NZ IBS Primary Care Navigator

01

Does the presentation fit IBS?

Rome V-informed clinical assessment

Recurrent abdominal pain and/or discomfort

Is it bothersome or affecting the patient’s usual function?

Is it associated with at least two of the following?Related to defaecation (better or worse)Change in stool frequencyChange in stool form / appearance

Why? · Evidence

The IBS symptom pattern requires pain and/or discomfort associated with at least two of these three bowel features. Rome V re-introduces “discomfort”, lowers the symptom threshold and separates research criteria from clinical diagnostic criteria. This navigator therefore uses clinical judgement, bothersomeness and functional impact rather than excluding a plausible presentation because it misses a research duration or frequency cut-off.

Rome Foundation: Rome V ↗

02

Safety check

Select any present or clinically suspected

Age when these symptoms first began

Rectal bleeding not clearly benign or melaenaIron-deficiency anaemia or abnormal FBCUnintentional weight loss or systemic illnessNocturnal diarrhoea, fever or severe/progressive symptomsAbdominal/rectal mass or abnormal examinationRelevant family history of colorectal cancer, IBD or coeliac diseaseNew persistent bowel change later in life or cancer concernPerianal fistula/abscess or extra-intestinal IBD features

Why? · Evidence

New-onset symptoms at age ≥50—and a lower threshold from age 40 for Māori and Pacific peoples—warrant colorectal pathway consideration. The 2026 Health NZ pathway generally uses symptomatic FIT and clinical risk rather than age alone to determine colonoscopy.

Health NZ lower bowel guidance ↗bpacnz IBD ↗

03

Target the investigations

Avoid a blanket “IBS panel”

Baseline tests already completed and reassuringFBC, CRP, coeliac serologyMeaningful diarrhoea is presentOpens IBD, infection and microscopic colitis prompts

04

Classify and prioritise

Use the predominant clinical bowel pattern

Which pattern best describes this patient?

Dominant symptom / patient priority

05

What has already been tried?

Select adequate, tolerated trials — the plan will move forward