Stomach and bowels · For patients and doctors
Answer a few questions about your belly pain and your motions. You find out whether the pattern fits irritable bowel syndrome (IBS), which type it is, how severe it is, which signs mean you need a doctor first, and what helps day to day. Doctors get the full clinical view: both sets of criteria, the subtype, the tests the guidelines ask for, the medicines and diabetes problems that copy IBS, and treatment by type.
A calculator, not a diagnosis. IBS is diagnosed by a doctor from your history, an examination and a few basic tests. If you have severe belly pain with vomiting, cannot pass wind or stool, are passing a lot of blood, or feel faint, call 108 now. Nothing you enter leaves this page.
Doctors use the Bristol stool scale. Find your stools on it:
These are not part of IBS. Tick any that apply, even if you think you know the reason.
0 means none at all, 10 means the worst you can imagine.
Many common medicines change the motions. Look for the generic name on the strip.
BSG 2021 asks for these at first presentation in every adult with suspected IBS, with calprotectin in those under 45 with diarrhoea. A positive diagnosis does not need more than this when there are no alarm features.
| Test | This patient | Why |
|---|
Generic names. Rows that fit this subtype are shaded green; rows that do not are greyed. Grades are BSG 2021 (strong or weak); ACG 2021 is noted where it differs. Check the current label and Indian availability before prescribing.
| Therapy | For this patient | Evidence |
|---|
| Medicine | Dose |
|---|---|
| Ispaghula (psyllium husk) | Start at 3–4 g a day and build up slowly (BSG 2021) |
| Mebeverine | 135 mg three times a day, 20 minutes before meals; or 200 mg modified-release twice a day |
| Hyoscine butylbromide | 10 mg three times a day, up to 20 mg four times a day |
| Dicyclomine (dicycloverine) | 10–20 mg three times a day |
| Peppermint oil, enteric-coated | 0.2–0.4 mL (1–2 capsules) three times a day, swallowed whole |
| Loperamide | 2 mg after a loose stool, or before going out; maximum 16 mg a day |
| Macrogol (polyethylene glycol) | 1 sachet a day, adjusted to a soft stool |
| Amitriptyline | 10 mg at night, increased slowly to 30–50 mg; continue for at least 6 months if it helps (BSG 2021) |
| Ondansetron | 4 mg once a day, increased to a maximum of 8 mg three times a day (BSG 2021) |
| Rifaximin | 550 mg three times a day for 14 days; up to two repeat courses if symptoms return (US label) |
| Linaclotide | 290 micrograms once a day, 30 minutes before a meal |
| Lubiprostone | 8 micrograms twice a day with food (US label, women) |
The Indian consensus (INMAS with the Indian Society of Gastroenterology, 2023) puts IBS at 0.4 to 4.2% of the population, and as common in men as in women, unlike Western data. It prefers the Rome III criteria to Rome IV because Rome IV misses many Indian patients: the pain-weekly rule is stricter. A large share of Indian patients do not fit any Rome subtype. Small intestinal bacterial overgrowth was found in about one in three Indian patients with IBS, more often with diarrhoea. In India, persisting giardiasis and amoebiasis after a gut infection, lactose intolerance and intestinal tuberculosis are worth excluding before the label is settled. Repeated courses of antibiotic combinations for loose motions are common and should stop.
Irritable bowel syndrome is a long-term problem with how the gut and the brain work together. The bowel is more sensitive than usual and its movements are out of rhythm. This causes belly pain with loose motions, constipation or both, and often bloating. It does not damage the bowel, does not cause cancer and does not shorten life. It can come and go for years, and the right food habits and medicines make a large difference.
The type depends on your stools on the days they are not normal. IBS-C: mostly hard stools (constipation). IBS-D: mostly loose stools (diarrhoea). IBS-M: both hard and loose, mixed. IBS-U: neither is frequent enough to say. The type matters because the medicines are different, and a medicine for one type can make another worse. The type can change over time.
These are the internationally agreed rules for diagnosing IBS. Rome IV (2016) needs belly pain on at least 1 day a week on average, over the last 3 months, linked to at least two of: passing stool, a change in how often you go, a change in what the stool looks like. The trouble must have started at least 6 months ago. Rome III (2006) also counts discomfort, not only pain, and needs it on at least 3 days a month. Indian experts prefer Rome III because it picks up more Indian patients.
A stool test for inflammation in the bowel. It is normal in IBS and raised in Crohn's disease, ulcerative colitis and some infections. It helps a doctor avoid an unnecessary colonoscopy in a young person with loose motions. Painkillers and acidity tablets can raise it a little.
Coeliac disease is a reaction to gluten, a protein in wheat, barley and rye. It is common in North India, where wheat is the staple, and more common in people with type 1 diabetes or thyroid disease. It can look exactly like IBS. The blood test only works while you are still eating wheat, so do not stop chapati before the test.
Five questions, each scored out of 100, add up to a score out of 500. Under 75 means no active IBS, 75 to 174 mild, 175 to 299 moderate and 300 or more severe. A fall of 50 points is a change you will notice. Repeat it after a few weeks of treatment to see whether it is working.
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