What is IBS-C
As you know, everyone's IBS symptoms are different. For some, the most common symptom is constipation. For those with IBS-C, constipation is associated with stomach and abdominal pains, as well as bloating and straining to go to the bathroom. But know this: this symptom may come and go over time. Doctors may even define constipation differently than you do. The doctor definition is "hard, pellet-like stools", while many individuals define constipation as having difficulty going to the bathroom, or the infrequent nature of going to the bathroom.
Passing stool three times per week is a good baseline for whether you should talk to your doctor about IBS-C treatment. Doctors and scientists think that constipation is caused by two main things:
- Food moving through your digestive system too slowly
- Your body absorbs too much liquid as it digests your food
Treatment includes both medical and dietary improvements. Like broad IBS recommendations, non-medical treatments include slowly increasing fiber intake, drinking more water, and even increasing physical activity such as walking. Medical options include over-the counter drugs and prescription medicines.
What should I know about my constipation?
Pharmaceutical company Allergan defines IBS-C as a GI condition marked by constipation, belly pain, and when you do go, marked by infrequent or incomplete bowel movements. If this describes you, you're not alone. IBS-C impacts up to 13 million Americans.
Is my IBS-C actually Chronic Idiopathic Constipation (CIC)?
Doctors are beginning to understand CIC and IBS-C as similar functional disorders along a sliding scale of severity. Adam Leitenberger put it this way: "Our results argue that for many patients, CIC and IBS-C are not separate and distinct entities but more likely reside on a ‘spectrum’ of disease with abdominal symptoms."
However, in terms of definitions, think of it this way. Just because you experience constipation does not mean that you have IBS-C. Here are a few ways to tell the difference:
Your constipation is IBS-C if:
- Your constipation is associated with stomach pain
- Your constipation may alternate with other IBS symptoms such as diarrhea or bloating
- This graph clearly shows the continuum for CIC and IBS-C. You can find a more medical discussion here
How can I treat my IBS-C?
Many fellow Americans are frustrated with existing remedies for IBS-C.
It may take a mix of treatments to relieve your IBS-C symptoms, namely, stomach aches, bloating, and general abdominal pain. Treatments for IBS-C include:
- Increasing your fiber intake, especially soluble fiber
- You may even want to try a fiber supplement such as Calcium Polycarbophil (Fibercon) or Psyllium (Fiberall, Metamucil, Perdiem, and others)
- In addition to seeking certain foods, avoid known IBS triggers: coffee, carbonated drinks, and alcohol
- You may choose to try a laxative. Be careful, however, as laxatives can be habit forming and lose their effectiveness over time
Stimulant laxatives include bisacodyl (Correctol, Dulcolax), sennosides (Ex-Lax, Senokot), castor oil, and the plant cascara. With these laxatives, the active ingredient triggers muscles in the bowels to contract, moving stool through. Talk with your doctor before you take these medications. Over time, senna can damage nerves in the colon wall, and the drugs may stop working.
Osmotic laxatives include lactulose, which is prescribed by a doctor, and polyethylene glycol (Miralax), which you can buy over the counter. They pull water back into the colon to soften stool. That makes it easier to pass, but research has found that they only help with constipation. They may actually make other symptoms worse. Side effects include diarrhea, dehydration, and bloating. Osmotics are considered fairly safe for long-term use for some people with IBS-C, but talk it over with your doctor before you use them regularly.
- There are a number of prescription drugs currently on the market. Work with your nutritionist and doctor to design a treatment regiment:
Linaclotide (Linzess) treats both men and woman with IBS-C when other treatments have not worked. The drug is a capsule you take once daily on an empty stomach, at least 30 minutes before the first meal of the day. It helps relieve constipation by helping bowel movements happen more often. People age 17 or younger shouldn’t take it. The most common side effect is diarrhea.
Lubiprostone (Amitiza) treats IBS-C in women who haven’t been helped by other treatments. Studies haven't fully shown that it works well in men. Common side effects include nausea, diarrhea, and belly pain.
Plecanatide (Trulance) is a prescription medication that has been shown to treat constipation without the usual side effects of cramping and abdominal pain. The once a day pill can be taken with or without food. It works to increase gastrointestinal fluid in your gut and encourage regular bowel movements.Doctors may suggest other medications to help relieve some symptoms of IBS, such as constipation, diarrhea, or belly cramping.
Antispasmodics: Antispasmodic drugs such as dicyclomine (Bentyl) and hyoscyamine(Levsin) relieve the stomach cramps brought on by IBS by relaxing the smooth muscle of the gut. But they also may cause constipation, so they aren't usually prescribed for people who suffer IBS-C. Other side effects are dry mouth, drowsiness, and blurred vision.
- Stress Management: techniques such as meditation and mindfulness can help alleviate IBS-C symptoms
Have you joined our IBS Support Group yet? Led by Kaitlyn Willwerth MS, RD, use this Q&A group as a forum to learn from experts and support the community.