The irritable bowel syndrome (IBS) is a common disorder of unknown etiology. Recently, a group of dysregulated microRNAs (miRNAs) in blood microvesicles and in colon tissue have been identified in IBS patients. miRNAs have been shown to modulate specific biological processes such as differentiation, proliferation, apoptosis and metabolism. The ideal strategy would be to use specific miRNAs as both diagnostic and therapeutic tools to recover intestinal function and treat intractable gastrointestinal symptoms. In conclusion, further study of the functional role of miRNAs will lead to a better understanding of the dysregulation of intestinal pathways in IBS patients. The results may lead to preventive and/or therapeutic strategies that use small molecules (such as mimics or inhibitors of specific miRNAs) to affect genetic and epigenetic control. Future clinical trials may use microvesicle-associated miRNA-based therapies by using specific inhibitors/mimics of miRNA to target gene expression and treat IBS.