This is a useful tool that can help you
track down stressors,triggers and medication issues pertaining to IBS.
Fill these out for a period of time and present them to your doctor so they can
knowledgeably treat your symptoms.
| Pain | Bloating | Diarrhea | Constipation | Nausea | |
| Date/Time Symptoms Began. | |||||
| Date/Time Symptoms Ended. | |||||
| Rate the severity of symptoms: 1 = mild 10 = being the most severe. |
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What was I doing when symptoms began? (Identify your stressors. Were you at home, work, play, paying bills, family function etc.) |
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| Food Eaten prior to symptoms. | |||||
| Amount of Food Eaten: 1) Less than normal 2) Normal 3) A bit more than normal 4) Excessive amount. |
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| Medications tried. | |||||
| Notes: List suspected triggers, stressful situations, and medications tried. |
Do not try to treat your IBS on your
own, over use of laxatives, anti-diarrheals and supplements can cause new health problems.
Contact a health care provider for professional advice.
Please feel free to print off as many copies as you need.