Irritable bowel syndrome (IBS)

Background

Irritable Bowel Syndrome (IBS) is a common condition that results in a high number of referrals to the Gastroenterology Service. Traditionally these patients are either seen in Gastroenterology clinics as a new patient or referred directly for endoscopy.

This pathway aims to give patients information on how to self-manage their condition and highlight to Primary Care the more complex cases that should be referred on to Secondary Care.

It also provides an opt-in mechanism so that patients that continue to have problems can be seen at specific nurse-led clinics and so still have access to Secondary Care.

NHS Scotland IBS pathway

Rome IV Criteria for diagnosis of IBS

Recurrent abdominal pain on average at least 1 day/week in the last 3 months associated with 2 or more of the following criteria:

Related to defecation
Associated with a change in frequency of stool
Associated with a change in form (appearance) of stool

*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.

Consider medical treatment as per British Society of Gastroenterology(BSG) Guidelines on the management of IBS e.g. Buscopan.

Click on the image below to open the pathway.

Pathway recommendations

Guidance for primary care

The most common symptoms of IBS are:

abdominal pain and cramping
change in bowel habits, such as diarrhoea, constipation or sometimes both
bloating and swelling of your stomach
excessive wind
occasionally experiencing an urgent need to move your bowels (especially nocturnal)

Other less common symptoms may also be experienced, such as:

lack of energy
feeling sick
heartburn

Lifestyle advice

People experiencing IBS symptoms should:

eat a healthy, balanced diet
stay hydrated
exercise regularly
manage their stress levels

Sources of information for patients are provided in the references and further resources section below.

Diagnosis

The Rome IV Criteria (see pathway above) should be used to exclude coeliac disease and inflammatory bowel disease.

Treatments to try before referring

Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021 Jul;70(7):1214-1240. DOI: 10.1136/gutjnl-2021-324598

References and further resources

Patient resources

British Dietetic Association (BDA) 2022 Food fact sheet: Irritable Bowel Syndrome (IBS) and diet

NHS inform Illnesses and conditions: Irritable bowel syndrome (IBS)

Guts UK 2025 Irritable Bowel Syndrome (IBS)

References

NICE CKS Irritable bowel syndrome July 2025

Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021 Jul;70(7):1214-1240. DOI: 10.1136/gutjnl-2021-324598.

Rome Foundation Rome IV Criteria theromefoundation.org

Scottish referral guidelines for suspected cancer 2025 Lower gastrointestinal cancers

gjnh.cfsdpmo@gjnh.scot.nhs.uk