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Patients with irritable bowel syndrome (IBS) report lower health-related quality of life (QoL) as compared to healthy controls. The aims of this analysis were to describe which IBS symptoms were rated on a daily diary as most distressing/severe by IBS women, and determine which IBS symptoms were most predictive of lower QoL and have the greatest impact on daily life.This report is a secondary analysis of prospective and retrospective symptom severity and impact data, collected on 242 women with IBS, aged 18–48, who were studied between 1997 and 2004.On the daily diary, intestinal gas was the most frequent IBS symptom with subjects reporting at least minimal intestinal gas on 74% of days and moderate or worse severity on 27% of days. Abdominal pain occurred at least minimally on 62% of days. Diarrhea was the least common. Across women, abdominal pain was most strongly related to life impact variables and QoL, followed by intestinal gas and bloating. Analysis of day-to-day variation within women showed that abdominal pain was most strongly correlated with daily life impact variables and constipation had the weakest correlation. While diarrhea had a lower correlation with life impact, this was due to the low prevalence of diarrhea. When it occurs, diarrhea has a large impact. Partial correlation analysis showed that the impact of diarrhea is independent of abdominal pain.Abdominal pain is the most disruptive IBS symptom. Diarrhea also has an independent and significant impact when it occurs, especially in those with diarrhea-predominant IBS.