Five years of alternating constipation and diarrhoea with no relief usually means two things: either the diagnosis of IBS was never confirmed, or the treatment kept targeting symptoms and never the triggers. Before we accept IBS-M, I want celiac serology,
thyroid, CBC, stool routine and a colonoscopy at least once at 43 - especially if there is blood, night-time diarrhoea, unintentional weight loss or anaemia, which are not IBS and need urgent scoping. If it is genuinely IBS, what works is a supervised low-FODMAP trial for 6 weeks, soluble fibre, an antispasmodic for pain, rifaximin if SIBO is proven, and gut-directed treatment for stress, not endless antibiotics. Your weight and sedentary work are adding to it. Bring all your old reports to a Practo consult with me and we will restart this properly instead of another random prescription.