Irritable bowel syndrome

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Blood in your stool, or black tarry stools
• Losing weight without trying
• Being woken from sleep by pain or by needing to open your bowelsNight-time symptoms are unusual in IBS and are worth a look.
• Symptoms starting for the first time after about the age of 50
• Being told you are anaemic, or a family history of bowel cancer or inflammatory bowel disease

What usually happens

IBS is real, and a normal test result does not mean nothing is wrong. The abnormality is in how the gut and the nerves supplying it communicate, and that does not show up on the tests that look for damage.

It is a positive diagnosis made from a recognisable pattern, not a label applied when everything else is excluded. When the pattern is typical and there are no warning features, repeating investigations rarely finds anything and often makes people more anxious about their gut, which makes symptoms worse.

Stress and food genuinely affect symptoms without being the cause. That distinction matters — it is why stress management helps some people considerably and why nobody should be told it is all in their head.

Structured diet approaches help a good proportion of people, but restriction should be time-limited and ideally supervised. Long unnecessary restriction narrows what you eat, affects the gut in its own right, and is hard to reverse.

Treatment usually targets whichever symptom dominates — pain, constipation, diarrhoea or bloating — rather than the diagnosis as a whole, so it is worth being clear about which one bothers you most.

At your appointment

We will ask about the pattern in some detail: whether pain eases after opening your bowels, what the stool is actually like, and whether anything wakes you at night. Those specifics are what distinguish IBS from the things that need investigating.

A small set of blood tests and usually a coeliac screen, and a stool test for inflammation if there is any doubt about inflammatory bowel disease. Not an open-ended series of tests.

We will go through what you have already tried, including anything bought over the counter, since a great deal has often been tried before anyone is asked.

We will agree a plan aimed at your main symptom, with a timeframe for judging whether it worked.

Worth asking

• —Are you confident this is IBS, or is there anything we should test for?
• —Which of my symptoms should we go after first?
• —Is a trial of a specific diet worth it for me, and for how long?
• —What would be a reason to come back sooner?