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Irritable bowel syndrome - Management
Overview of management

  • Assess for red flag indicators and refer for further investigation if present.
  • Assess the person's diet and lifestyle and offer advice accordingly.
  • Consider drug treatment with single or combination therapies, according to the person's predominant symptoms:
    • Antispasmodics for abdominal pain and cramp.
    • Antimotility drugs for people with diarrhoea.
    • Laxatives for people with constipation.
    • Advise people to adjust doses of laxative or antimotility drug according to response, to achieve a soft, well-formed stool.
  • If symptoms do not respond to first-line treatment:
    • Consider a trial of a low dose tricyclic antidepressant, or a selective serotonin reuptake inhibitor if a tricyclic antidepressant has previously been shown to be ineffective.
  • Refer to secondary care anyone who presents with a red flag indicator (see Differential diagnosis).
  • Consider referral if:
    • There is uncertainty about the diagnosis.
    • The person has health-related anxieties that have not been allayed.
    • The person is following general lifestyle and dietary advice without clear benefit — refer to a registered dietitian for advice and treatment (including single food avoidance and exclusion diets).
    • There is no response to diet, lifestyle, and drug treatments after 12 months — consider referral for psychological interventions.

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