Irritable bowel syndrome (IBS) is a highly prevalent and frequently lifelong gastrointestinal disorder, but whether advancing age impacts on IBS is largely unknown and how the disorder manifests in the elderly remains unclear. Epidemiological studies suggest that the prevalence of IBS declines with age (possibly related to pain perception changes), but IBS remains a common gastrointestinal illness in the aged. Unfortunately, there has been very little research examining risk factors, diagnosis and treatment of IBS in the elderly. Since gastrointestinal cancer increases with age, diagnostic algorithms differ in the elderly. There is reason to believe that this very prevalent disorder may also behave differently in the elderly and that the approach to management needs to take age-related issues into account. These issues will be the focus of the present review.