Questions to Ask a Gastroenterologist About IBS

Most lists of questions to ask a gastroenterologist about IBS are interchangeable. They tell you to ask about diet, stress and medication, which is fine, except that a good clinician will cover those anyway and a rushed one will answer them in six words each.

The questions that actually change what happens are the ones that make the reasoning visible. There are five: what makes you confident this is IBS, which subtype do I have and how did you decide, which tests do I need and which do I not, what else can look exactly like this, and what are we trying first and by when will we know whether it worked. Underneath each one is a published guideline that says what a good answer looks like, which is what this guide sets out.

The five questions that change what happens next

Ask these in this order, because each one narrows what the next one has to cover.

1. What makes you confident this is IBS, and what else is still on the table?
2. Which subtype do I have, and how did you decide?
3. Which tests do I need, which do I not need, and why?
4. What are we trying first, and by when will we know whether it worked?
5. If this does not work, what is the next step, and who else should be involved?

Everything else in this guide is a follow-up to one of those five. If you have ten minutes and a clinician who talks fast, those are the ten minutes.

What to bring, and why it matters more than the question list

A question list without data behind it gets generic answers. A two-week log with dates and counts changes the texture of the conversation, because it moves you from adjectives to specifics.

When someone in r/ibs asked how to prepare for a first gastroenterology appointment, the most practical reply was a list rather than a script: a detailed symptom record, current medications, everything already tried, diet and lifestyle, and which tests had already been done (r/ibs thread). A separate thread from someone who had just got an appointment after years of constipation drew the same advice, with one addition that is worth repeating: make clear what you have already exhausted, so the appointment does not spend its first five minutes suggesting more water and more fibre (r/ibs thread).

Bring six things:

• A dated symptom log, ideally two to four weeks. Stool form on the Bristol scale, how many movements a day, pain location and severity, urgency, bloating, and any blood or night-time waking.
• Functional impact in numbers. Days of work or study missed, meals skipped, times you left somewhere early, nights broken. This is what conveys severity better than the word "severe".
• Everything you have already tried, with the dose or version and how long you gave it. Fibre supplements, peppermint oil, elimination diets, probiotics, laxatives, antispasmodics.
• Your full medication and supplement list, including anything taken occasionally. Some drugs, including NSAIDs and proton pump inhibitors, are relevant to the diarrhoea workup (Vasant 2021).
• Previous test results with dates, not just "my bloods were normal".
• Family history of bowel cancer, inflammatory bowel disease, coeliac disease or ovarian cancer.

If you are starting a log from scratch, our guide to keeping a food diary for IBS covers what to record and what to leave out, and how to find out what triggers your IBS explains why a diary makes suspects rather than verdicts.

"What makes you confident this is IBS, and what else is still possible?"

A good answer names the criteria your symptoms meet and the alarm features you do not have. A weak answer is "everything came back normal".

This matters because the phrase "IBS is a diagnosis of exclusion" is repeated constantly, including by clinicians, and it is no longer what guidelines say. Both the American College of Gastroenterology and the British Society of Gastroenterology recommend making a positive diagnosis from the symptom pattern, the absence of alarm symptoms or signs, and a limited set of blood and stool tests (Lacy 2021, Vasant 2021). The ACG phrases it as a suggestion that a positive strategy be used rather than a strategy of exclusion, specifically to improve time to starting appropriate therapy.

That is not clinicians being lazy. It was tested. In a Danish randomised trial, 302 primary care patients aged 18 to 50 who met Rome III criteria with no alarm signals were assigned either to a positive strategy (blood count and CRP) or to exclusion (broader blood tests, stool samples for parasites, and sigmoidoscopy with biopsies). At one year, quality of life was no worse with the positive strategy, symptoms and satisfaction were similar, direct costs were lower, and no inflammatory bowel disease, colorectal cancer or coeliac disease was found in either arm (Begtrup 2013). At five years, national registry follow-up found no coeliac disease and no gastrointestinal or gynaecological cancers in either group, with negligible and comparable numbers of inflammatory bowel disease diagnoses, and the positive strategy saved lower endoscopies overall (Engsbro 2021).

So "we are not scoping you" is not automatically a brush-off. The question that separates a reasoned decision from a shrug is simply: which criteria do my symptoms meet, and which alarm features did you check for? Rome IV defines IBS as recurrent abdominal pain on average at least one day a week in the last three months, associated with two or more of: defecation, a change in stool frequency, or a change in stool form, with symptom onset at least six months earlier (Lacy 2016). NICE uses a more pragmatic definition: abdominal pain or discomfort relieved by defaecation or associated with altered bowel frequency or stool form, for at least six months, plus at least two of four supporting features (NICE CG61).

Worth knowing: the criteria are stricter than they used to be. In the Rome Foundation Global Study of 73,076 adults across 33 countries, IBS prevalence was 4.1% using Rome IV against 10.1% using Rome III in the internet survey (Sperber 2021). Plenty of people with genuinely disruptive gut symptoms sit just outside Rome IV. Not meeting a research criterion is not the same as not being ill, and it is a fair thing to say out loud.

"Which subtype do I have, and how did you decide?"

Ask for the subtype by name, because almost every treatment decision that follows depends on it. The subtypes are IBS with constipation (IBS-C), with diarrhoea (IBS-D), mixed (IBS-M) and unclassified, and they are defined by the proportion of your abnormal bowel movements that are hard or lumpy versus loose or watery, using the Bristol scale on days when you have abnormal stools (Lacy 2016).

Two things follow from that definition and are worth raising.

It is based on your stool record, not on a vibe. If nobody has looked at a stool diary, the subtype is a guess. This is the single most useful reason to bring a log.

It changes the test list. Coeliac serology and faecal calprotectin are recommended specifically in the context of diarrhoea (Lacy 2021, Vasant 2021). Bile acid diarrhoea testing only applies to IBS-D. Anorectal physiology testing applies to constipation with difficulty emptying. Getting the subtype wrong sends the whole workup in the wrong direction.

It also changes how much a normal colonoscopy should reassure you. In a prospective study of 646 people attending outpatient colonoscopy whose symptoms met Rome IV criteria for a functional bowel disorder, organic disease was found in about 6% of those with functional constipation or IBS-C, about 9% in IBS-M, and about 17% in functional diarrhoea and IBS-D (Asghar 2022). The difference was driven almost entirely by microscopic colitis, found in 5.7% of the diarrhoea group and none of the constipation group. Importantly, one in four people with chronic diarrhoea in that study did not have colonic biopsies taken, which is exactly how microscopic colitis gets missed on an otherwise normal-looking scope.

"Which tests do I need, which do I not need, and why?"

The honest answer for most people is: a short list of blood and stool tests, plus more only if something specific points there. Knowing the list in advance turns "they did nothing" into a checkable question.

That table is assembled from the BSG guideline, which sets out the recommended first-line panel, the restricted role of colonoscopy, and the specific indications for bile acid testing and anorectal physiology, and from the NICE list of tests that are not necessary to confirm the diagnosis (Vasant 2021, NICE CG61). The ACG guideline reaches the same place from a different direction: it suggests serologic testing to rule out coeliac disease in IBS with diarrhoea, and faecal calprotectin in suspected IBS with diarrhoea to rule out inflammatory bowel disease (Lacy 2021).

Two numbers make the stool and blood tests worth insisting on. A meta-analysis of biomarker performance concluded that at a CRP of 0.5 mg/dL or below, or a faecal calprotectin of 40 µg/g or below, the probability of inflammatory bowel disease is 1% or less (Menees 2015). The same analysis found none of these markers usefully separates IBS from healthy controls, which is the point people often miss: they are not IBS tests, they are tests for the thing IBS is not.

And on coeliac disease: a meta-analysis of 36 studies and 15,256 people found the odds of biopsy-proven coeliac disease were 4.48 times higher in people meeting IBS criteria than in controls (95% CI 2.33 to 8.60), significantly raised across all IBS subtypes (Irvine 2017). The same review was careful to note that the odds were not raised in North American studies and that results in population-based samples were inconsistent, so the case for universal screening is stronger in some settings than others. That nuance is a reasonable thing for your gastroenterologist to explain rather than to skip.

"What else can look exactly like this?"

This is the question that most often produces new information, because it invites your clinician to say what they considered and ruled out rather than just what they concluded.

Inflammatory bowel disease. A meta-analysis of 12 studies and 28,630 people with IBS undergoing colonoscopy found a pooled IBD prevalence of 4.48%, higher in those with alarm symptoms (8.86%) than without (4.25%), and more likely in IBS-D than IBS-C (Wu 2023). A post in r/ibs from someone in their twenties who pushed for a colonoscopy after a GP diagnosed IBS describes finding an inflamed colon and a Crohn's disease diagnosis. Reading the comments, the clinically interesting detail is what several replies pointed out: she had rectal bleeding and had lost over 30 pounds, which are alarm features that should have triggered blood and stool testing first (r/ibs thread).

Microscopic colitis. Pooled prevalence of 2.35% among people with IBS at colonoscopy, higher with older age (Wu 2023). The BSG lists the features that raise suspicion and justify a scope with biopsies in IBS-D: female sex, age 50 or over, coexisting autoimmune disease, nocturnal or severe watery diarrhoea, diarrhoea of less than 12 months' duration, weight loss, and potentially precipitating drugs including NSAIDs and proton pump inhibitors (Vasant 2021).

Bile acid diarrhoea. This is the most commonly under-asked one. A systematic review of 18 studies and 1,223 people with IBS-D type symptoms found that 10% had severe bile acid malabsorption on SeHCAT scanning, 32% had moderate and 26% had mild malabsorption, with response to a bile acid binder in 96%, 80% and 70% of those groups respectively (Wedlake 2009). Those are older studies with varying methods, and SeHCAT is not available everywhere, but the review's own conclusion was that idiopathic adult-onset bile acid malabsorption is not rare. BSG recommends considering SeHCAT scanning or serum 7α-hydroxy-4-cholesten-3-one in IBS-D with atypical features such as nocturnal diarrhoea or a previous gallbladder removal (Vasant 2021). Several long r/ibs threads are people describing years of an IBS-D label before this was tested.

Exocrine pancreatic insufficiency. Less common than the internet suggests. In 140 people meeting Rome IV criteria for IBS-D, 5% had EPI on faecal elastase testing, and dyspepsia was the symptom independently associated with it (Olmos 2022). The test itself is better at ruling EPI out than ruling it in: against a secretin stimulation reference, pooled sensitivity was 0.77 and specificity 0.88, and in people with a high pre-test probability roughly 10% would be missed (Vanga 2018). BSG does not recommend testing for EPI in suspected IBS-D unless steatorrhoea is reported (Vasant 2021). So this is a reasonable question to ask, not a reasonable test to demand.

Endometriosis. A systematic review of studies using surgically confirmed endometriosis and Rome-defined IBS found that women with endometriosis appear to have roughly a twofold to threefold higher chance of also meeting IBS criteria, with a summary risk estimate of 2.39 (95% CI 1.83 to 3.11) across the four studies pooled (Saidi 2020). The review notes the studies did not consistently adjust for confounders, so this is an association rather than a mechanism. Practically: if your gut symptoms track your cycle, that is worth raising with both a gastroenterologist and a gynaecologist. Our guide on why IBS gets worse around your period covers what the cyclical pattern looks like and when endometriosis is worth asking about.

A defaecatory disorder. If your main problem is constipation with straining and a sense of incomplete emptying, the muscles may not be coordinating rather than the bowel being slow. BSG says anorectal physiology tests can be considered where symptoms suggest a defaecatory disorder or faecal incontinence, to select people who might benefit from biofeedback (Vasant 2021). A study of biofeedback therapy in people with dyssynergic defecation found it improved bowel symptoms in those with and without coexisting IBS, though abdominal pain improved less in the IBS group (Patcharatrakul 2011).

"Do I have any alarm features, and what should bring me back?"

Ask this explicitly, and ask for the answer to be written down. Alarm features are the hinge on which the whole workup turns, and they are the reason two people with identical-sounding symptoms get completely different plans.

The features that change the recommended approach include rectal bleeding, unintended weight loss, iron deficiency anaemia, an abdominal or rectal mass, a family history of bowel or ovarian cancer, symptoms that wake you at night, and a change in bowel habit at an older age. The BSG reproduces the referral thresholds for suspected colorectal cancer, which include being 40 or over with unexplained weight loss and abdominal pain, 50 or over with unexplained rectal bleeding, and 60 or over with iron deficiency anaemia or a change in bowel habit, alongside probable criteria for younger adults with rectal bleeding plus another unexplained feature (Vasant 2021). If you have any of these, say so plainly and ask for it to be documented, and see a doctor promptly rather than waiting for a routine review.

The numbers show why the distinction carries so much weight. In the colonoscopy meta-analysis, colorectal cancer was found in 2.47% of people with IBS and alarm symptoms against 0.11% of those without, and was under 0.1% in people without alarm symptoms or under 40 (Wu 2023). That is the evidence behind "we do not scope everyone". It is also the evidence behind "we absolutely scope you if that changes".

So the second half of this question matters as much as the first: what would change your mind, and what should bring me back sooner? A specific answer ("new blood, weight loss, waking at night, or no improvement by December") is a plan. A vague one is not.

"What are we trying first, and by when will we know?"

Ask for a named first treatment and a named review date. The most common complaint in patient communities is not that the wrong thing was tried, it is that nothing was tried and nothing was reviewed.

What "first" looks like depends on the subtype, but the broad shape is consistent across guidelines.

Dietary advice comes early, and it is not automatically low FODMAP. BSG recommends first-line dietary advice for everyone with IBS, with soluble fibre such as ispaghula started at a low dose of 3 to 4 g a day and built up gradually, and insoluble fibre such as wheat bran avoided because it can make symptoms worse (Vasant 2021). A low FODMAP diet is positioned as second-line dietary therapy, supervised by a trained dietitian, with reintroduction according to tolerance. A gluten free diet and IgG-antibody-based food elimination are both not recommended.

Medication is symptom-targeted. For constipation, the AGA recommends secretagogues such as linaclotide for IBS-C, and BSG rates linaclotide as the likely most efficacious secretagogue available (Chang 2022, Vasant 2021). For diarrhoea, the AGA guideline covers the pharmacological options for IBS-D and the ACG recommends rifaximin to treat global IBS-D symptoms (Lembo 2022, Lacy 2021). NICE names loperamide as first choice for diarrhoea, with dose titrated toward a soft, well-formed stool (NICE CG61). None of this is something to start or change on your own; it is what to ask about.

Second-line usually means a gut-brain neuromodulator. In a network meta-analysis of 51 randomised trials and 4,644 patients, peppermint oil ranked first for global symptoms (RR 0.63, 95% CI 0.48 to 0.83) and tricyclic antidepressants second (RR 0.66, 0.53 to 0.83); tricyclics ranked first for abdominal pain but on only four trials and 92 patients, and were more likely than placebo to cause adverse events (Black 2020). The authors were explicit that few of the trials were at low risk of bias and that considerable uncertainty surrounds the rankings. BSG recommends tricyclics as an effective second-line option with careful explanation of why they are being used, starting at a low dose and titrating slowly (Vasant 2021); NICE sets a review at four weeks (NICE CG61).

That "careful explanation" clause is worth quoting back if it is skipped. Being handed an antidepressant with no explanation is one of the most reliable sources of the feeling that a doctor thinks the problem is in your head. It is being prescribed for its effect on gut pain signalling at doses well below those used for depression, and a clinician who says so up front avoids a lot of avoidable distrust.

One more number worth having. In the CARIBS trial, 294 people with moderate to severe IBS were randomised to a low FODMAP diet plus traditional dietary advice, a low-carbohydrate diet, or optimised medical treatment chosen for their predominant symptom. After four weeks, 76% of the low FODMAP group, 71% of the low-carbohydrate group and 58% of the medication group had a clinically meaningful drop in symptom severity (Nybacka 2024). Diet did better, but medication helped well over half of people, which is a useful corrective to both "just change your diet" and "diet is pointless".

"Can I see a dietitian, and what would a proper FODMAP trial look like?"

Ask for the referral by name. A low FODMAP diet is a structured, time-limited process with a reintroduction phase, and guidelines say it should be supervised by a trained dietitian rather than improvised from a website (Vasant 2021). The ACG recommends a limited trial to improve global symptoms, with the emphasis on limited (Lacy 2021).

A good answer describes three phases: a short restriction period, a systematic reintroduction of each FODMAP group to find your own thresholds, and a long-term personalised diet that is as broad as your symptoms allow. If the plan you are given is a printed list of foods to avoid forever, that is not the intervention that was studied, and it carries its own risks. Our piece on whether the low FODMAP diet can cause an eating disorder covers the warning signs of food fear taking hold.

If a dietitian is not available, ask what the plan is instead, and ask what the waiting time is so you know whether to start something else in the meantime.

"What if diet and medication do not work?"

Ask this at the first appointment, not the fourth. It tells you whether there is a ladder or just a rung.

The answer should include brain-gut behavioural therapies, and it should not be framed as "the problem is psychological". These are treatments for how the gut and brain communicate, and the evidence for them in IBS is among the more robust in the field.

In the ACTIB trial, 558 adults with IBS that had not responded to first-line treatment received either telephone-delivered CBT, web-based CBT with minimal therapist support, or treatment as usual. At 24 months, mean symptom severity was 40.5 points lower in the telephone CBT group than in treatment as usual (95% CI 15.0 to 66.0, p=0.002), and a clinically meaningful improvement was seen in 71% of the telephone CBT group, 63% of the web CBT group and 46% of the treatment as usual group (Everitt 2019). The web CBT group's advantage over usual care was not statistically significant at 24 months, and follow-up data were only available for 58% of participants, so the long-term picture is encouraging rather than settled.

For hypnotherapy, the IMAGINE trial randomised 354 people to individual hypnotherapy, group hypnotherapy or educational supportive therapy. Adequate relief at three months was reported by 40.8% of the individual group, 33.2% of the group hypnotherapy arm and 16.7% of controls; hypnotherapy was more effective than control at both three and twelve months, and group delivery was non-inferior to individual (Flik 2019). Group delivery being as good matters for access, since it costs far less per person.

The Rome Foundation working team report on brain-gut behaviour therapies is a useful thing to name, because it sets out the five classes of therapy and how referral should be framed, which is precisely the conversation many appointments handle badly (Keefer 2022). BSG rates both IBS-specific CBT and gut-directed hypnotherapy as recommended, and says psychological therapy should be considered when symptoms have not improved after 12 months of drug treatment, or earlier if it is locally accessible and the patient prefers it (Vasant 2021).

There is one more item for this question. BSG states that severe or refractory IBS symptoms should prompt a review of the diagnosis, with consideration of further targeted investigation, and warns against iatrogenic harms from opioid prescribing, unnecessary surgery and unproven diagnostic or therapeutic approaches (Vasant 2021). If you have been treated as IBS for years and nothing has worked, "should we revisit the diagnosis?" is a guideline-supported question, not an awkward one.

A worked example: two weeks of prep, one fifteen-minute appointment

Here is what the difference looks like in practice.

What Nadia brings. Nadia is 29 and has had loose, urgent stools most mornings for eight months, with cramping that eases after she goes. Her appointment is in two weeks. She logs every day: Bristol type and number of movements, pain out of ten, urgency, whether anything woke her at night, and whether there was blood. She also writes one line a day on impact.

What her log shows. Fourteen days. Bristol 6 or 7 on 11 of them, between three and six movements on those days, and two days at Bristol 4. Pain averaging four out of ten, peaking at seven. No blood on any day. Woken at night twice. Six days where she did not leave the house before midday, and two meetings moved. She has already tried cutting dairy for three weeks with no change, and psyllium for ten days, which she stopped because of bloating.

What she asks. She opens with her one-line summary: she wants to know whether coeliac disease and inflammatory bowel disease have been tested for, what her subtype is, and what she can start this month. Then she hands over the log.

What that changes. The subtype is no longer a guess: the record supports IBS-D. That makes coeliac serology and a faecal calprotectin clearly indicated rather than optional, since she is under 45 with diarrhoea (Vasant 2021). The two nights of waking are worth flagging, and she says so rather than leaving it in the log. The clinician can see she has already tried the two things most appointments start with, so the conversation begins further along. They agree the tests, first-line dietary advice with a dietitian referral for a structured FODMAP trial if the tests are clear, and a review in eight weeks.

What she does not do. She does not add a symptom she has not had. If Nadia had claimed blood to get a colonoscopy faster, she would have put a false alarm feature in her permanent record, likely been booked for an invasive test with a low chance of explaining her actual problem, and spent that appointment discussing bleeding that does not exist rather than the morning urgency that does.

This is the kind of record Clairop is built to produce: Bristol type, urgency, blood and overnight episodes logged with one tap each, and a one-page report for a gastroenterology appointment with the source of each number stated above it. The method page explains how the delayed-trigger analysis handles the multiple-comparison problem that makes most food diaries find triggers that are not real.

What a good answer sounds like, and what a brush-off sounds like

The middle column is not a high bar. It is what the guidelines already describe. The right-hand column is what a lot of people actually get, and recognising it for what it is makes it easier to ask a follow-up rather than leaving deflated.

If you are dismissed: what actually helps

Dismissal is the single most common theme in IBS communities, and it deserves a practical answer rather than sympathy alone.

A post in r/ibs from a young woman whose new gastroenterologist told her he was not concerned and saw no need for testing, despite two years of worsening constipation, bloating, pain and gas, drew hundreds of replies describing the same experience (r/ibs thread). A separate thread titled simply "You're too young" collected variations on the same sentence from different specialists (r/ibs thread). Whatever else those threads are, they are evidence that this is common rather than personal.

Four things people in those threads reported as actually working, none of which requires confrontation:

Ask for the reasoning to be documented. A recurring and reasonable suggestion is to ask that the decision not to investigate, and the symptoms it was based on, be recorded in your notes. It is not a threat. It is a request for the record to reflect the consultation, and it tends to produce a more considered answer because it asks the clinician to commit to reasoning rather than a shrug.

Ask the two closing questions. "What is your working diagnosis?" and "What would change your mind?" Both are hard to answer dismissively, and the second gives you a concrete trigger for coming back.

Lead with function, not adjectives. One of the more thoughtful replies in the "what should I ask for" thread suggested emphasising the effect of symptoms on day-to-day functioning, because that is what signals severity (r/ibs thread). "I have missed nine days of work in two months and I do not leave the house before midday" lands differently from "it is really bad".

Get a second opinion, and consider subspecialty fit. A moderator in one of those threads made a point that is easy to miss: gastroenterologists subspecialise, and one whose focus is inflammatory bowel disease may not be the best fit for a disorder of gut-brain interaction (r/ibs thread). Asking whether there is a colleague with a functional gut or neurogastroenterology interest is a neutral way to change direction.

One caution. A common piece of advice in these threads is to exaggerate symptoms, or claim blood in the stool, to force testing. It is understandable and it is a bad idea. It puts inaccurate information into a record that follows you for years, it can direct you toward invasive procedures that have a low chance of explaining your actual problem, and it spends the appointment on a symptom you do not have instead of the one you do. Report red flag symptoms accurately if you have them, in detail, and push on specifics instead.

The opposite failure is worth naming too. A frequently upvoted post in r/ibs argues that IBS is a "bucket diagnosis" and that most people labelled with it have something else with a real name (r/ibs thread). That framing captures a real frustration, and sometimes it is right: the mimics section above exists for a reason. But IBS is also a positively defined condition affecting a substantial share of the population, with treatments that work for many people (Sperber 2021, Ford 2018). Treating the diagnosis as always wrong can mean years spent searching instead of years spent treating. The balanced position, and the one BSG takes, is that refractory symptoms should prompt a review of the diagnosis, not that the diagnosis is meaningless.

Myths worth dropping before you go in

Myth: "IBS is a diagnosis of exclusion, so they have to test everything." Current ACG and BSG guidance recommends a positive diagnosis with limited testing, and a randomised trial found this as safe as extensive exclusion over five years (Lacy 2021, Vasant 2021, Engsbro 2021).

Myth: "A normal colonoscopy proves it is IBS." Only if biopsies were taken, particularly if your problem is chronic diarrhoea. Microscopic colitis is invisible to the naked eye and was found in 5.7% of the diarrhoea group in one prospective series, where a quarter of chronic diarrhoea patients had no biopsies taken (Asghar 2022).

Myth: "IBS can turn into colitis or cancer." In a survey of 1,242 people with IBS, 43% believed IBS can develop into colitis and 21.4% believed it can develop into cancer (Halpert 2007). It is a widespread belief and it is not supported. IBS and inflammatory bowel disease are different conditions, which is exactly why ruling IBD in or out matters.

Myth: "A breath test will find the real cause." BSG states there is no role for hydrogen breath testing to exclude lactose intolerance or small intestinal bacterial overgrowth in IBS, partly because these tests are prone to false positives (Vasant 2021). NICE also lists hydrogen breath testing among the tests not necessary to confirm the diagnosis (NICE CG61).

Myth: "Being offered an antidepressant means they think it is in my head." Tricyclics are used in IBS as gut-brain neuromodulators at low doses, and they ranked first for abdominal pain in a network meta-analysis, though on thin data (Black 2020). BSG explicitly says careful explanation of the rationale is required, which means you are entitled to that explanation.

Myth: "Going gluten free first will give me useful information." It removes your ability to be tested accurately for coeliac disease, since serology requires gluten in the diet (Rubio-Tapia 2013). Test first, then experiment.

Myth: "If they will not test me, there is nothing more to do." Ask what would change their mind, ask for a second opinion, and keep logging. A record over weeks is more persuasive at the next appointment than any single description.

When to see a doctor promptly

Some symptoms should not wait for a routine appointment or a question list. See a doctor promptly if you have any of the following, and say clearly that they are new or worsening:

• Blood in your stool, or black, tarry stools
• Unintended weight loss
• Symptoms that wake you from sleep
• A new and persistent change in bowel habit, particularly if you are over 50
• Unusual tiredness or breathlessness, which can indicate anaemia
• A lump or mass in your abdomen or rectum
• Difficulty swallowing, or repeated vomiting
• A family history of bowel cancer, ovarian cancer or inflammatory bowel disease alongside new symptoms

Seek urgent, same-day medical help for severe abdominal pain that is constant or worsening, a swollen and tender abdomen, fever with abdominal pain, heavy rectal bleeding, or signs of dehydration such as dizziness on standing, passing very little urine or being unable to keep fluids down.

None of this is a reason to panic about ordinary IBS symptoms, which fluctuate for many people over years. It is a reason to describe changes accurately and promptly, because the presence or absence of these features is the single biggest determinant of what your gastroenterologist will recommend next. For more on preparing for appointments and describing symptoms clearly, browse our doctor visits guides.