A symptom monitoring record can be a very useful tool on your path towards relief from irritable bowel syndrome. Not only will this help you understand your own experience, it will also be useful to share with your doctor and other healthcare providers. They’ll usually want at least two weeks of symptom monitoring data if possible. Below, we describe the different aspects of symptom monitoring. Your action plan for this week will be to record your own personal information in a daily symptom monitoring record. 

• Rate your symptoms 

Identify the symptoms you had during the day, when you had them and how severe they were. Include things like stomach pain, constipation, diarrhea, bloating, wind and anything else you may have noticed (e.g., nausea, fatigue). For recurrent symptoms like diarrhea, you will also need to record the number of times it happened or the frequency of that symptom. Each time you go to the toilet and open your bowels counts as one time for the symptom record.

If you’re feeling creative, you can come up with your own way of rating your symptoms. Use a technique that works well for you. As a guide, you can use the following rating scale:

• 0= Not present
• 1= Present, not distressing
• 2= Mildly distressing
• 3= Moderately distressing
• 4= Severely distressing
• 5= Debilitating

E.g., Max identified that he was experiencing symptoms, including stomach pain (3), diarrhea (3), bloating (1), and nausea (2). His symptom ratings are contained in the brackets. Max also recorded that he had diarrhea 4 times that day.  The pain and nausea came on at 10:00am, the bloating at 12:00pm, and the diarrhea at 1:00pm. 

• Describe the situation and any triggers

What situation were you in when you first noticed your symptoms? Where were you? What happened that may have triggered your symptoms? What made you notice your symptoms? Note down details about how the situation and events played out. Include information about the context, your location, and things other people said or did. You can also note down anything else that you think may have triggered or worsened your symptoms, such as exercise or eating certain types of food. 

E.g., Max’s situation was listed as follows: “Slept poorly last night, so had coffee this morning. Felt nauseous around 10:00am and found it hard to concentrate on work. Went home from work early”. 

• Identify your thoughts, emotions and behaviours

Identify your main thoughts, emotions and behaviours that are related to your symptoms. For each category, include anything important that occurred just prior to your symptoms starting and anything important that happened afterwards. In other words, think about how you were before your symptoms came on and how you responded to them after they occurred. Include a ‘(b)’ next to important thoughts, emotions and behaviours that occurred beforehand, and an ‘(a)’ next to those that occurred afterwards. 

Be particularly mindful to note down any changes in your behaviour that occurred as a result of your symptoms. For example, did you avoid certain activities? Did you alter your eating patterns? Perhaps you took some medication? Note all of this down in your record. It can also help to think about and list any consequences of this behaviour. For example, perhaps you missed out on a friend’s birthday party or another special event.     

E.g., Max’s thoughts, emotions and behaviours are listed below. He identified that his reaction to the situation meant his work piled up and added to his stress even more. He had another poor night’s sleep, as he was worrying about work the next day. 

Thoughts: 

• “I’ve got so much to do” (b)

• “Can’t believe I left early again, I’ll probably lose my job soon” (a)
• “I can’t keep going like this, it’s unbearable” (a)

Emotions:

• Anxious (b)

• Sad (a)

• Hopeless (a)
• Guilty (a)

Behaviours

• Procrastinated (b)
• Went to bed. Avoided eating lunch and dinner Took some anti-nausea tablets. Ate a big meal late at night. Didn’t call my friend as planned. (a)
• List your meals for the day

Record information about the meals you had that day. This should include information about the types of food and drink you consume at each meal, what time you consume them, and how much you consume. Meal records are usually broken down into breakfast, lunch, dinner and snacks. If this breakdown doesn’t match your usual eating pattern, you can change the way you record the information to better suit your circumstances. 

You don’t need to be too specific about the size of the meal, just indicate whether it was small (S), medium (M), or large (L) by your usual standards. If you skipped a meal, you can record this as (NA) to indicate that the meal was not applicable. 

E.g., Max’s meal record included:

• Breakfast: Cereal & coffee (8am, L)

• Lunch: NA

• Dinner: NA
• Snacks: Fast food & chips (11pm, L)

As you can see, the symptom monitoring record is a great method for collecting data and assessing your symptoms. Over time, you can look for patterns in what triggers your symptoms, how your symptoms change over time, and how you tend to cope with them. With this information, it is possible to determine which of your current coping skills are effective, and which are making things worse. From there, you can start to make changes to manage your irritable bowel syndrome better.