symptoms such as abdominal pain, bloating, frequent diarrhoea or constipation, or a sensation of incomplete bowel clearance.
While the cause of IBS is not known, stress is a contributing factor and can worsen its symptoms.
"The gut and the brain are constantly signalling to each other, hence changes in mood or stress levels can lead to changes in how sensitive the gut is, producing symptoms," says Dr Andrew Ong, a consultant at the department of gastroenterology and hepatology at Singapore General Hospital (SGH).
To better treat IBS patients, SGH has been providing its patients with an integrated treatment via medical, behavioural and dietary therapy since 2019.
Patients are seen by a doctor and a psychologist, often in the same room, while a dietitian is in another room but also within reach.
While other hospitals may also have a dietitian or psychologist to treat their patients, they often work via a system, where gastroenterologists refer a patient to a psychologist or a dietitian for further evaluation and treatment, says Dr Ong.
This, he adds, may cause patients to assume that their doctors have given up on them and are sending them to a psychologist.
IBS patients at SGH undergo cognitive behavioural therapy with a psychologist to help identify negative thoughts linked to anxiety, stress and the fear of symptoms of the chronic condition.
In Singapore, IBS has become more common over the years, from a prevalence of 8.6 per cent in 2002 to 20.9 per cent in 2014.
Dr Ong says this could be due to people having more irregular meals or increased levels of work stress.
Highlighting the importance of psychological therapy in IBS, Ms Michelle Shi, a senior psychologist at SGH's department of psychology, says medical conditions related to the stomach and intestines affect people psychologically. And vice versa, a person's psychological state also disturbs the functioning of the stomach and intestines.
Behavioural therapy can improve the patient's state of mind and help him or her adopt effective coping strategies and reduce the severity of IBS symptoms, she adds.
Therapy methods can include learning relaxation techniques, such as breathing exercises and guided imagery therapy, where participants focus on mental images to feel relaxed.
Ms Sivasankeri, who has been undergoing treatment since March last year, says she did not know that IBS could be caused by stress until she spoke to a psychologist.
"I was very stressed at work, but I thought I was coping well. I didn't know that stress in the mind could cause the digestive system to react this way and cause such symptoms," she adds.
Apart from taking probiotics supplements daily, she has taken up meditation, breathing exercises and journalling. "My condition has improved because I am more aware of what causes my symptoms now. Even when I am stressed and my condition acts up, it is not as bad as before," she says.
Dr Leong Choon Kit, a family physician at Mission Medical Clinic in Serangoon, has observed a link between IBS among children and stressful periods in the school year.
For instance, he sees more children with the condition around the examination or competition periods in school.
Children as young as six also get IBS in the first few weeks of Primary 1, he adds.
There is no cure for the condition, but patients are usually given medication for the relief and management of symptoms.
However, Dr Ong says this may not work, especially if the symptoms are severe and have continued for a long time.
He adds: "Doctors usually see patients and focus on the symptoms while deciding the severity, but many doctors do not assess the contributing factors that lead to the symptoms. Even fewer doctors would target those factors as part of the treatment plan."
These include psycho-social factors such as the absence of social support, state of the patient's work environment and high stress levels, as well as dietary factors, including eating habits.
These factors can "interact to incite symptoms to appear" and cause them to worsen, he adds.
Freelance graphic designer Cassandra Koh, who gets IBS a few times a year, says she initially felt helpless because she did not know what triggers it.
The 29-year-old, who goes to a family clinic for her condition, says: "Consulting a doctor helped me find out what the triggers might be and allowed me to manage my condition more effectively."
She now takes frequent breaks during the day and practises mindfulness.
Apart from stress, another common trigger is food intolerance.
Foods high in carbohydrates called Fodmaps - fermentable oligosaccharides, disaccharides, monosaccharides and polyols - are poorly absorbed by the body and can result in bloating and diarrhoea, causing IBS, says Dr Ong.
Food high in these substances include wheat, milk, beans, onions, garlic, mushrooms and certain fruit and vegetables such as pears, cherries, cabbage and cauliflower.
A diet low in such foods can be helpful for IBS sufferers.
Beside managing one's diet and stress levels, Dr Ong says regular exercise and adequate sleep can help. Exercise has been shown to improve bowel movements within the gut, while adequate sleep can reduce the sensitivity of the gut.
"IBS is a lifelong condition that has no cure, but a healthy lifestyle with exercise, eating regular, moderate-size meals, good personal coping mechanisms and a good social support network are all helpful in reducing the frequency and severity of symptoms," he adds.
1. It is all in your head
Although IBS can be triggered and exacerbated by stress, anxiety, depression and other emotional factors, the symptoms experienced by patients are real and can negatively affect their lives. Patients with IBS are advised to see a gastroenterologist for help.
2. It does not cause serious health issues
Patients with mild symptoms may not have many difficulties in their daily lives. But those with moderate to severe symptoms will have their quality of life significantly reduced.
If the disorder is left untreated, patients may develop psychological issues such as anxiety or depression in the long term.
3. There is no cure, so do not bother
IBS can be triggered by stress and negative emotions and there is no magic pill for it.
However, it can be managed by adopting a healthy lifestyle and learning coping strategies.
4. Patients experience the same symptoms
The symptoms vary and the treatment should be individualised.
The success of one treatment plan may not apply to another person. It is important to work with healthcare professionals on a tailored treatment plan.
5. IBS damages the gut if you have persistent symptoms
This is a common fear of many patients. IBS does not damage the gut and does not lead to any scarring or cancer. It does not lead to long-term damage to any organs.
6. I need a scope or a scan to explain why I have these symptoms
Doctors can diagnose IBS using limited investigations such as blood tests and stool tests.
Endoscopy is for patients aged 50 and above, or those who have alarming symptoms such as weight loss or blood in stools.
A scope or scan does not show the nerves of the gut and does not shed light on the cause of the symptoms.
7. IBS is due to stress
This is a half-truth. Stress and mood issues can make IBS symptoms worse, but it is never the cause on its own.
Sources: Dr Andrew Ong, a consultant at the department of gastroenterology and hepatology at Singapore General Hospital (SGH) and Ms Michelle Shi, a senior psychologist at SGH's department of psychology