Questions to ask if you’re not getting relief—and how to build a care team that addresses the root causes
Written by Anna Katherine Black, PhD
Licensed Clinical Psychologist
GI Psychology
If you’re living with Irritable Bowel Syndrome (IBS) and finding that your current plan just isn’t cutting it, you’re not alone. Many people with IBS try several interventions—diet changes, medications, lifestyle tweaks—only to still feel stuck. In this post, we’ll walk you through when it’s time to revisit your plan, what questions to ask, how to build a better care team, and how focusing on root causes (not just symptom relief) can make a real difference.
What Is IBS, Really?
IBS is a chronic gastrointestinal condition characterized by abdominal pain and altered bowel habits (such as diarrhea, constipation, or a mix) without an underlying structural disease (Lacy et al., 2021). It is now classified as a type of disorder of gut–brain interaction (DGBI)—meaning the gut and the brain communicate in ways that influence symptoms (Lacy et al., 2021).
Because of this, treatment often needs to look beyond simply “fixing the bowels” and consider mood, stress, diet, and brain–gut signals.
When Should You Consider Rethinking Your Plan?
Ask yourself the following questions. If you answer “yes” to any of these, it may be time for a fresh approach.
1. Are your symptoms persistent or worsening?
Despite treatment, you’re still experiencing frequent pain, unpredictable bowel habits, or major flare-ups. When IBS meets the criteria for diagnosis, pain happens at least once a week and is associated with a change in stool frequency or form (Lacy et al., 2021). If it’s getting worse, or medication/diet changes aren’t helping, that’s a red flag.
2. Have you only treated the symptoms and not the causes?
Many treatments for IBS focus on relieving immediate issues—constipation, diarrhea, or pain—but if underlying contributors like gut–brain dysregulation, stress, diet triggers, or microbiome imbalance aren’t addressed, you may keep spinning your wheels. Diet plays a major role in IBS for many patients. If your current plan doesn’t include diet, stress, or brain-gut support, it might be incomplete.
3. Do you feel stuck alone in managing it?
IBS often requires a team: a gastroenterologist, dietitian, and a gut-brain psychologist/therapist. If you’re only seeing one provider and still not improving, broaden your care team (American Gastroenterological Association [AGA], 2022).
4. Are you still avoiding life because of IBS?
If you’re skipping social events, avoiding travel, missing work or school, or your mood/self-esteem have suffered because of IBS, then while symptom relief matters, so does quality of life (Lacy et al., 2021).
Questions to Ask Your Provider
Once you’ve decided it’s time for a new plan, take a list of questions to your provider(s). These help ensure you’re getting root-cause-oriented care, not just band-aid solutions.
- “Based on the Rome IV criteria, do I still meet criteria for IBS, and have other possible causes (like inflammatory bowel disease or celiac disease) been ruled out?” (Lacy et al., 2021)
- “What lifestyle, diet, or stress-management factors have we covered? Can you refer me to a dietitian or gut-brain therapist?”
- “Are we monitoring beyond the gut—for example, mental health, sleep, microbiome, nutrition, and brain–gut communication?”
- “If medications have been used, what are the next steps in case they don’t work? Are there alternative medication strategies or gut–brain therapies recommended by guidelines?” (Lacy et al., 2021; AGA, 2022)
- “How will we measure progress—beyond symptom relief? Are we looking at quality of life, emotional well-being, or daily functioning?”
Building a Care Team That Works
Here’s how you can assemble a care team to address root causes of IBS:
Gastroenterologist or GI Specialist
Choose one familiar with disorders of gut–brain interaction and the gut–brain axis. The ACG guideline for IBS highlights the importance of a structured diagnosis and treatment plan (Lacy et al., 2021).
Registered Dietitian (RD)
Diet is central: Many patients benefit from structured diet plans like the low-FODMAP diet or traditional IBS diet advice (Rome Foundation, n.d.). A skilled RD can guide you through trigger identification, reintroduction, and sustainable habits.
Gut-Brain Therapist
Since IBS involves the brain–gut connection, therapies such as cognitive-behavioral therapy (CBT) for GI or gut-directed hypnotherapy improve outcomes when symptoms persist (Lacy et al., 2021). Including mental-health support helps with stress, anxiety, coping, and quality of life.
Primary Care / Supportive Team
Many IBS patients have overlapping conditions—like fibromyalgia or anxiety—so a holistic perspective is key (National Institutes of Health [NIH], 2024).
You (Yes—You!)
You’re your own best advocate. Track symptoms, lifestyle, triggers, mood, and function. Share that data with your team and stay engaged.
How to Address Root Causes—Not Just Band-Aids
Here are key strategies you and your team should address:
1. Diet & Lifestyle
Start with traditional dietary advice for IBS: regular meals, adjusted fiber, adequate fluids, lower caffeine/alcohol, smaller frequent meals, and lower fat intake (Rome Foundation, n.d.). If that isn’t enough, consider a low-FODMAP diet under the guidance of a dietitian. The ACG guideline supports a limited low-FODMAP trial for global symptom improvement (Lacy et al., 2021).
2. Gut–Brain and Psychological Factors
Since IBS is a disorder of gut–brain interaction, treatments may include gut-directed psychotherapy, hypnotherapy, mindfulness, or stress-management strategies (American Psychological Association [APA], 2023). Addressing mood, anxiety, sleep, and stress often improves GI symptoms.
3. Medications—Tailored to Subtype
If you have IBS-C (constipation-predominant) or IBS-D (diarrhea-predominant), medication choices differ. Recent AGA guidelines recommend symptom-driven, personalized drug strategies (AGA, 2022). Ask your provider whether your medication strategy is still the best fit for your subtype and severity.
4. Monitor, Adapt, and Review
Treatment isn’t “set it and forget it.” If you don’t improve in 3–6 months, or if your life is still restricted, revisit your plan.
Real-World Patient Tip
Sarah’s story: Sarah had IBS for five years and relied on over-the-counter medications. After consulting a new gastroenterologist who confirmed her diagnosis per Rome IV criteria, she began a low-FODMAP trial with a dietitian and added gut-directed CBT and clinical hypnosis with a GI psychologist. Six months later, she had fewer flare-days, less anxiety, and a better social life. After improving her gut-brain connection, she was able to reintroduce a variety of foods to her diet (without symptoms) and return to living her life.
Takeaway: By re-evaluating her plan and addressing diet, stress, and gut–brain communication, Sarah moved from “just coping” to living better.
Conclusion & Takeaways
If you’ve been living with IBS and your current plan feels stale or ineffective, it’s worth asking: Is it time to rethink my treatment plan?
- IBS is a disorder of gut–brain interaction, not just a bowel problem.
- If symptoms persist or limit your life, revisit your care plan.
- Ask about diagnosis, diet, stress, and root causes.
- Build a team: GI specialist + dietitian + gut-brain therapist + you.
- Focus on root causes, not just symptom relief.
Ready to take the next step? Explore our resources, schedule a free consultation, or reach out at admin@gipsychology.com to learn how a gut–brain-focused care team can support you.
References
American Gastroenterological Association. (2022). Pharmacological management of irritable bowel syndrome with diarrhea (IBS-D). Gastroenterology. https://gastro.org/clinical-guidance/pharmacological-management-of-irritable-bowel-syndrome-with-diarrhea-ibs-d/
American Psychological Association. (2023). Understanding the gut-brain connection. https://www.apa.org/news/press/releases/2023/07/gut-brain-connection
Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2021). ACG clinical guideline: Management of irritable bowel syndrome. American Journal of Gastroenterology, 116(1), 17–44. https://doi.org/10.14309/ajg.0000000000001036
National Institutes of Health. (2024). IBS: Symptoms, causes, and treatments. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndromeRome Foundation. (n.d.). Diet in irritable bowel syndrome (IBS). https://theromefoundation.org/diet-in-irritable-bowel-syndrome-ibs/