IBS Symptom Tracking Journal

Patient Information

Name: ___________________ Date Range: //___ to //___

Daily Symptom Log

Date: //___

Bowel Movements

• Number of bowel movements today: ___
• Stool consistency (Bristol Scale 1-7): ___
• Urgency: □ None □ Mild □ Moderate □ Severe

Pain/Discomfort

• Abdominal pain level (0-10): ___
• Location: □ Upper □ Lower □ Left □ Right □ All Over
• Duration: ___ hours

Associated Symptoms

• Bloating: □ None □ Mild □ Moderate □ Severe
• Gas: □ None □ Mild □ Moderate □ Severe
• Nausea: □ None □ Mild □ Moderate □ Severe

Diet Log

• Meals/Snacks:
  • Breakfast: ________________
  • Lunch: ________________
  • Dinner: ________________
  • Snacks: ________________

Triggers

• Stress level today: □ Low □ Medium □ High
• Foods that may have triggered symptoms: ________________
• Other potential triggers: ________________

Medications

• IBS medications taken: ________________
• Other medications: ________________

Notes

Other observations or concerns: ________________________

Bring this completed log to your next appointment with your gastroenterologist