Treatment Guideline Chart
Irritable bowel syndrome is a common chronic gastrointestinal condition characterized by abdominal pain and bloating with altered bowel habits.
There are no identifiable physical, radiologic or lab abnormalities indicative of organic disease.
Symptoms may be exacerbated by stress, alcohol or food.

Irritable%20bowel%20syndrome Patient Education

Lifestyle Modification


  • Increasing exercise can result in overall symptom improvement in patients with IBS
    • A randomized trial showed that increased physical activity at 20-60 minutes of moderate to vigorous level improved severity of IBS symptoms with less likelihood of worsening as compared with the control group

Dietary Modifications

  • Dietary monitoring: It may be helpful to have patients keep a diary of food intake, symptoms including severity and possible exacerbating factors (eg emotional issues) for 2-3 weeks
    • Physician may then be able to make lifestyle or diet modification suggestions based on the above 
  • Elimination/empirical diet is recommended for 2-4 weeks when specific foods are suspected of causing IBS symptoms; if no improvement after 4 weeks, consider other factors or refer to specialist 
  • A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) is recommended to reduce IBS symptoms
  • Supplementation with soluble and poorly fermentable fiber is recommended for overall symptom improvement
    • Psyllium but not wheat bran is recommended for overall symptom improvement
  • If lactose intolerance is suspected, a trial period of low-lactose diet may be advised; if confirmed via a positive lactose hydrogen breath test, low-lactose diet is highly recommended
  • A gluten-free diet may be advised to patients with IBS-D though conflicting evidence exists regarding avoidance of gluten in IBS patients
  • Probiotics, eg Lactobacillus spp, Bifidobacterium spp and Saccharomyces spp  
    • May be considered to improve symptoms such as pain and bloating or flatulence
    • Benefit patients with IBS via multiple mechanisms 
    • A meta-analysis showed benefits for global symptoms of IBS
    • The use of metabolomic markers or unidentified gut biomarkers may help improve the efficacy of probiotics, but further studies are needed
  • Other general dietary modifications include drinking at least 2000 mL of fluid daily, reducing intake of alcohol, caffeinated drinks or softdrinks, avoiding foods that produce gas (eg beans, raisins, prunes, onions, etc), restricting fresh fruit intake to 3 portions daily, avoiding sorbitol if patient has diarrhea

IBS with Constipation (IBS-C) 

  • A 3-month trial with ground linseeds is recommended for IBS-C patients with abdominal pain and bloating
  • May suggest to patient to increase dietary intake of fiber to 20-35 g/day
  • Dietary fiber assists with constipation but does not seem to improve abdominal pain
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