IBS and Your Doctor: What to Write Down

At the appointment the questions come fast: how often, how bad, since when, and how are your bowel movements? In Sam's symptom diary you log abdominal pain, bloating, diarrhea or constipation per day as mild, moderate or severe. Sleep and stress level from your Apple Health data are in the same app, a few taps away.

What will your doctor ask about your bowel symptoms?

The NHS says a GP may ask whether your symptoms come and go, how often they happen and how long you have had them. They may also ask when you get them, for example after eating certain foods. The German S3 guideline also puts the history first: how long, how the symptoms developed, whether a gut infection came first, and targeted questions about signs of another illness.

A list you can fill in before the visit:

• Since when: the month it started, and whether it has stayed the same, got better or got worse.
• How often: on how many days a week you had pain or bloating.
• How strong: always on the same scale, for example 0 to 10.
• What it costs you: days off, cancelled plans, trips you avoid because of the toilet.
• Bowel movements: how many a day, and what they look like.
• Pain and the toilet: whether pain eases, worsens or stays the same after a bowel movement.
• Other bowel changes: straining, sudden urgency, a feeling of not having finished, mucus.
• Food: whether eating makes it worse, and after which foods.
• What changed: a gut infection before it began, new or changed medication, shift work, more stress, poor sleep.
• What you took, including over-the-counter remedies, and whether it helped.
• Family: bowel cancer, inflammatory bowel disease or celiac disease in close relatives.

The Rome IV criteria in the German guideline's appendix ask for recurrent abdominal pain on at least one day a week on average. This must hold for the last three months, with onset more than six months earlier. Two of three features go with it: a link to bowel movements, a change in stool frequency, a change in stool form. These are criteria for doctors, not a self-test.

Updated Rome V criteria came out in 2026. The American Gastroenterological Association's news service reports that they count abdominal discomfort as well as pain again and lower the required frequency from once a week to three days a month. These are criteria for specialists and studies, not a self-test: your doctor makes the diagnosis. For the rest of the visit, see the doctor appointment checklist for a chronic condition.

How do doctors diagnose IBS?

There is no single test for IBS. The German S3 guideline defines it by three points together. First, symptoms such as abdominal pain or bloating have lasted over three months or keep coming back, usually with changed bowel movements. Second, they are bad enough that you seek help or worry, and your quality of life clearly suffers. Third, no findings of another condition are likely to explain them.

The guideline frames this as a positive diagnosis, not just ruling things out. Your history, pattern and severity must fit IBS. Other relevant conditions must be ruled out, guided by your symptoms. The NHS and the German guideline describe different amounts of testing:

• NHS: a blood test for coeliac disease and stool tests for infection and inflammatory bowel disease.
• German S3 guideline: a detailed history, a physical exam including the rectum, blood tests with coeliac antibodies, stool tests, an abdominal ultrasound and, for women, a gynecological check. Further tests chosen case by case usually follow, such as a colonoscopy and a gastroscopy.

Which tests make sense for you is for your doctor to decide. If your symptoms are only a few weeks old, the German guideline says it is too early to call it IBS. They should still be looked into. The NHS advises seeing a GP if you think you have IBS and have had symptoms for over four weeks. Who does the tests, and what blood tests, stool tests and colonoscopy show, is in What kind of doctor for IBS? Colonoscopy and blood tests.

What is the Bristol stool scale, and why two weeks?

The Bristol Stool Form Scale sorts stool into seven types. In the German S3 guideline, types 1 and 2 count as hard and types 6 and 7 as loose. Types 3 to 5 count as normal consistency. To sort IBS into a constipation, diarrhea or mixed type, the guideline describes a two-week stool diary under Rome IV.

Your doctor does the sorting. Your part is to give every day an entry, the good ones too. When a food intolerance is suspected, the German guideline also recommends a food and symptom diary; agree the details with your doctor.

What does a two-week diary look like?

Here is one way two weeks could look on paper. "Pain" is pain strength from 0 to 10; "Stools" is the number of bowel movements and the Bristol type.

This example is invented: not a real person, not a benchmark, not a result. Do not put off an appointment because a diary looks harmless. If things get worse or a sign from the last section appears, go sooner, even mid-diary.

Summed up, the example shows pain on 9 of 14 days, twice noted as "better after a bowel movement". Whether that fits IBS, and which type, is for your doctor to judge. Whether paper or an app suits you better is covered in symptom diary: paper template or app. If symptoms get worse around your period, log over several cycles; IBS before your period shows how.

What does Sam keep, and what does it leave out?

Under Digestive, Sam's symptom diary offers Abdominal pain, Abdominal cramps, Bloating, Excessive gas, Diarrhea, Constipation, Nausea and Indigestion. Each symptom gets one entry per day: mild, moderate or severe. There is no time of day, no note field and no body spot. Anything missing from the list, such as urgency or mucus, you can add under "Other" as your own symptom; the field takes only the name. Missed days can be added later in Health History.

Sleep duration comes from Apple Health, and Sam calculates sleep quality and a stress level from your sleep, heart rate and HRV data. Sam does not calculate a link between them and your gut days in the statistics or the monthly report. Whether there is one is a question for your doctor.

Your medicines go in the medication list. Sam reminds you at set times, not for as-needed medicines; you tick those on today's symptom sheet under "Took something?".

The symptom diary has no Bristol scale, no count of bowel movements, no meals, no trigger tagging and no FODMAP tracking, and Sam has no separate diary for IBS. What else Sam shows for this condition is on the IBS page.

Heartburn is in the symptom list too. Once a doctor has confirmed reflux, Sam has a separate reflux diary.

You can log "Blood in stool" as a symptom, marked as present. The monthly report counts it as a symptom day like any other and does not single it out. Blood in your stool is a reason to call your doctor today, not something a diary handles.

What is in the monthly report, and what is not?

You create the monthly report for the previous month yourself. It needs notifications allowed, Apple Health access and your answer about chronic conditions saved. From the second report on, you must also have logged how you felt on at least 15 of the last 30 days: Good, A bit off or Sick. Symptom entries do not count toward that.

The "Lifestyle & Symptoms" page shows your symptom days on a calendar, the days with no symptom logged and your five most logged symptoms. The report also prints a general sentence on symptom days, for example that several in a row usually belong to one episode. The sleep, stress and activity pages print general recommendation lines. None of it is a medical assessment or about your gut.

The strength per day, stool type, meals and a medication list are not in the report.

When should you not wait for your appointment?

These signs need an urgent appointment today, even if you already have an IBS diagnosis:

• Blood in your stool, bleeding from your bottom or bloody diarrhea.
• Losing a lot of weight for no reason.
• A hard lump or swelling in your tummy.
• Symptoms that suddenly get much worse.
• Shortness of breath with palpitations and paler skin than usual.

Outside practice hours, use your local out-of-hours service (NHS 111 in the UK).

Also get these checked before anyone calls it IBS, and if you already have an IBS diagnosis:

• Fever.
• Anemia on a blood test.
• Unusual paleness.
• Symptoms that keep getting worse.
• Diarrhea that wakes you at night.
• Symptoms that first started after age 50.
• Smaller unintended weight loss.
• Bowel cancer, inflammatory bowel disease or celiac disease in your family.

These lists are not complete and are not a self-test. New or lasting bowel symptoms are worth a doctor's visit even without any of these signs. The first list follows the signs for which the NHS advises an urgent GP appointment or NHS 111. IQWiG, the German health information institute, says blood in the stool should as a rule be checked by a doctor. It also says marked weight loss, fever or paleness point more toward another bowel disease. The German S3 guideline names, among others, fever and other signs of inflammation, anemia, weight loss, blood in the stool and steadily worsening symptoms. A 2023 American Family Physician summary of the American Gastroenterological Association guideline adds nocturnal diarrhea, onset after 50, iron deficiency anemia and the family history.

Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US) for stomach pain that starts suddenly and is severe. The same applies to a lot of blood from your bottom, black sticky stool, or vomiting blood or vomit that looks green or like ground coffee. Not being able to pass stool or wind at all, struggling to breathe, and sudden chest pain or pressure also need an emergency call. Do not wait for it to pass. Sam is not built for this: it replaces neither an emergency call nor an examination.

Log your gut days in Sam and bring the monthly report

You walk in with counted gut days instead of "it comes and goes", without counting them up the night before.

• Instead of a note lost in a drawer: you tap abdominal pain, bloating, diarrhea or constipation per day as mild, moderate or severe. Missed days can be added later.
• Instead of sleep data in a second app: sleep and stress level from your Apple Health data sit in the same app, a few taps away.
• Instead of a tally sheet: you create the monthly report yourself; the PDF shows your symptom days on a calendar and your five most logged symptoms.

The symptom diary keeps no stool type, stool count, times of day or meals, so paper stays useful for those. The report has requirements, listed above. More on the IBS page.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• What kind of doctor for IBS? Colonoscopy and blood tests
• IBS before your period: what to log across your cycle
• Symptom diary: paper template or app?
• Heartburn doctor appointment: log your nights
• Doctor appointment checklist for a chronic condition

Sources

Updated: October 2026

• NHS: Irritable bowel syndrome (IBS) - Diagnosis and Symptoms (reviewed 17 March 2025)
• NHS: Stomach ache (reviewed 20 October 2026)
• NHS: Chest pain (reviewed 8 August 2023)
• Arnold MJ: Practice Guidelines: Irritable Bowel Syndrome. Am Fam Physician 2023;108(5):527-529, Table 1 (summary of the AGA guideline)
• DGVS and DGNM: S3 guideline on irritable bowel syndrome, 2021 update (PDF). Layer P et al., Z Gastroenterol 2021;59:1323-1415, AWMF 021-016 (as of June 2021, validity estimated to 2026; being updated per DGVS; in German)
• IQWiG (gesundheitsinformation.de): Reizdarmsyndrom (updated 22 February 2023, in German)
• GI & Hepatology News (AGA): Rome V criteria capture more people with IBS, but a milder group (20 August 2026)