Irritable Bowel Syndrome (IBS) is a change in the usual way you pass stool with feelings of bloating, diarrhea and/or constipation, mucus in the stool, and abdominal pain relieved with defecation. Diagnosing IBS requires these symptoms be present for 3 out of the last 12 months (can be non-consecutive) and that other diseases be excluded. Even with all these restrictions, irritable bowel remains one of the most common conditions we see- present in 15% of the population. Treatment can be challenging at times. Usually we recommend fiber therapy as a cornerstone of treatment. If this fails, then remedies based on symptoms are often attempted: antispasmotics for spasm, laxatives or Zelnorm® for constipation, cholesytramine, colestipol, or loperamide for diarrhea. There is some evidence that small bowel bacterial growth can produce IBS-like symptoms, and a portion of patients will respond to antibiotics. Likewise, a subset of patients with chronic pain will find anti-depressant medications very helpful in controlling their symptoms.