Irritable bowel syndrome with constipation (IBS-C) (original) (raw)

IBS-C is a subtype of irritable bowel syndrome (IBS) wherein people mostly experience constipation rather than diarrhea. IBS-C symptoms include abdominal pain, bloating, and changes in bowel habits.

Constipation occurs when a person does not pass bowel movements often enough. Typically, this is fewer than three times per week.

In this article, we will discuss IBS-C in more detail, including its symptoms, causes, diagnosis, treatment, and symptom management.

IBS-C is one of three IBS subtypes. People with IBS-C mainly experience constipation.

Its opposite is IBS with diarrhea (IBS-D), which primarily causes frequent or loose bowel movements. People who have episodes of both constipation and diarrhea have “mixed” IBS, or IBS-M.

These subtypes can help people more accurately describe their IBS symptoms.

IBS-C is not the same as chronic functional constipation. People with IBS often have abdominal pain and cramping. By contrast, those with chronic constipation alone typically do not experience pain.

The main symptom of IBS-C is frequent bouts of constipation. This may result in:

• straining
• gas or bloating
• infrequent bowel movements
• abdominal pain and discomfort
• bowel movements that are hard, painful, or uncomfortable
• a feeling as though bowel movements are incomplete
• the need to change position or push on part of the body to have a bowel movement
• secondary health problems, such as hemorrhoids

The symptoms can be persistent, or they may come and go. Often, the symptoms temporarily improve after a person has a bowel movement.

Doctors are not sure what causes IBS-C, but there are factors that may contribute to it, including:

• Infection: Some people develop IBS-C after a gut infection, such as food poisoning. Doctors call this postinfectious IBS.
• Reduced motility: Motility refers to the movements that push waste material along the digestive tract. Having low motility may mean a person’s digestion becomes slow, causing problems passing stools.
• Dysbiosis: Dysbiosis occurs when a person’s gut flora becomes imbalanced, with an excess of harmful bacteria or not enough useful bacteria. According to 2019 research, dysbiosis is common in people with IBS.
• Small intestinal bacterial overgrowth (SIBO): This condition occurs when bacteria from the large intestine migrate into the small intestine and grow in large numbers, causing bloating and other digestive symptoms.
• Visceral hypersensitivity: This refers to sensitivity in the intestines, which is one of the underlying mechanisms for IBS. Researchers do not yet know what causes it, but previous studies have linked visceral hypersensitivity to specific types of gut bacteria, changes in the nervous system, and the immune system.
• Stress and trauma: Frequent exposure to stress can disrupt digestion, causing it to slow down. This may contribute to or worsen IBS-C. Additionally, people with IBS are more likely to have had traumatic experiences early in life. As psychological trauma can cause physical changes in the body, it may contribute to IBS.
• Alcohol and smoking: An older 2010 study found that frequent alcohol consumption and current smoking were more common in people with IBS than in people without the condition. There was also a strong association between both of these factors and stress. However, the participants in the study were not diverse, so this finding may not apply to everyone.

Many of these factors are interrelated and have a knock-on effect on each other. It may be that multiple factors play a role in the development of IBS.

There is no single test for IBS. Often, doctors diagnose it by ruling out other potential causes that can produce similar symptoms. Some tests a doctor may recommend include:

• blood tests to measure inflammation and other markers of disease
• tests for thyroid disease, elevated calcium levels, or Celiac disease
• a stool test to check for harmful organisms
• a colonoscopy

Doctors may also test for associated conditions, such as SIBO, or carry out tests to determine how well a person’s digestive system is functioning. For example, they may perform motility testing. Once a doctor rules out other causes, they will base a diagnosis on a person’s symptoms.

In 2015, Dr. Mark Pimentel, along with other scientists from Cedars-Sinai Medical Center in Los Angeles, CA, developed a test that detects markers associated with IBS-D. However, while the test is promising, it is not widely available and may not work for IBS-C.

Medical treatment for IBS-C focuses on relieving constipation and improving a person’s quality of life. A number of medications could help with this, including:

• stool softeners or fiber supplements, which may make it easier to have bowel movements
• prokinetics, which are drugs that speed up motility in those with slow transit times
• laxatives, which stimulate bowel movements
• antispasmodics, which relax the muscles in the intestines and may help reduce painful cramping

If a person with IBS-C has another condition, such as SIBO, a motility disorder, or a mental health condition, they may find that treating these can have a positive effect on their IBS.

People can manage and sometimes even significantly improve their IBS-C symptoms by making changes to their diet or lifestyle. This could include:

• Avoiding trigger foods: Some people with IBS-C find their symptoms get worse in response to specific foods or food groups. Keeping a symptom diary can help determine whether this is the case. Dietitians can help individuals try a diet for IBS, such as an elimination diet.
• Changing bowel habits: A person should not delay a bowel movement, wherever possible. They should go to the restroom as soon as the urge arises.
• Being active: IBS-C can be very uncomfortable, but it is important to maintain or develop an exercise routine. Regular, moderate exercise can improve digestion.
• Reducing stress: It is not always possible to avoid stress, especially when managing a chronic condition. However, removing unnecessary stress could improve symptoms. If a person frequently experiences anxiety, they may benefit from speaking with a therapist.
• Stopping smoking or drinking: Quitting smoking has a number of benefits for the body, including the digestive system. Additionally, alcohol can be an IBS trigger. If a person finds it difficult to quit, they can seek guidance and support from a doctor.

It is of note that IBS is highly individual. What helps one person will not necessarily help another. It may be useful to try out different approaches one at a time to see what is effective.

A person should always discuss new diets, supplements, and major lifestyle changes with a doctor before trying them.

A person should speak with a healthcare professional if they are experiencing any persistent, recurring, or unexplained digestive symptoms.

While IBS is not life threatening, the symptoms can be similar to those of more serious conditions. A doctor can perform tests to rule these out.

People with IBS-C should also speak with a gastroenterologist if their symptoms change or worsen or if they are experiencing side effects as a result of a treatment they are trying.

A dietitian can help with making dietary changes for IBS in a safe and sustainable way.

IBS-C is a subtype of IBS that causes constipation as its main symptom. It can be uncomfortable and distressing to live with.

However, there are ways doctors can help ease the symptoms. There are also management strategies that can improve a person’s quality of life.

Finding the most suitable approach that helps with IBS can be difficult, so a person should seek support from a healthcare professional, where possible.