LESSON 15

Next Steps

VIDEO LESSON

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WRITTEN LESSON

With everything you have learned from our expert team, here are next steps to guide you on your IBS journey.

Step 1: Confirm the diagnosis

If you are unsure whether IBS is the right diagnosis you should bring this up with your medical provider. You will want to review the diagnostic criteria for IBS and the alarm symptoms we talked about previously to see if you need further testing. Some patients consider getting a second opinion if they do not feel their concerns are adequately addressed by their current provider.

IBS characteristics based on the Rome Criteria

The patient must experience abdominal pain or discomfort on a regular basis.
The pain or discomfort is associated with bowel movements. This could mean the pain either improves or worsens, before, after or during a bowel movement.
Changes in the form (appearance) of bowel movements, or how frequently they occur.

Symptom onset must be at least 6 months before diagnosis. Furthermore, abdominal pain or discomfort should not be only related to menses.

Alarm symptoms that warrant further testing

Unexplained weight loss
Blood in the stool
Black stool, which suggests upper gastrointestinal bleeding
Diarrhea that frequently disrupts nighttime sleep, also referred to as nocturnal bowel movements
Iron deficiency anemia
Sudden new onset of symptoms especially after age 45
Or a family history of inflammatory bowel disease, celiac disease or gastrointestinal cancers

If any of these symptoms or signs are present additional testing such as endoscopy, colonoscopy, blood, stool or imaging tests (CT, MRI, or ultrasound) may be considered.

Step 2: Lifestyle and diet changes

Once a diagnosis is confirmed, start by implementing some simple day-to-day lifestyle and diet changes that can improve IBS symptoms, including:

Prioritize consistent good quality sleep
Increase physical activity, starting with light-to-moderate activities like walking or yoga
Implement simple changes in eating habits such as avoiding large meals, adjusting fiber intake, and limiting fatty foods, caffeine, alcohol and carbonated drinks.

Step 3: Consider working with a GI dietitian or a GI Psychologist

If you consistently have issues with food and find that eating triggers your symptoms, seeing a GI dietitian can be very helpful. They will evaluate what changes you can make to your diet to relieve symptoms without overly restricting what you eat. A dietitian can also explore whether more structured approaches such as the low FODMAP diet are appropriate. They can also provide supplement recommendations that target specific symptoms, such as fiber, digestive enzymes and peppermint oil.

If you have a lot of anxiety around your symptoms or find that stress plays a big part in triggering your symptoms, then consulting with a GI psychologist can help. This can also be a good next step if you have already tried diet therapy and medications, and continue to have symptoms. A GI psychologist can walk you through the various options such as cognitive behavioral therapy and gut-directed hypnotherapy and help you find the right therapeutic approach for your unique circumstances.

Step 4: Discuss advanced therapies with your medical provider

If IBS symptoms persist, discuss supplements, medications, and other advanced therapies with your healthcare provider.

Your medical provider (gastroenterology or primary care) should be the person overseeing your care and typically would be the one to refer you to other members of the healthcare team such as a GI dietitian, GI psychologist or pelvic floor physical therapist.

Check out our resources page, which includes information about finding GI providers, brain-gut behavioral treatment and dietary therapy.