Imagine having stress so severe that it affects your stomach, with stabbing pains and sporadic attacks of gastric distress requiring urgent trips to the toilet. To avoid accidents, you may wear a diaper to travel between home and office – and you dare not take long-distance trips or travel abroad. About 10 to 15 per cent of people worldwide experience some degree of this disorder: irritable bowel syndrome, or IBS. IBS cases are rising in Asia, where prevalence is lower than in the US and Europe, because people are eating less healthy Western diets and experiencing higher stress, says Catherine Hermant, a kinesiologist at Balance Health in Hong Kong (kinesiology is the study of human body movement). Stress is a significant contributing factor to the disorder, she explains, something exacerbated by pandemic – she has seen more IBS sufferers in the last year than ever. “Our head plays a big role in IBS,” she says. Despite its prevalence, IBS is not easily diagnosed as it is a collection of symptoms – including lower abdominal pain or discomfort, diarrhoea, constipation, gas, and bloating – rather than a disease, Hermant says, explaining that the generic nature of those symptoms could point to any number of other illnesses. Justin Wu, a professor in gastroenterology and hepatology at the Chinese University of Hong Kong, refers to IBS as a “disorder of gut-brain interaction” that causes abnormal communication between the brain and the gut. “The ‘main control room’ of the gut is located in the inner part of brain and brainstem,” he says. “That ‘control room’ regulates gut functions through the nerves and hormones.” How much flatulence per day is normal? And how to stop passing wind so much Genetics, stress, anxiety, abnormal gut microorganisms and even too much spicy food are among the factors that can disturb the communication pathways between the central nervous system and the gut, Wu says. Research shows that stress promotes the development of unhealthy bacteria, which secrete inflammatory cytokines, Hermant says. These proteins affect the growth of blood cells and other cells that help the body’s immune and inflammation responses, causing more inflammation and increasing the number of food intolerances over time. To make matters worse, when gut flora is unbalanced, the healthy bacteria can’t do their job properly. This affects the healthy secretion of neurotransmitters – such as serotonin, the happy hormone – which also has a negative impact on our immune system. More women than men get IBS, and often as they near menopause, although many sufferers start to experience it in their teens. Genetics can make a person more susceptible, “especially the gene responsible for regulating serotonin metabolism in human body”, Wu says. He notes that childhood adversity, such as a history of abuse, can also trigger the abnormal development of digestive function in early life. How is this condition treated? “There is no single magic bullet,” Wu says, as there are many reasons it develops and many ways it affects a sufferer. “A multi-targeted approach is needed and medicines that act on various parts of the brain-gut axis should be used in combination.” Low-dose medicines containing serotonin, such as antidepressants known as SSRIs (selective serotonin reuptake inhibitors), can help control the disease by replenishing serotonin in the sensitive brain-gut axis. Newer medicines that regulate pain sensitivity and the abnormal passage of food through the digestive system have had variable success. Using probiotics, prebiotics and antibiotics to regulate gut bacteria has also shown modest results, Wu says. How healthy poo saves lives and relieves irritable bowel syndrome Patients can do a lot to manage their symptoms themselves. Dietary modification, such as following a low-fodmap diet, can be helpful. Fodmaps are “fermentable oligo-, di-, monosaccharides and polyols”, short-chain carbohydrates that are difficult to digest. Common fodmaps include fructose (the sugar found in many fruits and vegetables), lactose (milk products) and galactans, found in beans. Instead of being absorbed into your bloodstream during digestion, fodmaps travel to the far end of your intestine, where the largest populations of gut bacteria live. This bacteria then uses these carbs as fuel, producing hydrogen gas and causing unpleasant symptoms that present in many common bowel disorders, including IBS. Though it may sound counter-intuitive, make sure you eat enough fibre. Dietary fibre helps the body move waste through the gut and can improve common symptoms of IBS. Soluble fibre, found in foods such as oats, peas and psyllium, easily dissolves in water and breaks down into a gel-like substance in the colon. Insoluble fibre, in foods such as wholewheat flour, nuts and cauliflower, does not dissolve in water and is left intact as food moves through the gastrointestinal tract. Soluble fibre slows things down, helping alleviate diarrhoea, while insoluble fibre can speed things up, easing constipation. The benefits of green banana flour, a new superfood great for gut health A good intake of fluid is also important for gut health, as well as overall health. Regular exercise can help manage symptoms. Yoga is especially recommended – not just because some poses help stretch the abdomen and relieve symptoms, but also because mindful breathing is a powerful way to de-stress. Tips for managing IBS from a sufferer-expert Heather Van Vorous started suffering from IBS when she was nine. She gradually learned how to control her symptoms through dietary modifications. She has written two books on the subject – Eating for IBS and The First Year: IBS – and set up the Help For IBS website. She encourages fellow sufferers to build an understanding of their IBS and manage their diet and stress levels. Here are her top tips. 1. Be extremely vigilant about not just what you eat, but how. Take small meals regularly and leisurely – no gobbling – rather than having a single huge meal at the end of the day. 2. Practice creative substitution, not deprivation. Use soy or rice replacements for dairy, two egg whites to replace a whole egg, and bake with cocoa powder – it’s fat-free – instead of solid chocolate. High-fat foods are the enemy of IBS sufferers. 3. Take supplements that are symptom-specific for IBS. There is no cure – this is about preventing symptoms so you can lead a happy healthy life. To resolve diarrhoea or constipation or both, consider slowly fermenting prebiotic soluble fibre supplements. Do not use insoluble fibre, or rapidly fermenting prebiotics. 4. To alleviate pain, spasms, cramps, bloating and gas, consider enteric-coated peppermint and fennel oil capsules. These have been called the “drug of first choice” for IBS symptoms (Van Vorous developed a version, which she sells on her website). 5. Consider alternative therapies such as hypnotherapy , which Van Vorous says has been known to help sufferers stave off symptoms for years. 6. A good old-fashioned way to alleviate abdominal pain is to use a hot-water bottle, since heat is a muscle relaxant and the entire gastrointestinal tract is a smooth muscle. Like what you read? Follow SCMP Lifestyle on Facebook , Twitter and Instagram . You can also sign up for our eNewsletter here .