What can be done about IBS

Written by Kathryn Dunn · Published 23 October 2026 · Last reviewed 23 October 2026

You've got the diagnosis. You've got the leaflet. The leaflet says to eat regular meals, drink water and cut down on stress, and you've been doing all of that for years. So what else is there?

More than you've probably been told. Irritable Bowel Syndrome (IBS) has two detailed treatment guidelines in the UK, one for GPs and one from the gut specialists, and between them they cover diet, medicines, talking therapies and hypnotherapy. Most of it you can ask for by name. This page is the map. Each option on it has its own page, written to the same pattern, so you can compare them fairly.

How the guidelines are built

Two documents matter here. NICE guideline CG61 is the one GPs in England work to ^[1]. The British Society of Gastroenterology (BSG) guideline from 2021 is the specialists' own, and it's more detailed ^[2]. Both lay treatment out in steps: the things everyone's offered first, then the things offered if those haven't helped.

The BSG guideline does something useful with every recommendation. It grades it twice. First, how strongly the panel recommends it. Second, how good the evidence behind it is. Those are separate questions, and you'll meet combinations like "strong recommendation, low quality of evidence" on this site. That's not a contradiction. It means the panel was confident the treatment is worth offering, and also honest that the trials behind it have limits. The pages here give you both halves every time.

Two things worth knowing before you read any IBS study

First, people with IBS get better on dummy treatments at a high rate. In trials, somewhere around a third of people improve on a placebo, and sometimes more ^[3]. So the question is never "did people improve". It's "did more people improve than would have anyway". The pages here give you that comparison, not the raw number.

Second, you can't blind a talking therapy. In a drug trial, nobody knows who got the real tablet. In a trial of hypnotherapy or cognitive behavioural therapy (CBT), everyone knows which group they're in, and that counts against the evidence in the grading, whatever the results show ^[2]. It's a fair rule and it's applied to all of them. It also means a lower evidence grade for a therapy can reflect how hard it is to test rather than how well it works. You'll see that said again on the pages where it applies.

The options, in the order the guidelines use

Diet and lifestyle. Regular meals, enough fluid, less caffeine and alcohol, and looking at whether specific foods set things off. This is what everyone's offered first, and both guidelines say it should be tried properly before anything else ^[1][2]. It's less obvious than it sounds, and the page on it says what "properly" means.

The low FODMAP diet. A structured, temporary diet that cuts a group of poorly absorbed sugars, then brings them back one at a time to find out which ones matter to you. The BSG guideline recommends it as a second step if the basic diet advice hasn't helped, with a dietitian ^[2]. The second half, reintroduction, is the part people are often never given.

Fibre. More fibre is the standard advice, and for IBS it's the wrong advice if it's the wrong fibre. Both guidelines favour soluble fibre, such as ispaghula, and caution against insoluble fibre such as bran ^[1][2].

Over-the-counter medicines. Antispasmodics for cramping, peppermint oil, loperamide for diarrhoea, and laxatives for constipation. All are in the guidelines as things to try early, each with its own caveats ^[1][2].

Probiotics. The BSG guideline says it's reasonable to try one for up to twelve weeks and stop if it hasn't helped ^[2]. Which one is the hard part, and the page on it says why the evidence doesn't settle that.

Prescription medicines. Low-dose antidepressants, used for IBS at doses below those used for depression because of what they do to the nerves in the gut, and a small number of newer drugs designed for IBS itself ^[1][2]. The page explains why a doctor might suggest an antidepressant for your gut without thinking you're depressed.

Cognitive behavioural therapy. Talking therapy adapted for IBS, working on the thoughts and habits that keep symptoms going. Recommended in both guidelines for IBS that hasn't improved with the steps above ^[1][2]. Some NHS areas offer a digital version.

Gut-directed hypnotherapy. Hypnotherapy aimed specifically at the gut. The BSG guideline gives it a strong recommendation with a low quality of evidence ^[2], and NICE lists it alongside CBT as an option to consider when IBS hasn't responded to medicines after twelve months ^[1]. The page gives the trials, including the less encouraging ones.

Mindfulness and other psychological approaches. Less evidence than CBT or hypnotherapy, but some, and they turn up inside the two above ^[4].

Things people try that have little or no evidence. Acupuncture, food intolerance tests sold online, and most supplements. Listed on their own page with what the research found, so you know the site has looked rather than left them out.

Who decides what you're offered

What's available on the NHS varies by where you live. Some areas fund talking therapies for IBS only once it's been through the twelve-month route; some don't fund them at all ^[5][6]. That's why people end up looking privately, and it's why knowing what the guidelines say matters: you can ask your GP what your area offers, and what the guideline says you should be considered for.

If nothing has helped after a year, there's a page on what NICE says should happen next. And if you're about to see your GP, there's a list of questions worth taking.