Irritable Bowel Syndrome (IBS) is chronic disorder of the digestive system which has been given more coverage in recent years, with 10-20 percent of people in Western countries fitting the diagnostic criteria at any given time. However, with no clear-cut cause nor course of treatment, IBS remains a largely misunderstood condition.

IBS is described as a "functional" disorder because the way the gut works is affected but there are no notable physical changes. The symptoms are unpleasant and variable and may include bloating, diarrhea, constipation, cramping and stomach pain. Nausea, headache, heartburn and loss of appetite may also feature. It is crucial to get a firm IBS diagnosis from your doctor, mainly to rule out more serious disorders.

So what triggers this disagreeable condition? The causes of IBS are not explicitly known but in all likelihood several factors including stress, diet, fluid intake, sleep pattern, exercise and previous stomach infections may be involved.

IBS flare-ups are common among expats relocating to China, and that is hardly surprising; stress levels run high, ingrained routines are disrupted and food availability and choice are altered. Acknowledging such issues allows you to take action.

Stress is likely to be the most significant cause of IBS, and this may be connected with the amount of serotonin produced by the gut. Serotonin is a hormone (chemical) released by the body which can influence emotions, general mood, body temperature and appetite. Heavy release of serotonin into your gut may prompt over-activity of the muscles and nerves in the gut resulting in the characteristic symptoms of diarrhea, cramping and pain.

Dealing with stress is a vital step in treatment. Time planning, blocking time out for yourself, better communication at work or at home, making time for adequate sleep and even a change in job, may be necessary.

Getting in extra assistance is a good idea. For example, employing an ayi or driver. Coping techniques may also be beneficial - yoga, meditation, exercise or listening to music. A good massage is extremely affordable and easy to find here too. Counseling and psychotherapy are other options to consider.

Where matters of digestion are concerned it is logical to blame the diet, and in some cases with good reason. A disruptive dietary pattern can create big problems for those prone to IBS; irregularity of meals, eating on the run or under stressful conditions, or following a restrictive diet - can all exacerbate IBS.

The amount and type of fiber can also be important. People with constipation should try to increase fiber along with drinking more fluid. On the other hand, those with diarrhea and bloating may find a decrease to be beneficial.

Drinking plenty of water is important - at least 35ml/kg body weight per day and more if you are exercising. Caffeine (in coffee, tea, cola, chocolate) can encourage bowel movements, so cutting back may be useful for those who suffer with diarrhea. Conversely those with chronic constipation may benefit from the odd strong coffee to kick-start things.

Some artificial sugars found in "diet" products such as sorbitol or xylitol have a laxative effect - so if you're guzzling cans of diet soda while steadily chewing sugar free gum you may want to adjust this. Spicy and oily foods can be problematic for some.

Specific food intolerances may play a role, but it is important to identify these properly with the help of a doctor or dietitian before eliminating large food groups from your diet. The most likely suspects are lactose intolerance (difficulty in digesting dairy products) and wheat intolerance. These can form both independent diagnoses or be a factor in IBS.

Medication in the form of laxatives, painkillers, anti-spasmodics and even anti-depressants may also be necessary but it is important to discuss these with your doctor.

This nutrition-related column is written by Nina Lenton, a qualified dietitian living and working in Beijing. Contact her at nina_lenton@hotmail.com.

(China Daily October 22, 2008)