What to tell your GP about gut symptoms

Tell your GP four things: the pattern of your symptoms, when they started, what makes them better or worse, and what you have already tried. Write them down with dates before you go. If you think you might have IBS and have had symptoms for over 4 weeks, that is the point to book.

This page is about the conversation, not the answer. Nothing here tells you what is wrong, because that is your GP’s job, and they need good information from you to do it.

What does a GP need to hear about stomach problems?

Something they can sort into a shape. “My stomach has been bad for ages” gives them little to work with, and the detail people most often leave out is the timing. Awful since February tells a GP far more than awful. So does a note that it mostly happens on work days.

Four things do most of the work.

The pattern. How the symptom behaves, not only what it is. Is it there every day or does it come in bouts? Does it wake you at night? Has your bowel habit moved towards looser, harder, more often or less often?

The timing. When did it start, and has it changed since? Abdominal pain or discomfort, bloating and a change in bowel habit are the symptoms that national guidance asks GPs to consider for IBS, so how long you have had each one is part of the decision.

What changes it. Eating, a particular meal, stress, your period, being on nights, a bout of food poisoning, a new medicine. Symptoms made worse by eating are among the things clinicians look at, so mention a link to meals even if you are not sure of it.

What you have already tried. Any medicine bought over the counter, any food you have cut out, and whether it made a difference. This matters more than people expect, because cutting something out can change what some tests will show.

If you want a ready made format for those notes, a symptom log for your GP has one.

How much can a short GP appointment cover?

One problem, properly. Less than most people hope. Professor Kamila Hawthorne, as Chair of the Royal College of GPs, said “the College has called for 15-minute GP appointments as standard, and longer for those who need it”, which tells you the standard slot is currently shorter than the College thinks it should be.

A realistic appointment covers your account of the symptom, some questions back, often an examination, and a decision about what happens next. It does not usually stretch to three unrelated worries. So lead with your single most important thing in your first sentence, and if you do have a list, say so at the start so the GP can decide what fits today and what needs another booking. Handing over your written notes is quicker than remembering under pressure.

What questions should I ask my GP about gut symptoms?

These, near the end, tend to save a second appointment.

• What do you think is most likely, and what are you ruling out?
• Is there a test, and what will it tell us that we do not know now?
• How long will results take, and who contacts whom?
• What should I do if it gets worse before then?
• Is there anything I should not change in the meantime, such as my diet, in case it affects a test?

That last one matters. If coeliac disease is a possibility, Coeliac UK is clear that “it’s essential to continue eating gluten until your doctor makes a diagnosis”, because stopping beforehand is “very likely to cause an inaccurate result for both the blood test and the gut biopsy”.

And if food hasn’t come up, ask about it. When I was told I had IBS, the doctor listened to my stomach for a minute and wrote a prescription for antispasmodics. Nobody asked what I ate. You are allowed to bring it up yourself. If you are told it is IBS and want to know what that diagnosis rests on, how IBS is diagnosed in the UK sets it out.

Which gut symptoms should not wait?

These ones. Stop reading this page and contact a GP or NHS 111 if any of them apply to you. The wording below is the NHS’s own, quoted from its IBS, stomach ache and rectal bleeding pages.

Ask for an urgent GP appointment or get help from NHS 111 if:

• “you have lost a lot of weight for no reason”, or you are “losing weight without trying to”
• “you’re bleeding from your bottom or have bloody diarrhoea”, or “your poo is black or dark red”
• “you find a hard lump or swelling in your tummy”
• “you have shortness of breath, noticeable heartbeats (palpitations) and skin that’s paler than usual”
• stomach pain that “gets much worse” or “does not go away or keeps coming back”
• “bloating that does not go away or keeps coming back”
• “problems with swallowing food”
• “diarrhoea that does not go away after a few days”
• you have stomach pain and are pregnant

See a GP if “you’ve had blood in your poo for 3 weeks” or “your poo has been softer, thinner or longer than normal for 3 weeks”.

Call 999 or go to A&E if a stomach ache “came on very suddenly or is severe”, if “it hurts when you touch your stomach”, if “you’re vomiting blood or your vomit looks like ground coffee”, if “your poo is bloody or black and sticky and extremely smelly”, if “you cannot pee”, or if “you cannot poo or fart”.

You can reach NHS 111 by calling 111, or online at 111.nhs.uk for people aged 5 and over. Call 999 if you have signs of a life threatening illness. If you are unsure which service fits, NHS 111, GP or pharmacy for gut symptoms goes through it.

Why does my GP ask about weight loss and bleeding?

Because national guidance tells them to. NICE guideline CG61 asks clinicians assessing possible irritable bowel syndrome to examine people for red flag indicators and to refer to secondary care if any are present, including signs and symptoms of cancer as set out in NG12.

NG12 sets out when a GP offers further testing. For example, it recommends a quantitative faecal immunochemical test to guide referral for suspected colorectal cancer in adults with an abdominal mass, a change in bowel habit or iron deficiency anaemia, among other groups, and a suspected cancer referral if that result is at least 10 micrograms of haemoglobin per gram of faeces.

You do not need to work out where you sit in any of that, and you should not try. The useful thing you can do is give accurate dates and an accurate account, so the person applying the guideline is working from something real.

What should I do after the GP appointment?

Write down what was said before you leave the car park: any test, any timescale, and what you were told to do if things change. A safety net instruction, such as come back if this happens, is an instruction, not a formality. If you are still working out what you are dealing with, the bloating quiz is a place to start sorting your notes.

If your symptoms change in any of the ways listed above while you are waiting, contact the practice again rather than waiting for the original appointment or result.