3-in-1 Approach to Managing IBS

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder that affects millions of people worldwide. It is a chronic condition associated with symptoms such as abdominal cramping, bloating, constipation and/or diarrhoea, the severity and extent of which vary widely across individuals. Women are much more likely to suffer from IBS than men (2 in 3 sufferers), and younger people tend to get it more than older people. Studies in Singapore and Asian populations have estimated it at up to 15%, but the real figure is likely higher as many people go undiagnosed.

While there is no cure for IBS, managing the condition by addressing triggers can afford patients an improved quality of life. Food and stress are two of the most common triggers, however their management in treating IBS is highly nuanced and should only be done with professional guidance due to the complexity of the condition. 

Research has proven a strong connection between the gut and the brain, with each exerting influence over the other. This means that stress and anxiety can exacerbate symptoms, but also that symptoms can understandably increase stress. To add to the complexity, IBS sufferers are often put on a diet to eliminate “trigger foods” – however without extensive personalisation, this becomes restrictive and adds to stress, thereby perpetuating the problem instead. Many are also given wrong advice about this diet and end up doing it incorrectly, thus rendering it useless.

But there is hope! For those struggling with this condition, read on to find out more about how a multi-pronged approach from a dietitian, psychologist, and TCM physician works to improve quality of life. 

Nutrition

FODMAPs are a group of carbohydrates that are poorly absorbed by the gut and can contribute to IBS symptoms. A low FODMAP diet involves restricting foods that are high in FODMAPs for a period of time, then slowly reintroducing them to determine which ones trigger symptoms.

It’s important to note that while a low FODMAP diet can be helpful for managing  symptoms, it should not be attempted without the guidance of a healthcare professional or registered dietitian, as this can be dangerous and may lead to consequences like:

Nutrient deficiencies:

Many high-FODMAP foods are also good sources of essential nutrients, such as fibre, vitamins, and minerals. If these foods are restricted without a proper plan for replacing them with alternative sources of nutrients, it can lead to deficiencies that can negatively impact overall health.

Unwanted weight loss:

Following a low FODMAP diet can lead to unintended weight loss, which can be dangerous for some individuals, especially those who are already underweight or have a history of disordered eating.

Disordered eating:

Restrictive diets can trigger anxiety and disordered eating patterns in some individuals. 

In addition, following a low FODMAP diet without guidance can lead to confusion and frustration, as it can be challenging to identify which foods are high or low in FODMAPs without proper training. Working with a registered dietitian who specialises in IBS management can help ensure a safe and effective approach to managing your symptoms.

In summary, while a low FODMAP diet can be an effective way to manage IBS symptoms, it should only be attempted under the guidance of a healthcare professional or registered dietitian. Attempting this diet without proper guidance can lead to nutrient deficiencies, unwanted weight loss, disordered eating, and confusion. Be sure to consult with a qualified professional before making any significant changes to your diet.

Mental Health

Research has shown that IBS is strongly linked to psychological distress such as stress, anxiety and depression. In fact, the prevalence of at least one psychiatric disorder (e.g. depression or anxiety) among IBS sufferers typically ranges from 40% to 60%.  In a study done in 2016, the prevalence of IBS among Singaporeans was found to be 20.9%.

Psychological distress, left untreated, often leads to exacerbation of the IBS symptoms and hence, further disruptions to daily functioning and reduced quality of life.

IBS can cause significant impairment to daily functioning. For example, abdominal pain is often acute and unpredictable. When a person is in pain, it is difficult to sleep well, move about, concentrate on tasks or eat well. Both bloating and flatulence can be physically very uncomfortable. It can also be very embarrassing having to visit the toilet (due to diarrhoea) when one is in the midst of an important business meeting.

IBS is a chronic condition requiring long term management. While most people are able to control their symptoms by managing diet, lifestyle and stress; there remains a significant percentage of people with severe IBS symptoms requiring treatment with medication and psychotherapy.

The good news is that psychological treatment, such as cognitive-behavioural therapy (CBT), have been shown to be effective in reducing symptoms of IBS, through teaching individuals coping strategies to manage their psychological distress (e.g. anxiety and stress).

How does psychotherapy benefit IBS sufferers?

Provides emotional support:

Psychotherapy provides a safe and supportive environment for IBS sufferers to express their emotions and receive emotional support.

Identifies triggers:

Psychotherapy can help identify triggers for IBS symptoms, such as stress, anxiety, or poor compliance to diet restrictions. 

Reduces psychological stress:

Psychotherapy helps IBS sufferers reduce psychological stress, anxiety, and depression. These mental health issues can exacerbate IBS symptoms and make them more difficult to manage.

Improves coping strategies:

IBS sufferers can develop coping strategies that can reduce symptoms and improve quality of life. This includes techniques such as relaxation, deep breathing, and mindful meditation.

Enhances communication:

Learn how to improve communication with healthcare providers, leading to better treatment outcomes. It can also improve communication with family and friends, leading to better social support.

Improves self-esteem:

IBS sufferers can experience shame and embarrassment about their condition, leading to low self-esteem. Psychotherapy can help individuals to accept their condition and feel better about themselves.

Promotes lifestyle changes:

Psychotherapy can aid in making positive lifestyle changes, such as improving diet, exercise, and sleep habits, which can reduce symptoms and improve overall health.

Addresses past trauma:

Some IBS sufferers may have experienced trauma in their past, which can contribute to IBS symptoms. Psychotherapy can help address these underlying issues and reduce the impact of trauma on IBS symptoms.

Improves overall mental health:

Psychotherapy can improve overall mental health and well-being, which can have a positive impact on IBS symptoms.

Diagnosing IBS the TCM way

IBS is defined by a group of symptoms also known as the ABCDs of IBS. These symptoms include abdominal pain, bloating, constipation and diarrhoea. Other symptoms can include flatulence (gas), fatigue, depression and stress. There are 2 main subtypes of IBS, including IBS with diarrhoea (IBS-D) and IBS with constipation (IBS-C). If you have atypical stools that are loose and watery at least a quarter of the time, you belong to IBS-D. Whereas if you have atypical stools that are hard and lumpy at least a quarter of the time, then you belong to IBS-C. Since syndrome differentiation is the essence of TCM, we look into the details of the characteristics of your abdominal pain, stool texture, bowel movement pattern etc to further differentiate your IBS into TCM syndromes.

IBS falls under the category of “郁证“, “腹痛”, “泄泻”, “便秘” and is closely related to the liver, spleen and kidney. Let us take a look at the TCM function of the liver, spleen and kidney. Do note that this is not equivalent to the biological function of the organ itself.

According to the Yellow Emperor’s Inner Classic, the liver governs and regulates our emotions, the spleen governs our digestive system and is incharge of digestion and absorption of nutrients and the kidney controls our bowel and urinary function. When there is an external trigger such as stress, over worrying or an unhealthy diet, this will lead to an imbalance in our body and disturb the regulation and functions of these organs. 

 

In TCM, Diarrhea is defined by increased frequency of defecation and its loose and watery stool. It is a result of a weakened spleen function that causes an increase in dampness in the body. Let us identify your IBS-D based on your bowel movement and stool pattern as well as your abdominal sensation.

IBS-D

Let us now move onto IBS-C. Constipation is defined by reduced frequency of bowel movement; or having a regular bowel movement yet hard and dry stool or difficulty in defecation. In TCM theory, we identify your IBS-C  based on your bowel movement and stool pattern as well as your abdominal sensation.

IBS-C

Here are some acupressure points that you can use to manage stress and also strengthen our spleen function.



Stress and anxiety management

Strengthened spleen function

Food remedies for IBS-D

This soup helps to invigorate the spleen and dispel dampness. This is especially suitable for Singapore’s hot and humid climate.

Food remedies for IBS-C

Crush 10g of Biota seeds and add them into an appropriate amount of white rice and water to cook into porridge. You may also add some honey to the porridge if you like it sweet. 

Self care tips to avoid IBS issues

  • Avoid overeating and have regular and smaller meals
  • Reduce intake of stomach irritants such as dairy, cold, uncooked and oily fried food 
  • Maintain a work-life balance and avoid staying up late
  • Engage in stress relieving activities like yoga and meditation
  • Practise regular bowel habits and try to go to the toilet at the same time daily

IBS can be an annoying but manageable disease. Typically TCM acupuncture and medication are effective in reducing stress and anxiety level and improving our spleen function to manage IBS symptoms. Nevertheless, rectal bleeding, fever, weight loss and persistent pain are not symptoms of IBS and may be associated with other severe problems, especially for those with family history of colon cancer, celiac diseases and inflammatory bowel diseases. You should consult a doctor as soon as possible if you are in the high-risk group and experiencing above symptoms.




ABOUT THE AUTHORS

Dr Jaswyn Chin

Lead Clinical Psychologist

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Dr Jaswyn Chin Dietitian Anna Lim

Dietitian Anna Lim

Lead Clinical Dietitian

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Dr Jaswyn Chin Physician Chelsea Tan

Physician Chelsea Tan

TCM Physician

View more posts by Physician Chelsea Tan