You can describe severity in a few plain words, and many NHS food-and-symptom diaries do. The wording only needs to mean the same thing each time you use it. A number is not required, but a word that drifts from day to day is no more useful than a number that does.
This article is for readers who find a 0–10 rating awkward: unsure whether a symptom is a 4 or a 5, reluctant to put a number on discomfort, or tired of deciding. It is about recording, not about judging how serious a symptom is.
What the research on 0–10 scales does and does not show
A 0–10 numeric rating scale is common in symptom research, so it is worth knowing what that evidence covers.
A systematic review of 54 studies comparing numeric, verbal and visual analogue pain scales in adults found that numeric scales had better compliance than the other two in 15 of the 19 studies that reported it. It also found the numeric scale was the recommended tool in 11 studies, while 29 gave no preference. Most of those studies concerned pain, often after surgery, so the review does not tell us how people use a number for bloating or urgency in daily life. Its authors also noted that the labels at the ends of the scales varied between studies, and that whether this changes the scores had not been properly tested.
In irritable bowel syndrome (IBS), a US registry study of 277 adults asked about abdominal pain “today” on a 10-point scale. The ratings correlated with an established IBS severity questionnaire (r = 0.60) but not with stool frequency or stool form. The authors listed observational design, heavy loss of participants at follow-up and a short follow-up among their limitations. It supports using a number for pain in that population. It does not show that a number is necessary, or that it is the best option for a personal diary.
So the evidence is not an argument for or against numbers in your own diary. It is mainly evidence that a rating needs a consistent definition, which is the thing you control.
What the research says about using words
Words are used in real symptom records. The Cambridge University Hospitals food, mood and symptom diary asks patients to rate symptoms such as abdominal pain, bloating and reflux as mild, moderate or severe, and its example entry records pain as “moderate”. The Leicestershire Nutrition and Dietetic Services diary leaves a free-text column for “description of symptoms”. In a psychometric study of a daily diary for diarrhoea-predominant IBS, pain, cramps and bloating used a 0–10 scale while how often gas occurred used a five-point verbal scale. Verbal wording therefore appears alongside numbers even in research diaries.
Two cautions apply. The Cambridge diary does not define “mild” or “severe”, so it relies on you to be consistent. And words and numbers do not line up neatly: the pain-scale review above reported that many studies found wide spreads of numeric scores within each verbal category. A “moderate” on one day, or for one person, may sit anywhere in a wide range. That is a reason not to convert your words into numbers later and average them.
A plain-word scheme you can adapt
The scheme below is a suggestion, not a validated measure. It ties each word to what the symptom did, rather than how much it “hurt” in the abstract, because effect on what you were doing can be easier to judge on the spot.
| Word | What it can mean in your diary |
|---|---|
| None | You looked and noticed nothing. |
| Mild | Noticeable, but you could mostly ignore it. |
| Moderate | Hard to ignore; you adjusted what you were doing. |
| Strong | It stopped or changed something you had planned. |
Change the words if others suit you better. What matters is writing your definitions once, perhaps at the top of the page or in your notes, and using them unchanged. A fifth level is only worth adding if you keep wanting one.
If you use the downloadable diary template, its severity column is headed 0 to 10. You can rename the heading and use your own words instead.
Keep the rule steady
Most of the value comes from a few habits rather than from the words themselves.
- Choose the moment you are describing. Decide whether you record how the symptom felt at its worst or how it feels now, and stick to that. Ratings made at the end of the day may not match ratings made in the moment, as covered in why a short food diary can be misleading.
- Describe, then label. “Tight, hard to ignore, kept me from finishing my walk” is more informative than “bad”, and you can attach a label afterwards.
- Do not backfill from memory. A label added days later is a different kind of record, so mark it as such. A symptom already present before a meal should be recorded as such, as described in the before-meal check.
- Keep time and duration beside the word. “Mild, about 20 minutes, started around 4pm” can be compared across days; “mild” alone cannot. The minimal diary shows where this fits.
- Do not turn the labels into a score. A run of “moderate” days is a description of your records, not a measurement of how well or how badly you are.
Limits of a severity word
A word records how a symptom was for you, at that time. It cannot show a cause, and it does not tell you whether a symptom matters medically. Severity can also differ between bloating, pain and urgency, so avoid giving them one shared label.
A change in how you describe severity can itself change the pattern you see. If you adjust your wording partway through, note the date so the earlier days are not compared with later ones as if they were identical.
If you want a simple tool that keeps meals, symptoms and notes on one timeline without forcing a number, you can get GutBloom on Google Play.
When to seek advice
Severity words in a diary are not a triage tool. The NHS advises seeing a GP if possible IBS symptoms have lasted more than four weeks. It advises seeking an urgent GP appointment or contacting NHS 111 for unexplained substantial weight loss, bleeding from the bottom or bloody diarrhoea, a hard abdominal lump or swelling, or shortness of breath with noticeable heartbeats and paler skin. Outside the UK, use the equivalent local service.
Seek help sooner if you are worried or symptoms are severe or getting worse. Do not wait for a diary to look neat before you do. When you do see someone, your own words, dates and definitions can go into a summary for a GP appointment.
Sources
- Hjermstad and colleagues — Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review (2011)
- Spiegel and colleagues — Measuring IBS patient reported outcomes with an abdominal pain numeric rating scale: results from the PROOF cohort (2009)
- Delgado-Herrera and colleagues — Evaluation and performance of a newly developed patient-reported outcome instrument for diarrhea-predominant irritable bowel syndrome (2017)
- Cambridge University Hospitals — Food, mood and symptom diary
- Leicestershire Nutrition and Dietetic Services — Food and symptom diary (2022)
- NHS — symptoms of irritable bowel syndrome