Your complete reference for IBS.
Understand your type, try one change at a time, and walk into your appointment with a clear record.
Everything a person with irritable bowel syndrome needs in one place: what it is and is not, how it is diagnosed without a chain of tests, its types, first steps, the low-FODMAP diet and its phases, the medicine map, gut and brain, and hard days. Then the Bousla tools to follow your day.
- Understand10 reference sections
- Know your medicines10 medicines with schedules
- DecideWhen to contact your team
- FollowBousla tools
Do not wait if: Blood in the stool or bleeding from the anus, Unintended weight loss, Symptoms starting at an older age, A family history of colon cancer, inflammatory bowel disease or another significant digestive disease. These signs mean the symptoms need medical assessment and a diagnosis of IBS alone is not enough.
Medical supervisor of SADA: د. الفضل عبدالفتاح، استشاري الجهاز الهضمي والقولون والمستقيم. Scope of medical review
The absence of visible damage does not mean the symptoms are "psychological" or unreal.
What is irritable bowel syndrome? →One fact a day from the centre. Come back tomorrow for a new card.Understand IBS
Open any section for the explanation and its sources. Each one is written to be the last thing you need to read on its topic.
What is irritable bowel syndrome?A group of symptoms that recur together: abdominal pain usually linked to bowel movements, with a change in the stool pattern (diarrhoea, constipation or both), without a visible sign of damage in the digestive tract.
Doctors do not know a single cause. The absence of visible damage does not mean the symptoms are "psychological" or unreal.
IBS is a disorder of gut–brain interaction: gut sensitivity, bowel movement, nerve signals, sleep, stress and food can all interact; no single cause explains every patient.
Bloating, gas or a food intolerance can accompany the condition but do not define it on their own.
Limits: A general description; similar symptoms are not enough for a diagnosis.
Sources: NIDDK (2017) · Rome Foundation (2016)
How is it diagnosed without an endless chain of tests?The ACG guideline proposes a "positive diagnosis" based on the symptom pattern and examination instead of excluding every possibility first, so the right treatment starts sooner.
The pattern doctors use (Rome IV criteria): recurrent abdominal pain, on average at least one day a week over the last three months, linked to at least two of: defecation, a change in stool frequency, a change in stool form; with symptoms that began at least six months ago.
For people with diarrhoea the guideline suggests a blood test for coeliac disease and a stool calprotectin test to rule out inflammatory bowel disease.
A colonoscopy is not a routine test for every patient; it is requested when there are alarm features or according to age and the colon cancer screening programme.
Limits: The choice of tests is the doctor's, according to your age, symptoms and alarm features.
Sources: ACG (2021) · Rome Foundation (2016) · NICE CG61 (2017)
IBS types: constipation, diarrhoea, or mixed?The dominant pattern separates constipation, diarrhoea or alternation, but the type can change over time.
The type is set by stool form on abnormal days using the Bristol scale: types 1–2 are hard (constipation), 3–5 usual, 6–7 loose or watery (diarrhoea).
The type guides treatment: medicines for constipation differ from those for diarrhoea, and the mixed type needs a flexible plan.
Describe where the pain is, its relation to bowel movements, your stool pattern on the Bristol scale, and how many days it disrupts your life. This does not diagnose you but makes the medical discussion more precise.
Limits: Record what actually happened instead of treating every meal as an allergy test.
Sources: Rome Foundation (2016) · NICE CG61 (2017)
First steps: food, sleep and movementStart with meal pattern and obvious changes before removing many food groups.
Regular meals without skipping, eating slowly, and enough water. Reduce caffeine, fizzy drinks, alcohol and fatty foods if you notice they worsen your symptoms.
Fibre: soluble fibre (such as psyllium husk) can help both constipation and diarrhoea and is increased gradually; bran worsens bloating in many people.
Regular physical activity and enough sleep improve symptoms in many patients.
NIDDK notes that a patient may need to try more than one option before finding what suits them.
Limits: One change at a time, for long enough (at least two weeks) to know its effect.
Sources: NICE CG61 (2017) · BDA (dietitians) (2022) · NIDDK (2017)
The low-FODMAP diet: a limited trial in three phasesThe guideline recommends a limited trial of a low-FODMAP diet to improve overall symptoms. It is a trial with a beginning, an end and reintroduction, not a permanent diet.
FODMAPs are short fermentable sugars (found for example in wheat, onion, garlic, milk, some fruits and sweeteners) that draw water and produce gas in the gut, increasing pain and bloating in people with a sensitive gut.
The three phases: a short restriction (2–6 weeks), then structured reintroduction group by group, then personalisation as broad as possible. The aim is to find your personal threshold and keep your diet varied, not to reach a longer list of banned foods.
If symptoms do not improve after the restriction phase, the diet is not the answer for you; do not continue it.
Limits: Do not start a long restrictive diet on your own; it is best done with a dietitian to avoid nutritional gaps.
Sources: ACG (2021) · Monash University (2024) · BDA (dietitians) (2022)
The medicine map: by your type and main symptomMedicines differ by IBS type and are prescribed by the doctor. The table below explains each medicine: which symptom it targets, its usual pattern, and what to report.
- Antispasmodicspain and cramps, as needed
- Soluble fibre and laxativesIBS-C
- LoperamideIBS-D, as needed
- Linaclotide / rifaximinprescription for non-responders
- Low-dose amitriptylinepersistent pain, 4–6 weeks
- Gut-directed psychotherapyCBT or hypnotherapy
For pain and cramps: antispasmodics (such as coated peppermint oil, mebeverine, hyoscine) as needed or before meals.
For constipation: soluble fibre, then osmotic laxatives (such as polyethylene glycol), then prescription medicines such as linaclotide for those who do not respond.
For diarrhoea: loperamide as needed, and in selected cases rifaximin or other prescription medicines.
For persistent pain: low doses of tricyclic antidepressants (such as amitriptyline) act on pain signalling in the gut, not on mood, and take 4–6 weeks to show their effect.
The medicine map: for which symptom, how it is taken, and its usual pattern ↓
Limits: The table is educational. The dose and duration on your prescription are the reference.
Sources: ACG (2021) · NICE CG61 (2017) · BNF (NICE) (2026)
Gut and brain: stress modulates symptoms but does not make them unrealSleep, psychological pressure and attention to symptoms can change the intensity of pain and bowel movement. This does not mean IBS is "psychological"; the two systems talk in both directions.
The guideline suggests gut-directed psychological therapy, such as cognitive behavioural therapy or gut-directed hypnotherapy, to improve overall symptoms.
Gut-directed behavioural therapies can be part of a comprehensive plan, not a judgement on the patient's personality.
Pick one applicable skill and watch its effect instead of demanding of yourself "not to be stressed".
Severe or new symptoms are not automatically explained by stress.
Limits: No psychological diagnosis comes from this page.
Sources: ACG (2021) · NIDDK (2017)
Four ideas that save years of trial and errorNot every bloating is small intestinal bacterial overgrowth, gluten is not everyone's enemy, feeling better after a food does not prove an allergy, and banning FODMAPs forever is not the goal.
"Every bloating is bacterial overgrowth" — inaccurate; bloating has many causes and breath tests have limits.
"A commercial intolerance test sets my banned list" — many non-standard tests do not prove a clinical sensitivity.
"If the colonoscopy is normal the symptoms are not real" — wrong; disorders of gut–brain interaction do not require visible damage.
"Any probiotic will do" — products, strains and results differ, and one product cannot be generalised.
Limits: Ask your doctor before buying any test or supplement marketed for IBS.
Sources: ACG (2021) · NIDDK (2017)
Hard days: what to do, and when you need a doctorMost IBS episodes pass with simple adjustments; what matters is telling a usual episode from a new symptom that needs assessment.
During an episode: smaller meals, enough water, warmth on the abdomen, a light walk, and the antispasmodic your doctor prescribed when needed.
Log bowel movements, stool form and pain day by day; this record guides your doctor to adjust the plan instead of guessing.
Night symptoms, bleeding, weight loss, anaemia or a clear new change shift the priority from the program to assessment.
Limits: The alarm features above mean seeing the doctor, not adjusting the diet.
Sources: NICE CG61 (2017) · NHS (2024) · ACG (summary) (2021)
Living with IBS: travel, work and fastingIBS does not shorten life and does not turn into cancer or inflammatory bowel disease, but it disrupts daily life if left without a plan.
When travelling: carry the antispasmodic and the diarrhoea or constipation medicine you know, and keep meal times as regular as possible.
At work: a regular breakfast and enough bathroom time in the morning reduce daytime episodes for many people.
When fasting: a calm two-stage breaking of the fast, enough water between the evening and pre-dawn meals, and avoiding fat and fried food in one large meal.
Limits: Medicines during fasting are arranged with your doctor.
Sources: NHS (2024) · NICE CG61 (2017)
The medicine map: for which symptom, how it is taken, and its usual pattern
The schedule shown is the usual licensed adult pattern. Your prescription is the reference and may differ for reasons specific to you. The "My treatment" tool reminds you of the dose your own doctor wrote.
Peppermint oil (coated capsules)Antispasmodics
- Brand names
- Colpermin, Mintec
- Usual schedule
- One 0.2 mL capsule 3 times a day half an hour before meals, for up to 3 months
- Before and during
- Do not chew the capsule; it can worsen heartburn in some people
- Tell your team about
- Severe heartburn, rash
MebeverineAntispasmodics
- Brand names
- Colofac, Duspatalin
- Usual schedule
- Tablets 135 mg 3 times a day twenty minutes before meals, or a 200 mg prolonged-release capsule twice a day
- Before and during
- Few side effects
- Tell your team about
- Rash or swelling
Hyoscine butylbromideAntispasmodics
- Brand names
- Buscopan
- Usual schedule
- Tablets 10 mg 3–4 times a day when needed (up to 20 mg per dose)
- Before and during
- Avoided with glaucoma and prostate enlargement; may cause a dry mouth
- Tell your team about
- Sudden eye pain, difficulty passing urine, palpitations
Psyllium husk (ispaghula)Soluble fibre
- Brand names
- Fybogel, Metamucil
- Usual schedule
- One 3.5 g sachet in water once or twice a day after meals, increased gradually
- Before and during
- Drink enough water; start low to limit bloating
- Tell your team about
- Painful bloating or obstruction
Polyethylene glycol (macrogol)Laxatives
- Brand names
- Movicol, Laxido, Miralax
- Usual schedule
- One sachet (13–17 g) in water once a day, adjusted to response
- Before and during
- Improves constipation but usually not pain
- Tell your team about
- Persistent diarrhoea, new abdominal pain
Linaclotide (IBS-C)Prescription for IBS-C
- Brand names
- Constella, Linzess
- Usual schedule
- One 290 microgram capsule once a day half an hour before breakfast; effect reviewed after 4 weeks
- Before and during
- Diarrhoea is the commonest side effect; not for under-18s
- Tell your team about
- Severe diarrhoea or dizziness
Loperamide (IBS-D)For IBS-D
- Brand names
- Imodium
- Usual schedule
- 2 mg when needed after each loose stool, within the daily maximum on the pack; or a preventive dose before going out
- Before and during
- Improves diarrhoea, not pain; may cause constipation or bloating
- Tell your team about
- Severe constipation, painful bloating, palpitations
Rifaximin (IBS-D)For IBS-D
- Brand names
- Xifaxan
- Usual schedule
- A course of 550 mg 3 times a day for 14 days; may be repeated if symptoms return, at the doctor's decision
- Before and during
- An antibiotic acting in the gut only
- Tell your team about
- Severe watery diarrhoea after the course
Amitriptyline (low dose for pain)Pain-signal modulators
- Usual schedule
- Tablets 10 mg at night, increased gradually to 30 mg according to response; effect appears after 4–6 weeks
- Before and during
- The dose is far lower than for depression; may cause drowsiness, dry mouth or constipation
- Tell your team about
- Palpitations, urinary retention, severe drowsiness
SSRI antidepressants (selected cases)Pain-signal modulators
- Usual schedule
- Daily tablets at the dose set by the doctor; may suit people with accompanying anxiety or a constipation type
- Before and during
- Take weeks to work; do not stop suddenly
- Tell your team about
- Persistent nausea, new troubling thoughts
Sources: ACG (2021) · NICE CG61 (2017) · BNF (NICE) (2026)
When is a diagnosis of IBS not enough?
- Blood in the stool or bleeding from the anus
- Unintended weight loss
- Symptoms starting at an older age
- A family history of colon cancer, inflammatory bowel disease or another significant digestive disease
These signs mean the symptoms need medical assessment and a diagnosis of IBS alone is not enough. Sources: ACG (summary) (2021) · NIDDK (2016)
Questions to take to your appointment
Bousla tools and programs: your day, medicines and tests in your pocket
Everything above is open to everyone. The tools turn knowledge into daily follow-up, and your data stays on your device.
- "Today": one minute to log bowel movements, stool form (Bristol), bloating and pain, with a weekly strip that shows your pattern.
- "My treatment": your antispasmodic, laxative or loperamide and a rifaximin course on their schedule, with reminders and a "Taken" button.
- "My tests": coeliac test, calprotectin and colonoscopy with their dates, and the next test if your doctor set one.
- "Doctor summary": one page with your quiet and hard days and your medicines, to show at your appointment.
- Bousla program: one-change trials compared week by week, with the FODMAP journal (Arabic).
Try the tools now with sample numbers
Bought it before? Open the Bousla tools · Bousla program · Restore my purchases
Educational content from published sources; it does not diagnose and does not replace your doctor. Reference version with all sources (Arabic) · Scope of medical review · Content version 1.0.0.