Irritable bowel syndrome (IBS) is diagnosed based on clinical criteria of regular abdominal pain and disordered defaecation. If first-line treatments such as lifestyle changes fail, patients with diarrhoea-predominant IBS may respond to rifaximin, eluxadoline or, for women, alosetron, if tolerated. For constipation-predominant IBS, options are tegaserod for younger women, and the secretagogues linaclotide, plecanatide, lubiprostone and tenapanor. As IBS is a gut-brain interaction disorder, neuromodulators such as tricyclic antidepressants may help.