Irritable Bowel Syndrome (IBS) Treatment in Chennai: Understanding Symptoms, Diagnosis & Diet

You've been experiencing recurrent abdominal pain, bloating, and unpredictable bowel habits - sometimes diarrhoea, sometimes constipation. You've tried home remedies, avoided certain foods, and perhaps even been told it's "just stress." If this sounds familiar, you share these symptoms with millions of urban Indian adults. Irritable Bowel Syndrome (IBS) affects a significant portion of the urban Indian population, with estimates suggesting a prevalence of 10-15% among adults. At THANC Hospital in Chennai, we understand that IBS is a real and often debilitating condition that requires a structured, evidence-based approach to diagnosis and management.

IBS is now understood as a "disorder of gut-brain interaction" (DGBI), reflecting the complex interplay between your gut, brain, and microbiome. This means your symptoms are not imagined; they stem from genuine physiological changes in how your gut functions and communicates with your brain. Our gut wellness clinic department at THANC Hospital specialises in diagnosing and managing such complex gastrointestinal conditions, offering comprehensive care right here in Chennai. Learn more about our Gut Wellness Clinic.

What is Irritable Bowel Syndrome (IBS)?

IBS is a chronic functional gastrointestinal disorder characterised by recurrent abdominal pain associated with defecation or a change in bowel habits. Unlike inflammatory bowel diseases (IBD) like Crohn's disease or ulcerative colitis, IBS does not cause visible inflammation or damage to the digestive tract. The diagnosis of IBS is primarily based on symptoms, following established criteria.

The most widely accepted diagnostic framework is the Rome IV criteria, which defines IBS by:

• Recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following:
  • Related to defecation.
  • Associated with a change in frequency of stool.
  • Associated with a change in form (appearance) of stool.

These criteria must have been fulfilled for the last three months, with symptom onset at least six months prior to diagnosis. Understanding these criteria is crucial for an accurate diagnosis, helping to distinguish IBS from other gastrointestinal conditions.

IBS presents in different ways, leading to specific subtypes:

• IBS with Constipation (IBS-C): Characterised by hard or lumpy stools more than 25% of the time, and loose or watery stools less than 25% of the time.
• IBS with Diarrhoea (IBS-D): Characterised by loose or watery stools more than 25% of the time, and hard or lumpy stools less than 25% of the time.
• IBS with Mixed Bowel Habits (IBS-M): Characterised by both hard/lumpy stools and loose/watery stools more than 25% of the time.
• IBS Unclassified (IBS-U): For patients who meet the Rome IV criteria but whose bowel habits do not fit the criteria for IBS-C, IBS-D, or IBS-M.

Identifying your specific subtype helps us tailor the most effective treatment plan for you.

When to Worry: Alarm Symptoms and Comprehensive Diagnosis

While IBS is a common condition, it's vital to rule out more serious underlying diseases that can present with similar symptoms. In our clinical practice at THANC Hospital, we always look for "alarm features" that warrant further investigation beyond a simple IBS diagnosis.

You should seek immediate medical evaluation if you experience any of the following alarm symptoms:

• Unexplained weight loss
• Blood in your stool (either visible or occult)
• Iron deficiency anaemia
• Family history of colorectal cancer, inflammatory bowel disease (IBD), or coeliac disease
• Onset of symptoms after the age of 50 years
• Nocturnal symptoms (waking up from sleep due to abdominal pain or diarrhoea)
• Persistent fever

If these alarm symptoms are present, Dr. Aditya Shah, our senior consultant and a leading medical gastroenterologist in Chennai, will recommend specific diagnostic tests. These may include blood tests such as a complete blood count (CBC) to check for anaemia, C-reactive protein (CRP) to assess for inflammation, and faecal calprotectin to differentiate between IBS and IBD. A test for anti-transglutaminase IgA (anti-tTG IgA) is also crucial to rule out coeliac disease, especially given its prevalence in India. In some cases, an upper GI endoscopy or colonoscopy may be necessary to directly visualise the digestive tract and take biopsies, ensuring no inflammatory or structural issues are missed.

Navigating Your Diet: IBS-Friendly Indian Food Strategies

One of the most common questions we receive from patients in Chennai is about diet. What foods can you eat, especially within the context of Indian cuisine, without triggering IBS symptoms? While there's no single "IBS diet" that works for everyone, the low-FODMAP diet has shown significant promise for many individuals. FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are types of carbohydrates that can be poorly absorbed in the small intestine, leading to fermentation by gut bacteria and subsequent gas, bloating, and pain.

Implementing a low-FODMAP diet typically involves three phases:

1. Elimination Phase: Temporarily restrict high-FODMAP foods for 2-6 weeks to see if symptoms improve.
2. Reintroduction Phase: Systematically reintroduce FODMAPs one group at a time to identify your specific triggers and tolerance levels.
3. Personalisation Phase: Maintain a diet that avoids your triggers while allowing as much variety as possible.

Here's how this can apply to common Indian foods, keeping in mind that portion control is key, and individual tolerance varies:

| Food Category | Common Indian Examples | FODMAP Status & Considerations

• Fibre: Adequate fibre intake is important. Soluble fibre, found in oats, psyllium (Isabgol), and certain fruits and vegetables, can help regulate bowel movements and improve stool consistency in IBS patients. Insoluble fibre, found in whole grains and some vegetables, might worsen symptoms for some individuals, especially those with IBS-D. Our dietitians can guide you on appropriate fibre intake.

Beyond Diet: Medical Management and the Gut-Brain Connection

Understanding that IBS is a disorder of gut-brain interaction is paramount. It means that while stress doesn't cause IBS, the brain and gut are intricately linked, and psychological factors can significantly influence symptom perception and severity. This is why stress management isn't "just stress management" but a crucial part of medical care for IBS.

Medical management for IBS often involves a multi-pronged approach:

• Antispasmodics: Medications like Mebeverine or Otilonium bromide can help relax the smooth muscles of the bowel, reducing abdominal pain and cramping.
• Laxatives/Anti-diarrhoeals: For IBS-C, osmotic laxatives (e.g., Polyethylene Glycol) or newer agents like Linaclotide can improve bowel frequency and stool consistency. For IBS-D, Loperamide can reduce stool frequency, and Rifaximin, a non-absorbable antibiotic, can target bacterial overgrowth in the small intestine, which may contribute to symptoms in some IBS-D patients.
• Neuromodulators: Low-dose tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) are sometimes prescribed. These medications, at lower doses than those used for depression, can help modulate pain perception and gut motility by affecting nerve pathways between the brain and gut (visceral hypersensitivity).
• Gut-Directed Therapies: Cognitive Behavioural Therapy (CBT) and gut-directed hypnotherapy have strong evidence supporting their effectiveness in reducing IBS symptoms by helping patients manage stress, anxiety, and their perception of pain.
• Small Intestinal Bacterial Overgrowth (SIBO): There's an overlap between SIBO and IBS, with some IBS patients testing positive for SIBO. If suspected, breath testing can diagnose SIBO, and specific antibiotics may be used for treatment.
• Probiotics: While evidence is mixed, certain probiotic strains, such as Bifidobacterium infantis, have shown some benefit in improving global IBS symptoms in specific patient populations. We can discuss if a targeted probiotic might be suitable for you.

Living with IBS: Realistic Expectations and Long-Term Management

The question "Is there a cure for IBS?" is common. While there isn't a single "cure" that eliminates IBS entirely, effective management strategies can lead to significant symptom improvement and a much better quality of life. With structured, personalised care, many patients experience a 60-70% reduction in their symptoms. The goal is to identify your triggers, manage your symptoms, and empower you to live a full life.

At THANC Hospital, our multidisciplinary team, including gastroenterologists, dietitians, and psychologists, works together to provide comprehensive care. We focus on educating you about your condition, developing a personalised treatment plan that addresses your unique symptoms and lifestyle, and supporting you through the long-term management of IBS.

If you are experiencing persistent abdominal pain, bloating, or changes in bowel habits, our gastroenterology team at THANC Hospital can help. For expert evaluation and personalised care, book an appointment at THANC Hospital.