Background <p>Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, affecting 10%-15% of the global population, characterized by symptoms such as abdominal pain, bloating, and altered bowel habits. A low fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP) diet has shown promise in managing IBS symptoms. This study evaluates the combined impact of continuity care guided by Orem’s Self-Care Model with a low FODMAP diet on gut microbiota composition and IBS symptoms.</p> Methods <p>A retrospective cohort study included 196 patients with IBS, divided into conventional treatment (<i>n</i> = 84) and low FODMAP care (<i>n</i> = 112) groups. The intervention spanned six weeks, integrating Orem’s Model to enhance dietary adherence. Outcomes were assessed using IBS Symptom Severity Scale (IBS-SSS), gut microbiota analysis via qPCR, and quality of life measures (IBS-QOL, SF-36).</p> Results <p>Baseline characteristics between the groups showed no significant differences. Post-intervention, the low FODMAP group experienced significant improvements in IBS-SSS scores, reporting reduced abdominal pain severity (<i>P</i> = 0.01), frequency (<i>P</i> = 0.002), bloating (<i>P</i> = 0.006), and greater bowel movement satisfaction (<i>P</i> = 0.003). Gut microbiota analysis revealed increased Bifidobacterium and Lactobacillus, and decreased Enterococcus levels in the low FODMAP group (<i>P</i> &lt; 0.001). SF-36 scores indicated elevated physical functioning (<i>P</i> &lt; 0.001), role physical (<i>P</i> = 0.002), and mental health (<i>P</i> = 0.005) domains. Notably, IBS-QOL scores improved markedly, especially in dysphoria (<i>P</i> = 0.003), worry about symptoms (<i>P</i> = 0.001), and food avoidance (<i>P</i> = 0.004).</p> Conclusion <p>The integration of a low FODMAP diet with continuity care guided by Orem’s Self-Care Model significantly alleviates IBS symptoms and improves gut microbiota composition and quality of life.</p>