Keep a symptom diary (foods, stress, sleep, bowel habits)
Identify and limit trigger foods (common: high-FODMAP foods, fatty foods, caffeine, alcohol, carbonated drinks)
Try a low-FODMAP diet with professional guidance
Increase soluble fiber (psyllium) and adjust gradually
Avoid insoluble fiber if it worsens symptoms
Eat regular meals and avoid large meals
Stay hydrated
Exercise regularly
Manage stress (CBT, mindfulness, relaxation training)
Get adequate sleep
Consider probiotics (choose strains/products based on symptoms; trial for 4–8 weeks)
If IBS-D (diarrhea-predominant): consider loperamide as needed
If IBS-D: consider bile acid binders if appropriate (e.g., cholestyramine) with clinician input
If IBS-D: consider rifaximin in appropriate patients with clinician guidance
If IBS-C (constipation-predominant): consider polyethylene glycol (PEG) for constipation
If IBS-C: consider prescription options such as lubiprostone, linaclotide, or plecanatide with clinician guidance
If IBS-M (mixed): tailor diet and medications to dominant symptoms
For pain/cramps: consider antispasmodics (e.g., hyoscine, dicyclomine) with clinician guidance
For nausea/bloating: discuss options with a clinician (e.g., gut-directed therapies)
Consider peppermint oil (enteric-coated) for cramping if tolerated
Avoid smoking and limit alcohol
Review medications that can worsen symptoms (ask a clinician about alternatives)
Rule out other conditions if symptoms are new, worsening, or severe (celiac disease, IBD, infection, thyroid disease, colorectal cancer risk)
Seek urgent care for red flags (blood in stool, weight loss, fever, anemia, nighttime symptoms, persistent vomiting, family history of colorectal cancer/IBD, age onset after 50)