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14 Ways to Reduce IBS Symptoms and Manage Flare-Ups

Author: RVLNSV PRASAD
Updated On: September 2026

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Written by RVLNSV PRASAD, health content writer and creator of HealthTipsToYou. This article is researched using information from trusted medical and public-health organizations and is written to provide clear, practical, evidence-informed health education. It is not a substitute for personalized medical advice, diagnosis, or treatment.

Medical Disclaimer

This article is for educational purposes only and does not diagnose or treat irritable bowel syndrome (IBS). If you have persistent, severe, new, or concerning digestive symptoms, speak with a qualified healthcare professional.

Quick Answer: What Are the Best Ways to Reduce IBS Symptoms?

The best ways to reduce IBS symptoms depend on your individual symptoms and triggers. Helpful approaches may include keeping a food and symptom diary, eating regular meals, adjusting fiber gradually, identifying personal food triggers, staying adequately hydrated, being physically active, managing stress, getting enough sleep, and working with a healthcare professional when symptoms persist.

Some people benefit from a structured low-FODMAP diet, while others may respond better to simpler dietary or lifestyle changes. There is no single IBS diet that works for everyone. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that different dietary changes can help different people with IBS, and treatment may also include medicines, probiotics, and mental-health therapies. NIDDK: IBS Treatment

The goal is not to eliminate every possible trigger from your life. A better goal is to understand your own pattern and find a manageable routine that reduces symptoms without creating unnecessary food restrictions.

Key Takeaways

IBS can cause abdominal pain, bloating, gas, diarrhea, constipation, or changes in bowel habits.
IBS symptoms can come and go, and different people can have very different triggers.
Keeping a food and symptom diary can help you identify patterns without immediately blaming a single food.
Increasing fiber too quickly may cause more gas and bloating, so gradual changes are important.
Stress and poor sleep may make symptoms harder to manage for some people.
Regular physical activity can be part of an overall IBS-management plan.
A low-FODMAP diet may help some people, but it should not automatically become a permanent highly restrictive diet.
IBS with constipation, IBS with diarrhea, and mixed IBS may require different approaches.
Persistent or concerning symptoms should be medically evaluated rather than automatically attributed to IBS.
The most effective plan is usually one that is personalized, practical, and sustainable.

Introduction

If you live with IBS, you may have already discovered something frustrating: advice that works for one person can make another person feel worse.

One person may complain that onions trigger bloating. Another may eat them without a problem. Someone with constipation may benefit from a gradual increase in certain types of fiber, while another person may notice more gas when they suddenly increase fiber intake.

That is why managing IBS is rarely about finding one perfect food list.

I believe one of the most useful ways to approach IBS is to think in terms of patterns rather than rules. Instead of asking, “Which foods must every person with IBS avoid?” it can be more helpful to ask, “What consistently seems to make my symptoms better or worse?”

IBS is a group of symptoms involving abdominal pain and changes in bowel movements. These changes can include diarrhea, constipation, or both. NIDDK explains that IBS occurs without visible signs of damage or disease in the digestive tract, although its symptoms can significantly affect everyday life. NIDDK: Irritable Bowel Syndrome

This article focuses on practical ways to reduce IBS symptoms while avoiding a common trap: becoming so focused on food restrictions that eating becomes stressful and unnecessarily complicated.

What Is IBS?

Irritable bowel syndrome is a digestive condition characterized by recurring abdominal symptoms and changes in bowel habits.

Common symptoms include:

Abdominal pain or cramping
Bloating
Gas
Diarrhea
Constipation
Changes in stool appearance
Changes in how often you have bowel movements
A feeling that you have not completely emptied your bowel
Mucus in the stool in some people

Symptoms can vary considerably. Some people primarily experience constipation, while others mainly experience diarrhea. Some experience both at different times. NIDDK: IBS Symptoms and Causes

IBS is also different from conditions such as inflammatory bowel disease. The symptoms may overlap, but they are not the same condition.

Because other digestive diseases can cause similar symptoms, you should not assume that recurring abdominal pain, diarrhea, constipation, or rectal bleeding is automatically IBS.

IBS Symptoms at a Glance

Symptom	What you may notice	What may influence it
Abdominal pain	Cramping, discomfort, or pain	Meals, bowel movements, stress, individual triggers
Bloating	Fullness or abdominal swelling	Certain foods, constipation, individual sensitivity
Gas	Increased passing of gas or discomfort	Food choices, swallowed air, bowel patterns
Diarrhea	Loose stools or urgency	Individual food triggers, bowel sensitivity
Constipation	Hard stools or difficulty passing stool	Fiber intake, fluid intake, activity, individual factors
Mixed bowel habits	Alternating constipation and diarrhea	Can require a more individualized approach

The important point is that the same symptom does not always have the same trigger.

For example, bloating may occur after a particular meal in one person but primarily during constipation or periods of stress in another.

Why IBS Triggers Are Different for Everyone

IBS management becomes easier to understand when you stop looking for a universal trigger list.

Food is one possible factor, but it is not the only one.

Other factors can include:

Meal size
Eating patterns
Certain carbohydrates
Caffeine
Alcohol
Stress
Sleep
Physical activity
Constipation
Diarrhea
Individual food tolerance

Mayo Clinic notes that IBS symptoms can be influenced by food and stress, while also explaining that stress may worsen symptoms without being the simple underlying cause of IBS. Mayo Clinic: IBS Symptoms and Causes

This distinction matters.

Telling someone with IBS that their symptoms are “just stress” can be dismissive and medically unhelpful. At the same time, ignoring the gut-brain relationship can mean overlooking a factor that genuinely influences symptoms.

14 Ways to Reduce IBS Symptoms

1. Keep a Food and Symptom Diary

One of the simplest ways to learn about your IBS pattern is to keep a short record of what happens before symptoms appear.

Instead of writing only:

“Bloating after lunch.”

Record several details:

What to record	Example
Meal	Rice, vegetables, and yogurt
Portion	Medium
Time	1:00 p.m.
Symptoms	Bloating
Bowel movement	Normal
Stress	Moderate
Sleep	6 hours
Exercise	20-minute walk

Try tracking consistently for about one to two weeks rather than changing five things at once.

The purpose is not to diagnose yourself. It is to look for repeatable patterns that you can discuss with a healthcare professional.

Mayo Clinic also recommends being aware of symptoms and potential triggers, including specific foods, when preparing for medical evaluation.

A common mistake

Do not assume that the food you ate immediately before symptoms is automatically responsible.

IBS symptoms can be influenced by several factors at the same time.

2. Eat Regular Meals Instead of Constantly Changing Your Routine

Irregular eating can make it difficult to understand your symptoms.

Some people find it easier to manage IBS when meals occur at reasonably predictable times rather than alternating between skipping meals and eating very large meals.

This does not mean everyone needs to eat exactly three meals a day.

The useful idea is consistency.

Try to notice whether your symptoms are associated with:

Long gaps between meals
Very large meals
Late-night eating
Eating rapidly
Frequent snacking
Certain meal combinations

Mayo Clinic includes eating regular meals among lifestyle approaches that may help people manage IBS symptoms. Mayo Clinic: IBS Diagnosis and Treatment

3. Increase Fiber Gradually When Appropriate

Fiber can be helpful, particularly for some people with constipation-predominant IBS.

But “more fiber” does not automatically mean “better.”

NIDDK explains that soluble fiber may be more helpful for IBS symptoms and warns that increasing fiber too quickly can cause gas and bloating.

If you are increasing fiber:

Start gradually.
Pay attention to bloating and gas.
Drink adequate fluids.
Notice how your bowel movements respond.
Discuss persistent constipation with a healthcare professional.

Examples of foods containing soluble fiber include oats, certain fruits, and legumes.

What not to do

Do not suddenly add a large amount of bran, raw vegetables, or fiber supplements because you read that fiber is “good for IBS.”

Your digestive system may respond poorly to a rapid change.

4. Identify Your Personal Food Triggers

One of the biggest mistakes in IBS management is assuming that every food on an online “IBS foods to avoid” list must be removed from your diet.

That approach can become unnecessarily restrictive.

Instead, identify foods that repeatedly correlate with your own symptoms.

Potential triggers may include:

Certain dairy products
Some wheat-containing foods
High-fat meals
Caffeine
Alcohol
Carbonated drinks
Certain fruits or vegetables
Foods containing fermentable carbohydrates

NIDDK notes that different dietary changes can help different people with IBS.

The word “different” is important.

Your goal is not to build the longest possible list of forbidden foods. Your goal is to discover the smallest number of changes that provide meaningful improvement.

5. Consider a Low-FODMAP Diet Carefully

The low-FODMAP diet receives a lot of attention in IBS discussions.

FODMAPs are certain carbohydrates that can be difficult for some people to digest or absorb. A structured low-FODMAP approach temporarily reduces certain high-FODMAP foods before foods are gradually reintroduced.

NIDDK notes that a healthcare professional may recommend a low-FODMAP diet for some people with IBS and may later recommend adding foods back gradually.

This is important because a low-FODMAP diet should not simply become:

“I must permanently avoid every food on this list.”

The goal is to identify tolerance and create the least restrictive diet that controls symptoms.

If dietary changes are complicated or you are struggling to maintain adequate nutrition, professional dietary guidance can be valuable. NHS guidance notes that a dietitian may recommend a low-FODMAP approach when general dietary and lifestyle changes have not helped. NHS: Further Help and Support for IBS

6. Drink Enough Fluids

Adequate fluid intake is an important part of general digestive health and can be particularly relevant when constipation is present or when you are increasing fiber.

However, drinking excessive amounts of water is not a cure for IBS.

Think of hydration as one piece of the overall picture.

You can also monitor:

Whether your urine is unusually dark
Whether constipation worsens when you drink less
Whether certain beverages trigger symptoms
Whether caffeine or alcohol appears to affect your bowel habits

Choose fluids that you personally tolerate well.

7. Stay Physically Active

Regular movement can be a useful part of an IBS-management routine.

You do not need an extreme workout program.

Depending on your abilities and health, physical activity might include:

Walking
Cycling
Swimming
Strength training
Yoga
Gentle mobility exercises

NIDDK lists increasing physical activity among lifestyle changes that may help IBS symptoms.

The key is consistency rather than intensity.

A 20- or 30-minute walk that you can maintain regularly may be more practical than an exhausting workout you abandon after a week.

If exercise itself seems to trigger symptoms, pay attention to timing, hydration, meal timing, and intensity rather than assuming exercise is inherently bad for IBS.

8. Manage Stress Without Blaming IBS on Stress

Stress management is worth considering, but the message needs to be balanced.

IBS is not simply “all in your head.”

At the same time, stress can influence digestive symptoms for some people.

Mayo Clinic notes that many people experience worse or more frequent IBS symptoms during periods of increased stress.

Possible approaches include:

Walking
Relaxation exercises
Meditation
Yoga
Breathing exercises
Regular physical activity
Talking with someone you trust
Professional psychological support when appropriate

The goal is not to eliminate every stressful event.

Instead, ask:

“What helps my body handle stress better?”

That is a more realistic question.

9. Protect Your Sleep Routine

Poor sleep can make an already difficult day feel harder.

NIDDK includes getting enough sleep among lifestyle changes that may help people manage IBS symptoms.

Try creating a predictable sleep routine.

Useful habits may include:

Going to bed at a consistent time
Limiting stimulating activities before bed
Keeping your bedroom comfortable
Avoiding very large meals immediately before sleep if they worsen symptoms
Addressing persistent sleep problems with a healthcare professional

Sleep is not a treatment that cures IBS, but it can be an important part of an overall routine.

10. Pay Attention to Meal Size and Eating Speed

Sometimes the issue is not only what you eat.

It may also be how much you eat at one time.

A very large meal can feel uncomfortable for someone who is already sensitive to abdominal stretching or bloating.

Try observing whether symptoms differ after:

Small versus large meals
Slow versus rapid eating
Eating while relaxed versus eating under pressure
Eating earlier versus very late at night

Do not assume that everyone with IBS needs small meals.

Use your own symptom pattern as the guide.

11. Develop a Predictable Bathroom Routine

If constipation or irregular bowel habits are part of your IBS pattern, your bathroom routine deserves attention.

Try not to routinely ignore the urge to have a bowel movement.

Allow yourself enough time and avoid unnecessary straining.

A bathroom diary can also help you notice:

Frequency
Stool consistency
Urgency
Whether you feel completely emptied
Whether symptoms improve after bowel movements

If constipation is persistent or severe, do not rely solely on home strategies. Medical advice can help determine whether additional treatment is appropriate.

12. Understand Your IBS Pattern: IBS-C, IBS-D, or IBS-M

IBS is not one identical experience.

Healthcare professionals commonly describe IBS according to the predominant bowel pattern.

IBS pattern	Main feature	What management may focus on
IBS-C	Constipation	Bowel regularity, fiber, and appropriate treatment
IBS-D	Diarrhea	Trigger identification and diarrhea-focused treatment
IBS-M	Mixed pattern	Adjusting management as bowel patterns change

Mayo Clinic describes constipation-predominant, diarrhea-predominant, mixed, and unclassified forms of IBS.

This distinction is useful because advice designed for constipation may not be appropriate for someone whose main problem is diarrhea.

If your bowel pattern changes significantly over time, tell your healthcare professional rather than repeatedly changing your diet without guidance.

13. Review Medicines and Supplements With a Healthcare Professional

Sometimes people focus so heavily on food that they forget about medicines and supplements.

Certain products can affect bowel habits or digestive symptoms.

If you think a medication or supplement may be contributing to your symptoms:

Do not stop a prescribed medicine on your own.

Instead:

Write down what you take.
Note when you started it.
Record when symptoms began or changed.
Discuss the pattern with your doctor or pharmacist.

This can be especially useful when several changes occurred around the same time.

14. Use Professional Treatment When Lifestyle Changes Aren’t Enough

Lifestyle changes are useful, but they are not the entire IBS treatment picture.

Depending on your symptoms, a healthcare professional may consider:

Dietary changes
Fiber supplements
Medicines for diarrhea
Medicines for constipation
Medicines for abdominal pain
Probiotics in selected circumstances
Cognitive behavioral therapy
Other psychological therapies

NIDDK explains that IBS treatment can include diet and lifestyle changes, medicines, probiotics, and mental-health therapies.

NHS guidance also notes that psychological therapies such as CBT may be considered when IBS has lasted a long time and other treatments have not helped, particularly when stress or anxiety contributes to symptoms.

Treatment should be based on your symptoms rather than a one-size-fits-all plan.

7 Common IBS Management Mistakes

Sometimes knowing what not to do is just as useful as learning another symptom-management strategy.

1. Removing Too Many Foods at Once

If you eliminate ten foods simultaneously and feel better, you may not know which change actually helped.

That makes your long-term diet harder to manage.

2. Increasing Fiber Too Quickly

Fiber can be useful, but sudden increases may cause more gas and bloating.

3. Assuming Every Symptom Comes From Food

Stress, sleep, bowel habits, meal size, and other factors can also influence symptoms.

4. Copying Someone Else’s IBS Diet

Your friend’s trigger may not be your trigger.

5. Treating Stress as the Only Cause

Stress can worsen symptoms, but IBS should not be dismissed as imaginary or purely psychological.

6. Staying on an Extremely Restrictive Diet Without Reassessment

A restrictive diet that never gets reviewed can make eating unnecessarily difficult.

The aim should be symptom control with adequate nutrition and as much dietary flexibility as possible.

7. Ignoring Warning Signs

Not every digestive symptom is IBS.

New or concerning symptoms deserve appropriate medical evaluation.

IBS Trigger Tracker You Can Actually Use

Instead of recording only food, track several variables.

Day	Meal	Symptoms	Bowel pattern	Stress	Sleep	Activity	Possible pattern
Monday	Breakfast	Bloating	Normal	Moderate	7 hrs	Walk	None obvious
Tuesday	Lunch	Cramping	Loose stool	High	5 hrs	None	Stress/meal
Wednesday	Dinner	None	Normal	Low	8 hrs	Walk	Stable

You do not need to create a complicated spreadsheet.

A notebook or phone note can work.

The most useful question is:

“What repeatedly happens before my symptoms?”

rather than:

“What did I eat immediately before this symptom?”

That small change in thinking can prevent you from blaming foods too quickly.

What to Do During an IBS Flare-Up

When symptoms suddenly become worse, avoid making ten major changes at once.

Instead:

1. Pause and look for what changed.

Ask yourself:

Did I eat something unusual?
Did I eat a much larger meal?
Did I sleep poorly?
Has stress increased?
Has my bowel pattern changed?
Did I start a new medicine or supplement?

2. Return to familiar, tolerated foods.

If you already know that certain simple foods are comfortable for you, you may find it easier to return temporarily to those foods rather than experimenting with several new diets.

3. Maintain reasonable hydration

This can be particularly important when diarrhea is present.

4. Avoid unnecessary restriction.

Do not conclude that you suddenly need to eliminate dozens of foods.

5. Monitor the pattern.

If symptoms continue, worsen, or are accompanied by concerning signs, contact a healthcare professional.

Which IBS Strategy Should You Focus On First?

Your main problem	Area worth exploring	Important caution
Constipation	Gradual fiber changes, fluids, and activity	Sudden fiber increases can worsen gas.
Diarrhea	Food and symptom tracking	Persistent diarrhea needs medical assessment.
Bloating	Meal patterns and individual triggers	Avoid unnecessary food restriction.
Abdominal pain	Trigger tracking and professional evaluation	New or severe pain should not automatically be called IBS.
Stress-related worsening	Stress-management strategies	IBS is not “just stress.”
Mixed bowel habits	Individualized management	Treatment may need to change over time

This is not a substitute for diagnosis or individualized medical care.

When Should You See a Doctor for IBS Symptoms?

One of the most important parts of managing digestive symptoms is knowing when not to self-manage.

Speak with a healthcare professional if your bowel symptoms are persistent, unexplained, worsening, or interfering substantially with everyday life.

Seek prompt medical evaluation for concerning symptoms such as:

Unexplained weight loss
Rectal bleeding
Bloody diarrhea
Persistent vomiting
Fever
Iron-deficiency anemia
Significant or unexplained changes in bowel habits
Diarrhea that occurs during the night
Abdominal pain that is unusual, severe, or not related to bowel movements

Mayo Clinic lists weight loss, rectal bleeding, anemia, unexplained vomiting, nighttime diarrhea, and certain patterns of abdominal pain among features that warrant further medical assessment.

These symptoms do not automatically mean you have a serious disease.

They mean that assuming IBS without proper evaluation may not be appropriate.

How Is IBS Diagnosed?

There is no single home test that can confirm IBS.

A healthcare professional generally considers:

Your symptoms
How long they have been occurring
Your bowel habits
Medical history
Family history
Physical examination
Whether other conditions need to be ruled out

NIDDK explains that doctors look for a particular symptom pattern and may order tests when needed to rule out other health problems.

Mayo Clinic similarly explains that IBS diagnosis involves medical history, physical examination, and, when appropriate, tests to exclude other conditions.

That is why an online symptom checklist should not replace medical assessment.

IBS Treatment: What Happens If Lifestyle Changes Aren’t Enough?

You do not have to keep changing your diet indefinitely if symptoms are not improving.

A healthcare professional can help determine whether you may benefit from:

Dietary counseling
Fiber supplementation
Medicines for constipation
Medicines for diarrhea
Treatments for abdominal pain
Psychological therapies
Other individualized treatments

NIDDK lists several medication options depending on whether constipation, diarrhea, or abdominal pain is the predominant problem.

Some people also explore probiotics or complementary approaches. However, evidence and individual responses vary, so it is sensible to discuss supplements and complementary treatments with a healthcare professional rather than assuming that “natural” means risk-free. NIDDK specifically recommends talking with a doctor before using probiotics or other complementary or alternative approaches.

A Simple Starting Plan for the Next Two Weeks

If all of this information feels overwhelming, start small.

Days 1–7: Observe

Track:

meals
symptoms
bowel movements
sleep
stress
activity

Do not eliminate large numbers of foods.

Days 8–14: Look for patterns

Ask:

Does the same food repeatedly precede symptoms?
Do symptoms occur mainly after large meals?
Does constipation correlate with low activity?
Do symptoms become worse during stressful periods?
Does poor sleep appear alongside worse symptoms?

After two weeks: Choose one manageable change.

For example:

Adjust meal timing.
Increase fiber gradually if appropriate.
Add regular walking.
Improve sleep consistency.
Discuss a possible dietary strategy with a dietitian.

The purpose is not to complete a perfect IBS program in 14 days.

The purpose is to learn what your body appears to respond to.

My Personal Perspective

One thing I have learned while writing about health is that people often want a simple list of foods to avoid.

That sounds convenient, but IBS is rarely that simple.

A better approach, in my view, is to become a careful observer of your own patterns. Instead of removing everything that someone online labels as an “IBS trigger,” I would rather understand what repeatedly happens before symptoms and make one reasonable change at a time.

That approach also makes the process less overwhelming.

If a person changes their breakfast, lunch, dinner, supplements, exercise routine, and stress-management routine all on the same day, they may feel better but still have no idea what actually helped.

A slower approach can provide more useful information.

This is a personal perspective, not medical evidence or a substitute for professional advice.

Can IBS Symptoms Go Away?

IBS is generally considered a long-term condition, but symptoms can fluctuate.

Some people have periods when symptoms are mild or absent, followed by flare-ups.

Mayo Clinic describes IBS as an ongoing condition that requires long-term management, while noting that some people can control symptoms through diet, lifestyle, and stress management.

That means success does not necessarily have to mean:

“I never experience another IBS symptom.”

A more realistic goal may be

“My symptoms happen less often, are less intense, and interfere less with my life.”

That is a meaningful improvement.

Frequently Asked Questions

What are the best ways to reduce IBS symptoms?

Useful approaches may include identifying personal triggers, eating regular meals, making appropriate dietary changes, gradually adjusting fiber, staying active, managing stress, getting enough sleep, and seeking professional treatment when needed. The best combination varies between people.

How can I reduce IBS flare-ups?

Start by looking for your own recurring patterns. Track meals, bowel movements, sleep, stress, and activity. Then make one change at a time rather than eliminating many foods simultaneously.

What foods commonly trigger IBS symptoms?

Potential triggers can include certain high-FODMAP foods, fatty foods, caffeine, alcohol, carbonated drinks, and individual foods that a person does not tolerate well. However, not every person with IBS reacts to the same foods.

Is fiber good for IBS?

Fiber can help some people, especially when constipation is present, but increasing it too quickly may cause gas and bloating. Soluble fiber may be more helpful for IBS symptoms than some other forms of fiber.

Is the low-FODMAP diet good for IBS?

A low-FODMAP diet can help some people with IBS, but it should be approached carefully. It generally involves reducing certain FODMAP-containing foods and then gradually reintroducing foods to identify individual tolerance. Professional dietary guidance can be particularly useful.

Can stress make IBS symptoms worse?

Yes. Stress can worsen symptoms for some people. However, this does not mean IBS is imaginary or caused simply by stress. Stress management is one part of a broader management plan.

Can exercise help IBS symptoms?

Regular physical activity may help as part of an overall IBS-management approach. NIDDK includes increasing physical activity among lifestyle changes that may help IBS symptoms.

How do I find my IBS food triggers?

Keep a food and symptom diary for a period of time and look for repeated patterns rather than blaming the most recent meal. If symptoms are complicated, a dietitian can help you evaluate your diet without unnecessary restriction.

Should I avoid gluten if I have IBS?

Not everyone with IBS needs to avoid gluten. Some people report symptom improvement when they reduce gluten-containing foods, but dietary changes should be individualized. If you suspect gluten is causing problems, discuss an appropriate evaluation with your healthcare professional rather than making assumptions about the cause.

When should I see a doctor for IBS symptoms?

Seek medical advice for persistent or worsening symptoms, and especially for warning signs such as unexplained weight loss, rectal bleeding, bloody diarrhea, persistent vomiting, fever, anemia, nighttime diarrhea, or unusual abdominal pain.

Final Thoughts

The most useful ways to reduce IBS symptoms are rarely about following one perfect diet.

IBS management is more personal than that.

Start by observing your symptoms. Look for patterns. Make gradual changes. Give your body enough time to respond before changing everything again.

If fiber helps, use it thoughtfully and increase it gradually when appropriate. When a particular food repeatedly triggers symptoms, consider discussing with a healthcare professional whether reducing or modifying it makes sense for you. Similarly, if stress appears to worsen your symptoms, focus on practical stress-management habits while recognizing that IBS is a real gastrointestinal condition and is not simply “all in your head.”

And if symptoms are persistent, severe, new, or accompanied by warning signs, get medical advice rather than continuing to experiment on your own.

The goal is not to build the most restrictive diet possible.

The goal is to find a practical, sustainable routine that helps you feel better while maintaining good nutrition and quality of life.

Trusted Medical Sources

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14 Effective Strategies To Avoid IBS Symptoms