Irritable bowel syndrome (IBS) symptom diary

IBS Symptoms and causes

Up to 20% of people in the UK have Irritable Bowel Syndrome (IBS)¹, with 5% to 10% of the population seeing their GP every year as a result of their symptoms.² While IBS is one of the most common gastrointestinal conditions, the cause is not fully known. IBS is characterised by abdominal pain, bloating, and often a change in bowel habits that includes instances of constipation and diarrhoea.

How a symptom diary can help

IBS is a troublesome condition that can have a negative impact on someone’s quality of life. If you have been diagnosed with IBS, it’s important to keep track of your symptoms, as this can be helpful in managing the condition. The symptoms can seem to occur without any pattern, but many people find that their IBS is worsened by certain factors – such as stress or after eating certain foods.³

Keeping a symptom diary can help you gain a better understanding, and instead of trying to deal with symptoms as and when they happen, you can pro-actively manage your condition – and hopefully, prevent future flare-ups.

The majority of IBS triggers are a combination  of diet, stress, and other medication. Here are five factors you should record on a daily basis:

• Your diet
• Pain
• Bowel movements
• Medication
• How you’re feeling that day

Try to do this over the course of four weeks. A detailed symptom diary should be able to highlight any obvious triggers, and you can share this with your doctor in order to find the right course of treatment for your symptoms.

Diet

Closely monitoring your diet is one of the recommended treatments  for IBS. A study by the British Society of Gastroenterology found that 50% of people with IBS reported pain within 90 minutes of eating.⁴ The study noted that this is likely to be the result of an increase in digestive system sensitivity, particularly after eating fat. There isn’t a standard diet for all IBS sufferers – the right diet for you is the one that you feel lessens your symptoms the most.

Important things to track in your diary includes:

• How your food was cooked – was it freshly cooked or reheated? Was it fried or baked?
• Did you cook the meal from scratch or was it pre-made?
• The number of fruit and vegetables you had that day
• Your sugar and fat intake. There are a number of different apps you can use to make this simple to monitor
• What you’re drinking. You might find that certain drinks – such as drinks with caffeine and sugary drinks – can trigger your symptoms

Pain

Recurrent abdominal pain that lasts for at least three days in a month is one of the defining characteristics of IBS. If you’re experiencing any pain, note down the following:

• If you are in constant pain or if it comes and goes at certain times of the day
• Where the pain is present – if it is limited to a certain area or throughout  your abdomen
• What the pain feels like – for example, sharp, dull, cramping, or burning
• Any other pain that’s not abdominal, such as a headache or backache.

Bowel movements

Irregular bowel habits, such as instances of constipation or diarrhoea, tend to come and go in what’s known as a “flare up”. You’ll likely find that your bowel movements will return to normal after a flare up, but for some people, constipation and diarrhoea is almost always present.⁵ When you’re tracking bowel movements, note down the following:

• How many bowel movements you have in a day
• The nature of the bowel movement – was it difficult to pass or did you feel a level of urgency beforehand?
• Did you have any abdominal pain before the movement and if so, did it lessen afterwards?

Medication

Some drugs, such as certain antibiotics and medicines containing sorbitol, can trigger spasms within the colon, leading to constipation or diarrhoea.⁶ If you’re taking medication other than bulking agents and antimotility drugs (drugs used to stop diarrhoea) and antispasmodics (drugs used to relax the muscles of the gut), try to keep track of the following:

• Which medication you’re taking and what it's for
• When you take the medication
• Any side effects of the medication
• Whether or not you take medication in conjunction with any vitamins or complementary therapies such as herbal remedies or acupuncture

How you’re feeling that day

Stress and anxiety are closely linked to IBS due  to the connection between the brain and the gut.⁷ The connection means that people with IBS are very sensitive to stress and anxiety – which is then exacerbated by the worry about needing to go to the toilet, resulting in a vicious circle. Your day-to- day emotions may well have an impact on your bowel, which is why you should pay close attention to how you’re feeling. Try to track:

• If you were feeling stressed and when this happened
• If there were any issues that day that caused you stress, such as work pressure or personal problems
• If you were feeling particularly anxious about bowel movements or not being close to a toilet

If you stick to keeping a daily diary for at least four weeks that encompasses these five areas along with any other observations, you should be able to identify a pattern and better manage your condition. For example, you could remove certain problematic foods from your diet, or find a suitable treatment for your abdominal pain. Ultimately, you should be able to understand your condition and lessen the number of flare ups you experience.

FODMAP

If you're struggling with the diary and trying to find out what foods may be aggravating your symptoms – then you could look at the FODMAP diet. The FODMAP diet appears to offer some people relief from their IBS symptoms.⁸

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These types of carbohydrates are not easily absorbed by the body and they may be responsible for the abdominal pain and bloating in IBS.

The FODMAP diet can be very confusing and complicated, so we would always advise a discussion with a dietician about how to incorporate this regime in your life.  Some manufacturers of prepared food, are creating FODMAP-free ready meals.

Next steps

If you’re experiencing symptoms similar to those associated with IBS, it’s important to see your GP to make them aware and rule out any other possible diagnosis. They’ll be able to offer advice and where applicable, treatment to suit your particular circumstances.

In the meantime there are things you can do to improve your overall gut health. Our articles How to have a healthier gut and Exercises to aid digestion, contain lots of information and tips, which you might find helpful.

Finally, if you want to find out more about IBS, or any other aspect of your or your family’s health, medication or perhaps an upcoming procedure, our team of medical experts are here to help, 24 hours a day, 365 days a year. Get in touch whenever you need us via our Ask the Expert service.

Sources

¹ Irritable bowel syndrome in adults: diagnosis and management - National Institute for Health and Care Excellence (NICE)

² Managing Your Life with Irritable Bowel Syndrome - National Primary Care
Research & Development Centre, University of Manchester

³ Irritable bowel syndrome - NHS inform

⁴ BSG guidelines on the irritable bowel syndrome: mechanisms and practical management (Section 3.3) - British Society of Gastroenterology

⁵ Irritable bowel syndrome: Symptoms - NHS

⁶ IBS Triggers and How to Avoid Them - WebMD

⁷ Stress, Anxiety and Irritable Bowel Syndrome - WebMD

8 Fodmaps FAQ - King's College London