More than 5 million people in the UK are thought to suffer from irritable bowel syndrome (IBS). This is a long-term condition that has significant impact on quality of life and well being of patients and also impacts their working and social lives. Patients often struggle to receive a positive diagnosis based upon current NICE guidance (https://www.nice.org.uk/guidance/cg61). It is important that patients receive a positive diagnosis on the basis of a typical history and examination, exclusion of red flags and appropriate tests based upon exclusion of coeliac disease and inflammatory pathology within the gut. They can then move forward in identifying their triggers and managing the lifestyle factors which exacerbate their disease.

People with irritable bowel syndrome are significant users of healthcare resource although self-management underpins the treatment of this condition. Despite the fact they often use significant health resources most patients with IBS spend relatively little of their time in consultation with healthcare professionals. Most of their time is spent at home, at work or with friends and families. Whilst many patients manage their condition themselves and become “experts through experience” most can benefit from additional support and education from professionals.

Most patients recognise the importance of self-management for their condition but there is variable ability to do this successfully. There are a number of strategies professionals can use to support patients in manging their disease. Patient education, peer support and health coaching can all enable patients to better address the lifestyle factors that may exacerbate their disease.

Patient education is key to improving understanding and empowering patients, both to ask pertinent questions and to make appropriate changes to their lifestyle based upon their own knowledge and personal experience and awareness of their lifestyle. This may be undertaken on a face to face basis or by directing them to appropriate online resources. The IBS Network is an excellent resource and patients can both visit their website (www.theibsnetwork.org) and become members, this enables them to access a range of educational materials that help people to make better decisions and choices for themselves.

IBS self-help groups, many provided by the IBS Network, provide peer support and whilst not available in every location enable patients to access mutual support. Many of the self-help groups address issues which are common to all patients. Diet and psychological stressors are common triggers for many and mutual support and mentorship of “senior” members by those in the early part of their disease journey can provide  invaluable support.

Health-coaching can support behaviour change. Evidence suggests that few patients undergo “Damascus” conversion and radically change their behaviour overnight regardless of how forceful the message to change their lifestyle might be. Indeed forceful and patronising lectures appear to make most people less likely to change their behaviour. Much more likely to effect change is an approach which helps patients identify the opportunities for themselves and explores how they might make small incremental changes in the right direction. An example would be reduction of a particular beverage such as caffeinated coffee that can both exacerbate symptoms in IBS and is habit forming. Patients might struggle to give up caffeine overnight but reduction can help so it is worth exploring whether it is possible to alternate caffeinated with decaffeinated coffee.

In terms of psychological support both face to face and online psychological therapies have evidence for efficacy. Patients may find apps such as “Zemedy”, a useful aid to addressing some of the psychological factors which exacerbate irritable bowel syndrome. Similarly Food Maestro is well evidenced diet focussed app form the team at King’s College Hospital designed to support patients make the necessary changes involved in undertaking the low FODMAP diet, with the support of an appropriately trained health professional. Patients often need help to select from the plethora of apps some of which are less well evidence based.

Many professionals are concerned that investing time in educating patients about their disease, coaching them and exploring how they might change their lives and investing in advising them about the apps, groups and resources available to support them takes too long, but evidence suggests that time invested in supporting meaningful lifestyle change and self-management pays dividends in reducing the demand for ongoing support and repeated attendance.