Health Insights · Gastroenterology
IBS: understanding irritable bowel syndrome and managing it
IBS is a disorder of how the gut and brain communicate. Nothing shows on a scan or a camera test, which has led generations of patients to be told there is nothing wrong — when in fact there is a well-described condition with treatments that work.
These symptoms are not IBS and need investigating
- bleeding from the back passage, or black tarry stools
- unintentional weight loss
- a persistent change in bowel habit over the age of 50
- waking at night with pain or diarrhoea
- anaemia, a lump in the abdomen, or a family history of bowel cancer or IBD
- symptoms that began after travel abroad, or following antibiotics
IBS is a positive diagnosis based on a characteristic pattern, not a label applied when tests are normal. Any of the above needs excluding first, and a diagnosis of IBS should not be made without at least basic blood tests and coeliac screening.
What to exclude first
- Coeliac disease — a blood test, done while still eating gluten. It is found in a meaningful proportion of people labelled with IBS.
- Inflammatory bowel disease — a stool calprotectin test distinguishes inflammation from IBS well.
- Full blood count, inflammatory markers and thyroid function.
- Bile acid diarrhoea, particularly after gallbladder removal — treatable and frequently missed.
- Lactose intolerance, and in women endometriosis and ovarian pathology, both of which mimic IBS.
First-line management
- Regular meals, not skipped or rushed. Erratic eating destabilises gut motility more than most single foods.
- Limit caffeine and alcohol, and fizzy drinks.
- Reduce fatty and highly processed food, and restrict fresh fruit to about three portions a day.
- Soluble fibre such as oats and ispaghula for constipation-predominant IBS. Avoid insoluble bran, which typically makes IBS worse.
- Peppermint oil capsules and antispasmodics for cramping pain.
- Regular exercise, which has good evidence in IBS.
- Laxatives for constipation — avoid lactulose, which worsens bloating.
The low FODMAP diet needs a dietitian
It is effective — around 70% of people improve — but it is a three-phase clinical intervention, not a permanent list of banned foods. The restriction phase lasts four to six weeks, followed by systematic reintroduction to establish your personal tolerances, then a liberalised long-term diet. Staying on the restriction phase indefinitely, which is what happens when people attempt it from the internet, harms the gut microbiome and risks nutritional deficiency. Do it properly with support, or do something else.
When first-line is not enough
- Low-dose tricyclic medication — prescribed at a fraction of the antidepressant dose, acting on gut nerve sensitivity rather than on mood. It is one of the more effective treatments and is often declined because people assume it means their symptoms are considered psychological. It does not.
- Gut-directed hypnotherapy and IBS-specific CBT have strong evidence, comparable to dietary change.
- Specific prescription treatments for constipation-predominant or diarrhoea-predominant IBS.
- Probiotics may help some people; try a single product for at least four weeks before judging.
Realistic expectations
IBS fluctuates and typically runs a relapsing course over years, often flaring with stress, travel, illness or dietary change. The goal is good control rather than permanent cure, and most people achieve that with a combination of approaches. It does not turn into cancer, it does not damage the bowel, and it does not shorten life — which does not make it trivial, but is worth knowing.
Book an appointment if you have not had coeliac disease and inflammation excluded, symptoms have changed, or standard measures are not controlling things. We offer blood and stool testing and gastroenterology review on site, and arrange dietitian input for FODMAP through our CQC-registered partners.
Private gastroenterology assessment for IBS in London
IBS is common and manageable, but it is a diagnosis that first needs other causes excluded — especially where there are red flags such as weight loss, bleeding or a change in bowel habit over 50. A private GP in East London can assess you, arrange blood and stool tests, and start a management plan, while our private gastroenterology clinic in London can advise on further tests including endoscopy where indicated. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Irritable bowel syndrome in London: common questions
Is IBS diagnosed by a test?
There is no single test — it is diagnosed on symptoms after excluding other conditions with blood, stool and sometimes endoscopic tests.
What red flags need urgent assessment?
Weight loss, blood in the stool, difficulty swallowing, a persistent change in bowel habit, or symptoms starting after 50 warrant prompt investigation.
Can I be seen the same day?
Yes — same-day private GP appointments are available most days, with gastroenterology referral within our own team where needed.
How is IBS managed?
Through diet, lifestyle, targeted medication and sometimes specialist input — tailored to your symptom pattern.
Testing and gastroenterology on site
7 days a week, 9am–7pm, on Whitechapel Road.