What to expect from nutrition counselling for irritable bowel syndrome

Your counsellor may ask about abdominal pain, bloating, diarrhoea, constipation, urgency, stool changes, sleep, stress and the timing of symptoms. A diary can show whether portion size, meal spacing or particular ingredients are relevant. The discussion should also consider coeliac disease, inflammatory bowel disease, infection, medicines and other explanations when symptoms do not fit IBS.

Some people are offered a structured elimination and reintroduction plan, such as a low-FODMAP approach. This is usually temporary and should be supervised so foods are reintroduced, the diet remains balanced and unnecessary restriction does not continue.

Bring a list of medicines, supplements and foods you already avoid, plus a few days of meals and bowel symptoms. Agree on one change at a time where possible. Keep regular meals, drink according to your clinician’s advice and discuss fibre gradually, because a sudden increase can worsen gas or bloating. Review the plan before removing more foods or staying on a restrictive phase.

Seek prompt medical assessment for blood in the stool, unexplained weight loss, persistent fever, repeated vomiting, anaemia, a new change in bowel habit, severe night symptoms or pain that is escalating. Seek urgent help for severe abdominal pain with a swollen abdomen, faintness or inability to keep fluids down. These signs need clinical review rather than dietary experimentation.

Ask whether your symptoms have been assessed for other conditions, whether a supervised elimination plan is appropriate, how to maintain fibre and nutrients, and what symptoms should end the trial. Ask when to review progress and how to reintroduce foods.