Irritable bowel syndrome with constipation (IBS-C) is a type of IBS. Please continue reading to learn about IBS-C symptoms, diagnosis, treatment, and dietary changes that can have a positive effect on the quality of life and well-being of IBS-C patients.

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome belongs to a group of functional gastrointestinal disorders that cause symptoms without any specific findings on testing. These digestive tract conditions affect the stomach, small intestine, and large intestine. Approximately 10-15% of the US population has irritable bowel syndrome (IBS) symptoms, including stomach pain and other digestive symptoms. There are different types of irritable bowel syndrome.

What is the difference between IBS-C and IBS-D?

The main difference between IBS-C and IBS-D is the type of digestive symptoms a person experiences, specifically in terms of stool form and bowel movements. People with IBS-D have predominantly diarrhea, while those with IBS-C have predominantly constipation.

There are four types of IBS:

IBS-C (irritable bowel syndrome with constipation), in which a person experiences mostly constipation.
IBS-D (irritable bowel syndrome with diarrhea), in which a person experiences mostly diarrhea.
IBS-M (irritable bowel syndrome mixed form) in which a person has mixed bowel habits and alternates between diarrhea and constipation.
IBS-U (irritable bowel syndrome undefined) is when the symptoms and type of bowel movement vary.

What are the symptoms of IBS-C?

The main symptoms of IBS with constipation include:

Chronic abdominal pain or discomfort, which may be a dull ache or sharp and burning in nature
Cramping
Changes in bowel habits (predominantly constipation or infrequent bowel movements)
Hard, lumpy stools
Uncomfortable or painful bowel movements
Straining during defecation
Bloating, distension, fullness
Mucus in the stools
A feeling of incomplete emptying of the rectum after a bowel movement
Hemorrhoids as a result of straining during bowel movements

Symptoms of IBS-C are often relieved after a bowel movement. However, IBS symptoms can be worse after meals, after eating specific foods, and during times of emotional stress.

The symptoms associated with IBS-C are different from chronic constipation or functional constipation, which does not usually cause abdominal pain. However, treatment for IBS-C and chronic constipation is similar.

How do you get rid of IBS-C?

Systematic review and meta-analysis have not found any single best treatment for irritable bowel syndrome with constipation. Your doctor will select one or more medications based on several factors, including your most bothersome symptoms (abdominal pain, constipation, bloating, etc.), how you have responded to previous treatments, and personal preferences.

Patients with irritable bowel syndrome, specifically irritable bowel syndrome with constipation (IBS C), may benefit from the following medications:

Treatments for constipation

Stool softeners such as docusate sodium and osmotic laxatives such as polyethylene glycol and lactulose may improve symptoms of IBS with constipation. Stimulant laxatives such as bisacodyl and sennosides can also help but should not be used on a regular basis.

Bulk-forming laxatives or fiber supplements that contain soluble fiber, for example, psyllium, can provide relief from IBS symptoms. However, insoluble fibers such as those found in wheat bran, whole grains, and vegetables should be limited in people with IBS as they can exacerbate IBS symptoms such as abdominal pain and bloating. The target should be a total daily fiber intake of 20-30 grams.

FDA-approved medications for IBS-C

The following medications are FDA-approved to treat severe constipation-predominant irritable bowel syndrome (IBS-C). They work by increasing fluid secretion, gastrointestinal motility, and colon transit, thus helping food and waste move along the GI tract.

GC-C agonists such as linaclotide (Linzess) and plecanatide (Trulance)
Chloride channel activators such as lubiprostone (Amitiza)
5-HT4 receptor agonists such as renzapride and prucalopride (Montegrity)
NHE3 inhibitors such as tenapanor (Ibsrela)

Antispasmodics

Antispasmodic medications such as hyoscyamine may be prescribed off-label to treat IBS-C symptoms such as pain, discomfort, cramping, and bloating.

Off-label treatment for IBS-C

Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs), for example, fluoxetine, paroxetine, and citalopram, are sometimes used off-label in people with IBS. Learn about more medications with off-label uses.

What foods should you avoid if you have IBS-C?

It may help to keep a food diary to identify trigger foods that make your IBS symptoms worse. Avoiding these trigger foods may help in managing your IBS-C symptoms.

In addition, some people with irritable bowel syndrome benefit from eating certain diets, such as a low-FODMAP diet. FODMAPs, short for fermentable oligo-saccharides, di-saccharides, mono-saccharides, and polyols, are a group of carbohydrates that are difficult for the small intestine to digest and absorb.

Foods high in FODMAPs to avoid

Dairy products
Wheat products such as bread, cereal, crackers
Lentils and beans
Certain vegetables, such as onions, garlic, asparagus, artichokes
Certain fruits, such as apples, pears, peaches, cherries

Foods low in FODMAPs to eat

Almond milk
Eggs and meat
Grains such as oats, rice, quinoa
Certain cheeses, such as cheddar, Camembert, brie, and feta
Certain vegetables such as potatoes, cucumbers, tomatoes, eggplant, zucchini
Certain fruits, such as oranges, grapes, pineapples, strawberries, and blueberries

What lifestyle modifications can help with irritable bowel syndrome with constipation?

Adequate fluid intake, a fiber-rich diet, a regular toilet schedule, exercise, stress reduction, and adequate sleep can all help to improve symptoms in people with IBS-C. In addition, you should work with your healthcare provider to try and eliminate other factors that can cause or worsen constipation, for example, certain medications that can cause constipation as a side effect.

Frequently Asked Symptoms

What are common IBS symptoms?

Irritable bowel syndrome is a common condition of the digestive system. IBS symptoms include:

Abdominal pain
Cramping
Bloating
Gas
Changes in bowel habits (diarrhea, constipation, or both)

In addition to abdominal symptoms, IBS can also be associated with migraine headaches, chronic pelvic pain, fibromyalgia, sleep disturbances, anxiety, and depression. Together, these symptoms can affect a person’s quality of life.

What causes irritable bowel syndrome?

We don’t know what exactly causes irritable bowel syndrome, but it is a combination of environmental and genetic factors. Experts believe there is a link between the gut and brain axis that plays a role.

Triggers for IBS symptoms include certain foods and stress. Risk factors for IBS include age below 50 years, female gender, a family history of IBS, and anxiety, depression, or other mental health issues. Possible causes of IBS include infection, small intestinal bacterial overgrowth, visceral hypersensitivity and changes in the immune system, slowed digestion and gut motility, and imbalances in gut bacteria (harmful versus beneficial bacteria). Learn about the symptoms of IBS in women.

Note: Irritable bowel syndrome is different from inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn’s disease, in which chronic inflammation of the intestines is present.

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