Irritable bowel syndrome and six ways to beat the pain of bloating and stomach cramps it causes
There’s no stand-out factor causing IBS, but health experts say reducing stress, cutting alcohol and coffee intake and switching to alternative foods can offer relief for the millions of sufferers worldwide
An upset stomach can be debilitating, even humiliating, and the most common gastrointestinal disorder – irritable bowel syndrome, or IBS – affects about one in seven people globally. While not life-threatening, it greatly reduces quality of life. A change in diet, though, offers hope for sufferers.
For 24-year-old Mary (not her real name), a severe bout of food poisoning triggered IBS six years ago. She had experienced occasional spells of diarrhoea before but after the food poisoning, she regularly had painful stomach cramps, bloating and gas, and had to run to the loo, especially after eating.
“Even after a good meal like congee with no irritants, my lower abdomen will get bloated and painful. I am very petite, but I will look like I am three months pregnant. I can’t wear jeans,” she says.
“Over the past six years, there’s not a single day that I can lead a carefree existence.”
Her condition dominates her day, and she checks the location of public toilets before visiting shopping centres and other places.
While the precise cause of IBS is not known, stress, intestinal inflammation, viral infections such as gastroenteritis, and bacterial imbalance in the gut are some of the factors.
Dr Sze Wan-chee, a specialist in gastroenterology and hepatology at Sincere Medical Clinic in Tsim Sha Tsui, said IBS generally lasts a few months. People with acute gastroenteritis will usually recover after two to three days but IBS is recurrent, she says, and symptoms can last for years.
Sze recommends people who have suffered recurrent abdominal discomfort and issues with bowel movements for more than three days in the past three months seek medical advice.
Psychological factors play a key role in IBS, she says, and some patients’ lives can be filled with misery and embarrassment.
“One of my patients is a young man who has to leave midway during meetings. He told me he doesn’t want to look for toilets when dating girls.” He does not date.
Sze described the severe case of a woman with mild depression who stays home to take care of her sick mother. When she went to visit her church, she wore adult diapers and often had to exit the MTR train several stops into her journey to use the toilet.
For Mary, who moved to Seattle five years ago and is working in a non-profit organisation helping human trafficking victims, her condition prevented her from pursuing her dream job as a journalist.
“Growing up in Hong Kong and studying in a prestigious school were stressful. In Form Six in Hong Kong, I had to prepare for both the local diploma exam and SAT [Suite of Assessments Tests] so I could further study in the US.
“After eating sushi six years ago, I fell really sick with fever. I was fine after taking antibiotics for a few days. But in the months that followed, when I wasn’t sick any more, I had spasms in my lower abdomen and diarrhoea. And a specialist gave me a diagnosis of IBS.”
She says the most unbearable aspect of IBS was a loss of control over bowel movements, which made her feel embarrassed and ashamed.
“The condition makes me depressed and anxious,” Mary says. “When I am in pain, I have to work from home. I studied communications and gave up journalism as I can’t handle stress. Working for a non-profit allows for flexibility. I can work from home and take more sick leave.”
Dr Sze prescribes medicines to relieve constipation, or diarrhoea, and for mood swings. She refers patients with complex mood disorders to psychiatrists. But the most potent weapon in battling the illness is a Low Fodmap diet.
Monash University researchers in Australia developed the diet a decade ago. Fodmap – for fermentable oligosaccharides, disaccharides, monosaccharides and polyols – are poorly absorbed simple and complex sugars found in various vegetables, fruit, milk and wheat.
After passing through the small intestine, poorly absorbed sugars enter the colon where they are fermented by bacteria, releasing gas that distends the sensitive bowel causing wind, bloating and pain.
Lactose, fructose and polyols retain water in the bowel, causing loose stools and diarrhoea.
“For ordinary people, eating high-fibre food should be very healthy,” Sze says. “But IBS sufferers must eat a blander diet so their intestines will not have a heavy workload.”
Low Fodmap diet followers must avoid cauliflower, broccoli, legumes and chewing gum with artificial sweeteners, among other foods, she says.
Ninety IBS patients joined a six-week study at the University of Michigan in 2016. About half the patients followed a Low Fodmap diet, the rest an ordinary diet but cutting down on large meals, binges and known irritants like caffeine and alcohol. More than half the patients on the Low Fodmap diet had less abdominal pain, compared with just 20 per cent of the control group.
Mary’s condition has also improved after adopting the Low Fodmap diet.
“I took a lot of medicine all the time before. Now I take it only when I am in pain. I am also trying Eastern medicine like acupuncture. I will try anything that helps.”
Dr Sze said medicine, proper diet and stress reduction can alleviate the condition.
Her stay-at-home patient has been on treatment, including the Low Fodmap diet, for about six months and is much better.
“She no longer needs to wear diapers when going out.”
Six ways to find relief from IBS
Nutritionist Kathy Ng Yiu-fan, founder of Kat-Spirit Nutrition Centre in Mong Kok, suggests six ways people with IBS or its symptoms can find relief.
1. Have food-allergy tests to identify irritants in their diet.
2. Avoid oily, pungent and processed foods, particularly deep-fried, spicy and canned foods.
3. Avoid consuming large amounts of fruit or fruit juice (except for pineapple).
4. Eat foods with Vitamin B complex, tryptophan and serotonin such as kidney beans, bean curd, egg yolks, pineapple and deep-green vegetables to soothe anxiety.
5. Eat at regular hours and drink sufficient water.
6. Adopt a Low Fodmap diet by cutting down on vegetables (asparagus, onion, legumes/pulses, beetroot, celery, sweetcorn); fruits (apple, pear, mango, watermelon, peach); dairy (cow’s milk, yogurt, soft cheese, ice cream); wheat-containing breads, cereals, pasta and biscuits; and nuts and seeds (cashews, pistachios).