IBS: your diagnosis and treatment plan
Short patient information to print or keep.
Understand the diagnosis
IBS is a clinical diagnosis based on the symptom pattern, examination and exclusion of the important alternative diagnoses relevant to you. You do not need every possible investigation before starting treatment; often a limited, targeted set of tests is enough. If symptoms are unusual, change or raise concern, I may recommend further investigation. IBS can be diagnosed at any age, but new symptoms later in life need careful assessment for other causes.
Which tests might I need?
I ask about your symptoms, examine you and arrange tests if needed. Keep eating gluten until coeliac testing is complete. Calprotectin can help check for inflammation in some people with diarrhoea. FIT does not diagnose IBS or replace another test that has been recommended.
Start with practical changes
Simple steps to try: regular meals and manageable portions; soluble fibre such as psyllium husk, oats or kiwifruit, started gradually; review excess caffeine, alcohol and sugar-free products if diarrhoea is prominent. Make one change at a time. A dietitian can guide a short low-FODMAP trial if simpler changes have not helped.
Choose fibre carefully
Psyllium can help. Start low, increase gradually and follow fluid instructions. Ask first about swallowing problems, narrowing or fluid restriction. Large amounts of wheat bran may worsen pain and bloating. Do not automatically remove all fibre-rich foods.
Adding foods back after a low-FODMAP trial
A dietitian can help you try a low-FODMAP diet for a short time, then add foods back to see which you tolerate. The aim is to eat as varied a diet as possible. Tell me if you are losing weight, worried about eating or already avoiding many foods.
Target symptoms and review
Treatment targets your main symptom. Options include macrogol for constipation, selected use of loperamide for diarrhoea, mebeverine or peppermint for cramping, and gut-pain medicines or gut-directed therapy when appropriate. Peppermint can worsen reflux. Agree how to judge benefit and when to review. New bleeding, iron deficiency, weight loss or worsening symptoms need reassessment.
Changes that need reassessment
Contact your GP or our team for persistent bleeding, unexplained weight loss, iron deficiency, worsening symptoms or diarrhoea that repeatedly wakes you from sleep. These should not be assumed to be IBS. Severe pain, significant bleeding, repeated vomiting or dehydration need urgent assessment.
Call 111 if you collapse or are too unwell to travel safely. Do not wait for a routine appointment or an email reply.
General information. Follow your own care instructions.