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IBS guide

Irritable bowel syndrome (IBS): help with food, fiber, and medicine

For adults 18 or older whose IBS was already diagnosed by a doctor, nurse practitioner, or physician assistant, and whose symptoms are the same as they usually are.

Start online

Start a $59 online review for Irritable bowel syndrome (IBS).

IBS is a common gut problem. It causes belly pain with constipation, diarrhea, or both. It can come and go. This visit is for IBS that a doctor, nurse practitioner, or physician assistant has already told you that you have. The doctor reads your answers and sends a plan. Signs that need an exam, or a different kind of care, send you there before you pay.

If treatment is appropriate, your physician can send a non-controlled prescription to your pharmacy and provide portal instructions for the next step.

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Already in ongoing care with us for this? Check-ins are $39 (your first one is free).

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Quick facts

  • You must be physically located in Virginia or West Virginia at the time of request.
  • Starts at $59
  • No insurance needed
  • No app download
  • Physician review around the clock
  • Non-controlled prescriptions can be sent to your pharmacy when appropriate
  • A work or school note can be included when medically appropriate
  • Response times apply 24/7, every day

Common symptoms

  • Belly pain that comes and goes
  • Constipation, diarrhea, or both
  • Bloating or cramps
  • Symptoms that follow your usual pattern

May fit online care

  • Adults 18 and older
  • You are 18 or older
  • A doctor, nurse practitioner, or physician assistant has told you that you have IBS
  • Your symptoms are the same as they usually are
  • For a diarrhea medicine, you had a celiac blood test and a stool or blood test for inflammation, and both were normal
  • None of the warning signs below apply to you

Look for another care setting

  • Sudden severe abdominal pain, fainting or collapse, vomiting blood, or heavy or ongoing bleeding from the rectum (call 911 or go to the ER now).
  • Blood in the stool, or black, tarry stool (call 911 or go to the ER now).
  • A hard or rigid belly, no stool and no gas passing at all, a swollen belly together with vomiting, or green vomiting (call 911 or go to the ER now).
  • Signs of dehydration: confusion, severe dizziness on standing, no urination for 8 hours or more, or not being able to keep down any fluids (call 911 or go to the ER now).
  • A fever, vomiting that keeps coming back, belly pain so bad that you cannot do your usual things, or feeling dizzy or lightheaded or not able to drink enough to keep up with diarrhea or vomiting (go to the ER or urgent care today).
  • New diarrhea after antibiotics in the past 3 months (see a doctor in person within 2 days).
  • Anemia (a low blood count) or unexplained weight loss, belly pain that keeps getting worse over days or weeks, diarrhea that wakes you from sleep, a new or steadily changing bowel pattern, or bowel symptoms that began in the last 12 months at age 45 or older (see a doctor in person within 7 days).
  • IBS symptoms that are different from your usual pattern, or bowel symptoms that were never diagnosed as IBS by a clinician (see your own doctor).
  • Age 45 or older and not up to date on colon cancer screening, or not sure (see your own doctor).
  • Pregnancy or possible pregnancy (see your own doctor, such as your pregnancy doctor or midwife).
  • An unresolved question of celiac disease or inflammatory bowel disease, or a family history of colon cancer, IBD, or celiac disease that was never evaluated (see your own doctor).
  • A known blocked or narrowed bowel, or bowel surgery in the past 30 days (see your own doctor).
  • Very restricted eating, an eating disorder, or concern about nutrition (see your own doctor).
  • A celiac or inflammation test that was not normal, or results you are still waiting for (see your own doctor).
  • Under 18 (see your own doctor).

What to have ready

  • What you have tried so far, like fiber, diet changes, or medicines, and what helped
  • Any celiac or inflammation test results, and the date of any earlier rifaximin (Xifaxan) course
  • Every medicine you take, including heart, antibiotic, and antifungal medicines
  • If you are 45 or older, when you last had colon cancer screening

What happens next

Standard

$59

Within 6 hours

Priority

$99

Within 3 hours

Rush

$149

Within 1 hour

Start the request on the website, answer a few questions to check that this visit fits you, and choose how fast you want an answer (the response window). If your concern still fits this service, a physician reviews it and sends you a secure update after you sign in. When appropriate, non-controlled prescriptions can be sent to your pharmacy, and a basic work or school note can be included at physician discretion.

How does the visit work?

The doctor reads your answers and sends a plan. Keep a food and bowel diary. Eat at regular times. Stay active and sleep well. Add a fiber called psyllium slowly. Mix one packet, about 3.4 grams of psyllium, in a full glass of water once a day. Later you can add more, up to 3 a day. Take it 2 or more hours before or after other medicines. Do not use it if you have trouble swallowing. Capsules of peppermint oil with a coating can help pain. Follow the label. You can also try a low FODMAP diet for a short time. Add foods back after that. A dietitian can help. Do not start a gluten-free diet before you ask your own doctor about a celiac test.

What if constipation is my main problem?

You can add polyethylene glycol powder from the store. Mix 17 grams in 4 to 8 ounces of a thin drink and take it once a day. Do not mix it with a thickener for swallowing. Stop it if you get diarrhea. If that is not enough after a few weeks, the doctor may send linaclotide or plecanatide. Take linaclotide, 290 micrograms, once a day on an empty stomach, at least 30 minutes before a meal. Take plecanatide, 3 mg, once a day, with or without food.

What if diarrhea is my main problem?

We can suggest or send a medicine for diarrhea only if you had a celiac blood test and a stool or blood test for inflammation, and both were normal. If you did not have those tests, you can still use the food and fiber plan. This visit cannot order the tests. Ask your own doctor about them. If your tests were normal, you can use loperamide from the store. It comes in 2 mg capsules or tablets. Take 2 after the first loose stool. Then take 1 after each loose stool. Never take more than 4 in 24 hours. Message us if you need it on most days for more than 2 weeks. If your diarrhea is different from your usual, follow the warning signs. The doctor may also send rifaximin, 550 mg. You take it 3 times a day for 14 days.

How do I use these medicines safely?

Tell us about any allergy to these medicines. Tell us if you have liver or kidney disease, trouble swallowing, or a heart rhythm problem. Tell us if you take pain medicine from the opioid family most days. Tell us if you are breastfeeding or trying to get pregnant. Tell us if your diarrhea began after travel, camping, untreated water, or a stomach bug. Tell us if you were on a gluten-free diet when you had your celiac blood test. Tell us if you take warfarin or another blood thinner that needs blood tests. The doctor will not send rifaximin if you do. Tell us if you take itraconazole, gemfibrozil, ritonavir, quinidine, or cyclosporine. The doctor may leave out some medicines for you.

When do I stop a medicine and get help?

Stop the medicine and call 911 or go to the ER now if you get hives, swelling of your lips, tongue, or face, or trouble breathing. Call 911 or go to the ER now if you have chest pain, vomiting, or trouble swallowing or breathing after psyllium. Call 911 or go to the ER now if you have a fast or uneven heartbeat, or you faint, while you use loperamide. If your belly gets hard, or you cannot pass any stool and any gas, or your belly swells and you vomit, call 911 or go to the ER now. If your belly only swells or bulges, stop it and go to the ER or urgent care today. Linaclotide or plecanatide can cause severe diarrhea. If that happens, stop it and drink fluids. Then, if you faint, are confused, feel very dizzy when you stand, have not peed in 8 hours or more, or cannot keep any fluids down, call 911 or go to the ER now. If you feel dizzy or lightheaded, or cannot drink enough to keep up with the diarrhea, go to the ER or urgent care today. If none of that happens, stop it and message us. Rifaximin can lead to a serious gut infection. If your diarrhea gets worse during or after it, see a doctor in person within 2 days. If peppermint oil gives you heartburn, stop it. If polyethylene glycol gives you diarrhea, stop it and message us.

When do I need care right away?

Call 911 or go to the ER now for sudden, severe belly pain, fainting, vomit with blood, heavy bleeding from your bottom that does not stop, blood in your stool or black, tarry stool, a hard or rigid belly, no stool and no gas passing at all, a swollen belly with vomiting, or green vomiting. Also call 911 or go to the ER now for confusion, very bad dizziness when you stand, no pee for 8 hours or more, or if you cannot keep any fluids down. Go to the ER or urgent care today for a fever, vomiting that keeps coming back, belly pain so bad that you cannot do your usual things, or feeling dizzy or lightheaded, or not being able to drink enough to keep up with diarrhea or vomiting.

Will I need a check-in?

If you start a daily prescription, we will ask you to check in after about 2 weeks. That first check-in is free. If you are not better after 4 weeks of this plan, message us. If any warning sign starts, get care as shown above. Do not wait for our reply.

Other conditions we treat

Not quite what you have? Here are other conditions we treat.

Diarrhea (sudden & traveler's)Anal fissureAnal itchingBloating & gasConstipation (functional)Heartburn & acid reflux (GERD)
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