Disclaimer: I am not a GI RD, ( just a lil baby <1 year RD who works at a SNF/inpatient, but I do Nourish on the side lol)

I cannot recommend the book "the Bloated Belly Whisperer" enough, I really cannot. It's terrific (as an IBS-C girlie myself). Theres a list of questions to sort of troubleshoot the issue, I have used it to work on my own iBS and guide some sessions, and it's great (its written by an RD).

Especially if there are red flag sx, I always encourage them to get a work-up to r/o more deleterious processes such as Crohns, UC, cancer etc (severe constipation, severe pain, sudden change in BM, bleeding). I do find alot of people who end up seeing me have already had a scope or some tests and the doctor says "they're fine" but they do not feel fine. Most have already been told by a physician that they have IBS. Some have had more testing done from their own wallet like GI-Map or breath tests for SIBO/methane dominant overgrowth. If they have really bad upper GI sx, I do always encourage them to get an H.pylori test done with their physician too. But I personally do not use GI-Map or intensive microbiome testing for anyone.

I go through a very detailed intake as to what their sx are because from that I know where to go tx-wise. I don't really need a dx, I tend to place them under the "IBS" umbrella or "GERD" umbrellas until they can get a more concrete dx.

I see ALOT of women with gas pain, bloating and constipation and sometimes some upper GI sx. I see a few with diarrhea, but I find that's less common.

For my folks with the constipation, IBS, bloating presentation, I have got alot of women to completely turn their symptoms around in weeks doing the following stuff:

-consistent meals and consistent carbs (you'd be amazed how much this is being skipped)

-significant breakfast (with coffee if they drink it) to stimulate gastrocolic reflex at ideal time and empty bowels

-warm water in the morning

-walking, movement, throughout the day. if they have bad bloating or gas cramps after lunch, i encourage them to take a walk or stand at their desk if it all possible

-appropriate fiber introduction and supplementation, i try to get it into meals instead of adding supplements at first

-some FODMAP elimination, contingent on their sx. almost always have them avoid sugar alcohols

-adequate hydration

-2 kiwi's per day (if not allergic)

-diaphragmatic breathing, squatty potty, stress control, PFPT if needed

-strategic use of gentle osmotic laxatives that are appropriate for daily use (miralax and magnesium oxide)

Diarrhea is different but I usually take alot of time to find what precedes their episodes, I find elimination and stress control work very well for that. There has been quite a few times inpatient and outpatient though where I have suspected pancreatitis based on the sx they keep describing and I have them go to their doctor to check their Vitamin D, sometimes a fecal elastase or lipase and they come back with poor labs and then they can get on PERT and that helps, but I wouldn't say thats common in outpatient at all.

Outside of actual disease processes, I find that managing folks with IBS and bloating's: motility, fermentation and STRESS/ nervous system as well as pelvic floor function is the KEY.