Approach to treating irritable bowel syndrome

This topic describes the management of irritable bowel syndrome (IBS). For general advice about managing functional gastrointestinal disorders, including patient support and psychiatric or psychological assessment, see Approach to managing functional gastrointestinal disorders.

Management of IBS begins with a good therapeutic relationship between doctor and patient. Reassure patients that there are no long-term sequelae from IBS. Also explain that the aetiology of IBS is multifactorial, so different aspects of disease may need to be addressed simultaneously; for example, diet, psychological health, gut microbiota and visceral hypersensitivity may all require attention.

IBS treatment needs to be individualised, considering the patient’s presenting symptoms and likely precipitants. Evidence to support the efficacy of therapies commonly used to treat IBS is limited, and clinical trials investigating therapies for IBS are often poorly designed.

The severity of IBS symptoms and impact on the patient’s quality of life can vary. Many patients can be managed in the primary care setting using dietary and pharmacological measures, while others require referral to a gastroenterologist and a multidimensional approach. Management by a team of expert clinicians (eg dietitian, psychologist, hypnotherapist, pelvic floor physiotherapist and clinical nurse specialist) has been shown to improve outcomesBasnayake, 2020.