Red Flag Symptoms


What are the red flag symptoms

– (Warning signs that what you have is not IBS)

When doctors diagnose IBS they use the Rome III criteria. But they also check for warning signs (‘red flag’ symptoms) that need further investigation.

Warning Signs / Red Flag Symptoms

  1. Dysphagia (difficulty swallowing)
  2. Gastrointestinal bleeding (blood in vomit or stool)
  3. Iron deficiency or anaemia
  4. Unexplained weight loss
  5. A family history of GI cancer, IBD (Inflammatory Bowel Disease) or Coeliac disease
  6. New onset of symptoms over the age of 50

If you have any of these warning signs, it is strongly recommended that you visit your doctor as soon as possible for a diagnosis.

Ruling out these warning signs is part of ‘exclusionary diagnoses’. This can be quite an arduous and stressful process, but it’s often necessary.

Ruling out infections, small intestinal bacterial overgrowth and coeliac disease is recommended for all patients before a diagnosis of IBS is made.

Doctors also generally ask patients to cut dairy out of their diets for a period of at least two weeks to see if lactose is causing problems. Lactose is a common trigger for IBS symptoms, especially for diarrhoea predominant IBS.

In people over 50 years old, it is often recommended a screening colonoscopy be conducted.

Once the warning signs are excluded, doctors will give you a positive IBS diagnosis with the Rome III criteria.

Rome III defines IBS as recurrent stomach pain or discomfort three days per month for three months, together with two or more of the following symptoms:

  • Improvement when the stomach works
  • And/or onset associated with a change in frequency or stool
  • And/or associated with a change in form (appearance) of stool

What’s a normal frequency you might ask? Well, if it’s normal for you to go to the toilet once in up to three days without apparent issues, and that’s what you do regularly, then that’s normal. If you go once or twice a day, and that’s what you do regularly, then that’s normal too.

Once you’ve got a positive diagnosis, your doctor will then advise you on the best way to manage your IBS, depending on the severity of symptoms. This is most often includes a combination of medication and lifestyle advice, directed at your predominant symptoms.

Please note that it is not a good idea to try and diagnose yourself – the consequences of a misdiagnosis can be severe. So visit a healthcare professional (its better if they’ve dealt with other IBS patients before) and get a proper diagnosis: after all, you might not have IBS at all.

One final note. IBS sufferers often experience a lot of different symptoms, not only constipation, diarrhea and abdominal pain. These other symptoms are not, generally speaking, a warning sign for something else. With that, here’s a list of non-alarm symptoms. They can be treated and you should tell your doctor about them if they don’t ask, but they aren’t something your doctor is likely to worry about to much.

Non-alarm Symptoms:

  1. Oro-faecal/ oro-colonic reflex (food going ‘straight through you’)
  2. Bloating
  3. Underlying depression / anxiety / stress (sometimes related to significant past life events)
  4. Mucous
  5. Incomplete Evacuation

Is all this confusing? Learn more about IBS or ask us.