Irritable Bowel Syndrome: The Practical To-Do List

A disorder of gut-brain interaction causing abdominal pain with altered bowel habit, without structural disease. It is common, genuinely disabling for some people, and a diagnosis made positively rather than only by excluding everything else.

Key takeaways

• Core features: abdominal pain related to defaecation, with changed stool frequency or form
• First-line dietary advice: regular meals, adequate fluid, limiting caffeine and alcohol
• Most useful single change: Try first-line dietary and lifestyle measures before restrictive diets.
• Commonest mistake: Long-term restrictive diets without dietetic supervision.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

Do

• Try first-line dietary and lifestyle measures before restrictive diets
• Keep a symptom and food diary before changing anything
• Ask for dietitian referral before attempting a low FODMAP diet
• Ask about psychological therapies, which have good evidence here

Do not

• Long-term restrictive diets without dietetic supervision
• Insoluble bran, which commonly worsens symptoms
• Assuming the diagnosis without coeliac testing first

The numbers behind the list

Where the items above come from.

If you change one thing

Try first-line dietary and lifestyle measures before restrictive diets. If you only change one thing, make it that.

Where to go next

• Why Irritable Bowel Syndrome Matters, Explained Simply
• Myths About Irritable Bowel Syndrome, Checked Against the Guidance
• Irritable Bowel Syndrome — the reference entry
• What the Guidance Really Says About Constipation
• What the Guidance Really Says About Acid Reflux

When to speak to a doctor

See a GP rather than self-managing for unexplained weight loss, rectal bleeding, a persistent change in bowel habit lasting three weeks or more, a family history of bowel or ovarian cancer, anaemia, or new symptoms over 50. These need investigation before IBS is assumed.

Where this comes from

• NICE — Irritable bowel syndrome in adults
• NHS — Irritable bowel syndrome

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.