April marks IBS (irritable bowel syndrome) awareness month. Did you know IBS affects up to 9 per cent of Singaporeans? It belongs to a group of benign conditions known as functional gastrointestinal disorders (FGID).

Although the exact causes of IBS and FGID are unknown, they can be attributed to diet intolerance, stress, depression, abnormality in intestinal bacteria content and abnormal intestinal tract movement.

While IBS generally does not result in death, symptoms may be bothersome but can be brought under control with treatment.

The Department of Gastroenterology & Hepatology at Singapore General Hospital (SGH), a member of the SingHealth group, answers questions about IBS and functional gastrointestinal disorders (FGID).

Posted by Kalyani

Dear Dr, 

I am taking 2 capsules of probiotic (Vivomix) in the morning & evening for my IBS prescribed by SGH doctor. 

How long do I have to wait to eat after taking the probiotics?.
I find that when I eat immediately after taking the probiotics, after few minutes I got the urge to pass motion. Is it normal?

Where can I buy the probiotics if I have finished consuming?


Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

While studies have shown probiotics can improve symptoms in around 60% of IBS patients, the exact mechanism of action of probiotics is still not known. The probiotics tend to be more effective when taken in high doses for at least a few weeks. There is no data to guide when best to take it. My suggestion is to take it when it is convenient for you.

Gastrointestinal symptoms are common especially on initiation of treatment. When in doubt please discuss with your managing doctor.

You should discuss probiotic treatment plan with your managing doctor.

Posted by Jason

Hi Doctor,

I don’t think I have IBS but I suffer frequently from loose stools. My stools are often not fully formed and while not watery like diarrhoea, is watery in a viscous way. It is also foul smelling. I have a fair amount of flatulence throughout the day and it does vary with somedays having a lot and some days little to none. I eat a balanced diet with everything in moderation and include a large amount of fruit and vegetables. I hydrate myself constant throughout the day but often feel dryness in my mouth and on lips. Wondering if my colon has some issues with water absorption? Seek your view on this, thanks!

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Your symptoms may be due to IBS but it should first be formally evaluated by a doctor. I suggest you seek medical consult..

Posted by Kaushal

Hello Dr,

I am 75 years old male. Some time, I get only 4-6 notice that I should run to toilet. But before, I could find a toilet, I let go as I couldn't hold it any longer and it is always very soft.

Is there any cure for it?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

You may have a combination of IBS and weak anal muscles. There are treatments to manage both these problems. I suggest you seek medical consultation.

Posted by S

Dear Dr,

How is IBS diagnosed in our healthcare, and where are the information to treatments and management of IBS?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

IBS is diagnosed through a combination of symptoms: abdominal pain or discomfort with altered bowel habit and, where necessary, tests to exclude other causes. You probably have severe IBS which may require multidisciplinary care. SGH Centre for Digestive and Liver Diseases (CDLD) provides multidisciplinary IBS care involving dieticians, psychiatrist, psychologist, gastroenterologists and surgeons.

Posted by Popiah

I am feeling easily bloated and difficulty passing stools...How do i know if it is IBS or Gastritis or if due to other factors? Any main difference?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

While these symptoms probably have a benign cause like IBS or chronic constipation, it is not always possible to distinguish from other more sinister causes through symptoms alone. The presence of presence of “alarm features” such as old age, blood in stool, unintended weight loss, pain while sleeping at night, fever, personal or family history of gastrointestinal cancer would usually prompt further investigations.

Posted by oauth2

Dear Dr,

Will taking a PPI (such as dexlansoprazole) combined with probiotics prescribed for IBS for a prolonged period of up to a year have any side effects to our gastrointestinal system?

Will the body become reliant on these medicines / supplement if these are taken for such prolonged periods?

Is it normal for IBS to cause a dull pain at the bottom left at the hip / stomach area, (where one usually puts our left hand at)?

Thank you

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

While PPI and probiotics are generally safe treatments. There is evidence showing a relationship between prolonged PPI use with adverse effects like osteoporosis and lung and intestinal infections. While these risks are low, treatment should be supervised by a doctor. With regards to probiotics, there is currently no evidence showing long term adverse effect but because its mechanism of action is unclear, it would be prudent to discuss the treatment plan with your doctor.

The body does not become reliant (like drug dependence) on PPI and probiotics but because some they may be used to treat chronic problems like gastroesophageal reflux or IBS, repeated use may be necessary.

IBS may cause pain in the abdomen, but it should be formally evaluated by a doctor.

Posted by piggyap

My husband farts around (no smell, just gas) 10 - 20 times throughout the day. He says that there is a lot of gas in his stomach, and the farting gets worse when he eats certain food like yoghurt, fried food, ice cream.

He says that this problem is because when he was young, he ate food that was prepared from 5-10 hours ago (mum will cook early in the morning, and he only consumes the food for lunch and dinner). As such, his stomach has been "spoilt" due to eating the cold food for many years.

He went for colonoscopy and so far nothing has been found. I would like to know what form of supplement / medicine / food can help to alleviate this condition? What is this condition? And what food should he avoid?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

If he has been evaluated and diagnosed as IBS by his doctor then there are several treatment options including probiotics and reduction of fermentable carbohydrates in his diet which may improve his gas related symptoms. The diet intervention should be supervised by his doctor/dietician to ensure it is done correctly and nutritional balance is maintained.

Posted by Jacelyn

Dear Dr,

When I was prescribed Metformin or normal or extended ones, I get intense stomach cramps and acute diarrhoea. However, GP does not quite buy my feedback. Just yesterday, during regular check-up, the doctor wanted me to try taking again at a lower dosage. But I refused.

Your advice, please.

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Diabetes and some diabetes medications including Metformin are known to cause gastrointestinal discomfort like abdominal pain and diarrhoea. This is can be challenging because Metformin is a very important first line diabetes medication with many good qualities. The use of extended release and lower dose can reduce symptoms. I would advise you to continue discussing your treatment plans with your GP.

Posted by Dr Rubini

Hi Dr,

I’m asking these questions on behalf of a family member (non-medical):

  1. It takes trial and error to figure out which types of food affect the body, and in what way. What is the best approach to figuring this out?
  2. Is there a rule of thumb to avoid certain groups of food e.g. dairy/ deep fried?
  3. Some alternative medicine practitioners advise breathing exercises. What is your take?
  4. How can one help our body to produce a normal level of good gut bacteria?
  5. How can one reduce flatulence?

Grateful for your responses please. Thank you

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Diet intervention like the “Low FODMAP” has been shown to improve symptoms in IBS. Research overseas and in SGH shows around 70% of IBS patients can have symptom improvement with this diet intervention which reduces fermentable carbohydrate consumption. This intervention is useful for management of gas related symptoms like bloating and flatulence. It has been shown to alter gut bacteria, but the long-term effect of these bacterial changes is not known. I would recommend that the diet intervention be guided by your healthcare provider to ensure it is sustainable and nutritionally balanced. The SGH CDLD dietician service provide the “Low FODMAP” diet intervention which has been shown improve IBS symptoms

Breathing exercises can be used to manage IBS in some situations. For example, It is known that anxiety may exacerbate IBS symptoms, and breathing exercises can be incorporated with psychological therapy such relaxational therapy and mindfulness-based therapy.

Posted by Just Dumpling

Hi Dr, what are the symptoms of IBS?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

IBS is defined by the presence of abdominal discomfort and change in bowel habit (diarrhoea or constipation) in the absence of a structural or biochemical abnormality which can cause these symptoms.

Posted by HH

Hi Dr,

The dietician recommended the low FODMAP diet, but it does not work on me. Is this diet really helpful for most people?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

While research has shown the low FODMAP diet improves symptoms in around 70% of patients, like all IBS treatment, it may not work for some patients. This may be because the diet is not effective, or it is difficult to follow the diet adequately. I would suggest you check with your doctor and dietician on your treatment options.

Posted by Leung WC

Dear Dr;

I got Helicobacter Pylori Infection Disease in 2011 Dec & cleared off the bacteria in 2012 Jan by ST treatment in CGH. The UBT also passed to double confirm no bacteria any presence. 

From since up to now; I've tried prescriptions in various stages like Omeprazole; Nexium ; Rabeprazole & Lanoprazole. Regrettably, they gave a bit relief of symptoms but with adverse side effects - joint pains & others. Gastritis Or Ulcer quite easily trigger after intake certain food. 

From certain Research studies; up to 60% Pylori cleared patients by TT or ST also comes across with the same problems.

There is no full recovery wishes!! If chronic & prolong in this way; is there a high risk of developing to Cancer? Any better medical ways to tackle these problems for us?? Thanks!

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

If your main symptom is abdominal discomfort and your investigations have not shown any problem apart from Helicobacter pylori infection. The persistence of symptom after eradication of Helicobacter pylori infection suggests you may have functional dyspepsia, an IBS equivalent of the stomach. Acid reducing treatment like omeprazole and Nexium may not be effective in some patients. Other treatment options include psychological therapy and medications which reduced nerve sensitivity. I would suggest you discuss further with your doctor.

Posted by Kaushal

Dear Dr,

In your reply to my earlier question, you said I may have a combination of IBS and weak anal muscles, and that I should seek medical consultation.

I would like to share that sudden and uncontrolled bowel movement for me occurs only once in 1 to 2 months. When I let go, I feel that my bowel is near empty. It is quite soft but not watery. 

Meanwhile is there anything else which I can do? Is there any food to avoid for IBS?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Since your symptoms are infrequent, you can try to identify trigger to avoid. Some medications which reduces intestinal peristalsis may also help reduce the urgency of your bowel motion.

Posted by Lanny

Hi Dr,

After severe bouts of stomach pain that started on July 2018, I was diagnosed as having IBS by a gastro specialist at TTSH after colonoscopy (on 28/01/2019) showed clear colon. This year, I seem to have severe pain during menses. After meals the pain is intensified & at times diarrhoea a few times a day. Lots of gasses, dull & sharp pain the whole day. Sometimes the pain left me rolling in bed crying in pain. The medicines (Meteospasmyl & Hyomide when necessary) seem to help lessen the pain & gradually the pain subsides as the menses stops. However, every cycle it happens again (now 3rd cycles). Interestingly, last year I didn’t experience this kind of pain during menses (I think it was quite random last year), it only happens this year. I take probiotic daily but it doesn’t seem to help.

My questions:

  1. Why do I get stomach (colon?) pain during menses when colonoscopy showed clear colon? Is this really IBS?
  2. Are the medicines given the only way to lessen the pain? I’m concerned about taking them long term. Is there no cure at all? 
  3. Is it possible that I have SINO (small intestines bacterial overgrowth)? Should I and how to test for it?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

  1. Hormonal changes during menses is known to alter intestinal movement and nerves which can make IBS symptoms worse. Given that your IBS symptoms are not always related to menses, I would agree with your TTSH doctor that this is IBS.
  2. There is no definite cure for IBS but satisfactory symptom control can usually be achieved. Some of the other treatment options include diet, psychological therapy and medication have been discussed earlier but they need to be individualised.
  3. Yes, it is possible you may have small intestinal bacterial overgrowth (SIBO) and one way to test it is with breath test. But this may not be necessary for your treatment.

Posted by tmrnvrcome

Hi Dr,

Is IBS still very much a debatable topic in the Healthcare industry? 

Is it possible to get MC if I visit the polyclinic / GP for my IBS as it has been causing me so much pain for the past week due to rushing projects' deadlines.

Because most of the time when I do , the doctors will just either laugh it off and say that it is just normal tummy ache , or they can be really mean and say in my face that I just want to fake an MC so that I can take the day off from work. I think that is really rude of them. My abdomen hurt like hell, day and night, I could not even sleep. I dare not go to visit the doctors for an MC as well as I am afraid of being ridiculed by them.

Also, can having gluten-free meals help with IBS? I just find that it does not cause my abdomen to bloat so badly. Not too sure if it will help in the long run.

Thank you.

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

IBS is a well-accepted diagnosis in healthcare. It is very common, and treatment and provision of medical certificate Is individualised depending on your doctor’s assessment. One of the key to successful IBS management is having a good relationship with a regular doctor to help guide your management.

Gluten-free diet is used to treat celiac disease, when exposure to gluten causes small bowel inflammation. The Low FODMAP Diet, discussed earlier, can be used to treat IBS and many of the gluten containing food are also high in FODMAP, so it is possible that a reduction of these foods has resulted in symptom improvement.

Posted by Lilyfox

Dear Dr,

My menses has stopped for several months since March 2018. But in between months, I had spotting. I had premenopausal symptoms such as hot flashes and insomnia for a few years. 3 years ago, I started experiencing difficulty in pooping and I had to put in more effort like drinking lots of water and exercise daily in order to clear my bowel. i eat fruits and vegetable more than meat. But still, I feel that i don’t have full evacuation. 2 weeks ago, I started to bloat and felt a lot of trapped gas. My constipation has worsened. kimchi, natto beans, kefir milk don’t seem to help. I can jump on the rebounder for 45 mins till I can feel the waste in my rectum but I still don’t have the urge to poop. Is this constipation IBS related to menopause and what can i take to relieve this IBS? Are there any enzymes, prebiotic or probiotic supplements that are suitable for my condition? Thanks and looking forward to your advice.

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Hormonal changes during premenopausal periods can cause changes to intestinal movement and nerves which causes IBS symptoms. There are many treatment options including, medications, probiotics and diet interventions. The treatment choice would need to be individualised.

Posted by 10XPD

My 6-year old daughter frequently complains of stomach pain after waking up. It sometimes persists toward the afternoon but subsides most of the time and is generally fine from evening onwards. She also coughs quite a lot (with accompanying mucus) in the morning. The stomach pain can come about before or after breakfast and so does not appear to be "hungry" pain. She eats yoghurt, cheese and drinks milk without problem. Her stools is normal although she farts a lot and is often bloated.

She appears to contract gastroenteritis quite frequently (every couple of months). Does this sound like SIBO and/or IBS?

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

She may have IBS and/or SIBO but the diagnosis should be made after assessment by her doctor.

Posted by Mandy

Dear Dr,

My son, 14 years old, has been told by KKH doctor that he has IBS. He always have stomach pain, diarrhoea and a lot of gas in his stomach which caused him to feel very full and has no appetite, thus he is very thin. He started to have this problem since he was 11 years old and he even missed his math exam because of the stomach pain. We were told by KKH doctor that there is no treatment for IBS and was only given debridat and was told to let him take it when he has stomach pain.

Since beginning of this year, my son's condition became worse. He keeps having stomach pain, diarrhoea and bloatedness very often and had to miss school. He has been on medical leave for more than 12 days since January till now and when we had school teachers/parents meeting, the teachers expressed concern and said that he should not be missing school as he is lagging behind. We were told that he has to go to school even he has diarrhoea. Unless he has fever, he can stay at home.

On 15 April, my son had stomach pain and diarrhoea 7 times in school. We brought him to see TCM this time (we usually bring him to our family doctor but because this doctor always prescribed him with antibotic, we were afraid he will do the same thing this time so we decided to see other medical help). In fact, on 14 April, he just finished the last dose of his antibotic (Zinnat) which he started 10 days ago. We were told that TCM medicines will take time to see results. We sent him to school on 16 April (as his form teacher had said that unless he has fever, he has to go to school). In school, he had stomach pain, kept burping and had diarrhoea 7 times and also vomitted. We had no choice but to bring him to our family doctor as this time he has fever. This time the doctor did not give him antibiotic but only lacteo fort and a green tablet (which I cannot remember the name) to stop the diarrhoea. Until today, my son has not recovered and his stomach is still very bloated and has frequent stomach pain. He still had diarrhoea once last night. Due to his bloatedness, he couldn't eat and drink. I am concern as I am afraid he might become dehydrated.

To make the matter worse, the school teacher has been calling me to feedback that he is very forgetful and disorganised. He always forgets to submit his homework and when asked, he will search his bag for a long time. Teacher also said it is a vicious cycle (when he was asked to submit his homework, he become anxious and starts to have stomach pain). His form teacher also feedback that he has low self-esteem and also feels agitated easily. I informed the family doctor about his poor memory and other feedback the school teacher told me and he thinks my son might be having attention span issue and asked me to go to polyclinic to ask for referral letter to seek medical attention. I am currently waiting for appointment from IMH Outram.

As this IBS is causing my son a lot of inconvenience and suffering, can I check with you a few things:

  1. Can IBS be treated?
  2. Is there any relation between IBS and ADHD?
  3. Is there any medicine for getting rid of the gas So far no doctor has given me any medicine for this. Does charcoal pill helps to relieve gas?
  4. Moving forward, can you advise the right place for us to seek medical attention for his IBS as KKH has not done anything except giving us debridat.

Thank you for your time and patience to read this long email. I am very worry for my son and am desperate to give him the right treatment as this is affecting his health and studies. I will greatly appreciate if you could kindly reply me.

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Thanks for sharing your experience Mandy. I would like to qualify that I am an adult gastroenterologist with limited experience managing children.

IBS cannot be cured but symptoms can usually be controlled. There is clear association between psychological disorders with IBS. In these instances, concurrent and coordinated management of both psychological and gastrointestinal disorders is important for successful management. I would suggest you communicate with your KKH and IMH doctors for coordination of care.

While IBS symptoms (including gas) can be managed in many ways including medications, diet and probiotics. Their response is variable and may not be suitable for your son. It is important for you to have a good working relationship with your physician so that a care plan can be developed to achieve sustainable symptom control.

Posted by Tang KM

Dear Doctor,

I have frequent bowel movements in the morning and sometimes throughout the day.

Here is my typical frequency:

  1. After waking up and having a cup of water, first bowel movement,
  2. After finishing breakfast, 2nd time,
  3. Very often there is a 3rd round or 4th round in the late morning or early afternoon.

The quantity is much higher in the first 2 rounds.

I do not feel any pain or have difficulty in discharging. After every movement, the feeling is like a complete job done, but it is not, considering how many times I need to go to the toilet.

The shape & texture is pretty normal and the diameter gets smaller after the 2nd movement, so is the quantity.

My diet is quite balance with more vegetables, fruits than meats.

I have done a colonoscopy & a gastroscopy just before a stapled hemorrhoidopexy in May 2018.

Results are negative.

I am active person and like to do morning activites like hiking, climbing mountains to see sunrise, but these frequently and sometimes uncontrolled bowel movements hampers such activities.

I am 63 years of age with no other medical conditions or taking any medications.

I appreciate your advice. Thank you.

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

In normal human physiology, the urge to pass motion is strongest in the morning and after meals. There is also great variability between individuals. If your bowel habit has been stable and your doctors have not attributed it to any serious medical problems, you have no cause for concerns. With regards to the impact on your daily, activity, there are lifestyle and medical options available. I would suggest you discuss further with your doctor.

Posted by Lee KL

My husband has been having constipation since he had a stroke in late November 2018. Although his doctor at CGH has prescribed oral lotion, he has been seeing GPs and Chinese sinseh as his condition does not improve. He also resorted to using fleet enema.

I have asked him to go for a colonoscopy as well.

Could it be due to IBS? And what can he do to ease his discomfort?

Thank you.

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Your husband’s symptoms could be due to IBS, but the but the diagnosis should be made after assessment by his doctor. In some instances, further investigations such as colonoscopy could be recommended. Should the diagnosis be confirmed, treatment options include diet, probiotics and medications which were discussed earlier in this forum.

Posted by Joanne

Dear Dr,

My colorectal surgeon mentioned I have a functional gut disorder (IBS) last October after a CT scan was done. OGD and colonoscopy was done recently too. Bloating and pain cause me to lose sleep at night. I downloaded the FODMAP app from Monash University but found the diet unsuitable in Singapore. I've been on meteospasmyl, lactulose, probiotics and Trimebutine (for pain) since last October. Should I see the dietician service in SGH to learn more about the low FODMAP diet? May I please seek your advice on what I should be doing to move forward in terms of managing the pain? Thank you.

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Thanks for sharing your experience Joanne. Together with our dieticians at CDLD, SGH, we have been implementing the low FODMAP Diet which has been adapted from the method developed at Monash University. We found that 70% of our patient had improvement of symptoms but indeed some of the recommendations need to be adapted to Singapore. I suggest you discuss with your doctor regarding the most suitable treatment for you. Should diet recommended, you may consider consulting the SGH Dieticians.

Posted by Mary

Dear Dr,

My son is 36 years old and suffers from schizophrenia for the past 20 years. He is on 2 types of antipsychotic drugs, anti-depressant and tranquillizer daily. He drinks plenty of water, takes plenty of fruits and walk 30 minutes daily. I refrain from giving him vegetables because it makes the stools more bulky. I gave him some prune juice and 2 probotics daily also. Besides that I also gave him lactulose 30ml and 70ml on alternate days. When lactulose alone does not work, I gave him 2 Dulcolax tablets as well just before he sleeps. I also resort to give him water enema as well when things gets bad.

Is there any other solutions for him as I hope not to give him the Dulcolax tablets often as the pharmacist told me that he will develop a dependence on it.

I have spoken to his doctor regarding the drugs and its side effects but he said that this combination of drugs work well for him and there is no alternative drugs.

Thank you

Answered by the Department of Gastroenterology & Hepatology at Singapore General Hospital:

Thanks for sharing your experience Mary. Psychological medications are known to cause gastrointestinal side effects. Most of the time, these side effects can be managed by adjustment of the psychological medications and the use of medications to treat the side effect. This may require a period of adjustment and it is important you have a good working relationship with your doctor to find the best balance. It is important not to stop the psychological medications without consultation with your doctor to avoid breakthrough of the underlying psychological disorder.