Irritable Bowel Syndrome With Constipation (IBS-C) Overview

How IBS-C Differs From IBS

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Constipation-predominant irritable bowel syndrome (IBS-C) is a condition characterized by chronic constipation with associated abdominal pain.

It's a subtype of irritable bowel syndrome (IBS). About one-third of people with IBS have the IBS-C type.

IBS-C is a functional gastrointestinal disorder. These are gastrointestinal (GI) disorders that produce symptoms but have no identifiable cause despite standard diagnostic tests. These disorders can cause significant distress.

Diet changes, supplements, medication, and behavior changes may reduce the symptoms of IBS with constipation. Some people also try the low-FODMAP diet to know which foods to avoid for symptom relief.

doctor examining abdomen of a patient
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Symptoms

The main symptoms of IBS-C are frequent constipation accompanied by abdominal pain when having a bowel movement.

Criteria

It's normal to have one or two bowel movements per day. It's also normal to have less than one per day. Characteristics of constipation include:

  • Having fewer than three bowel movements in a week
  • Lumpy or hard stools
  • The need to strain during a bowel movementddfdf

The Rome IV criteria defines IBS based on specific signs and symptoms. According to this criteria, IBS-C is specifically defined as a condition in which:

  • Constipation associated with pain occurs at least three days per month
  • Symptoms have persisted over the past three months
  • At least 25% of stools are hard and less than 25% of stools described as soft

Associated Symptoms

In addition to the Rome IV criteria for IBS-C, you may experience other symptoms if you have constipation-predominant IBS.

Common symptoms of IBS-C include:

Loose stools rarely occur with IBS-C, unless using a laxative.

IBS-C vs. Chronic Idiopathic Constipation (CIC)

IBS-C and chronic idiopathic constipation (also known as functional constipation) share many of the same symptoms.

According to the Rome IV criteria, the biggest difference is:

  • IBS-C causes abdominal pain and discomfort alongside constipation
  • Idiopathic constipation is typically painless

Gastroenterologists question if the two conditions are manifestations of the same disorder along a single disease spectrum, rather than two separate disorders.

However, the two conditions respond to different treatments. This suggests they may be two different conditions. At this point, the answer isn't clear.

Risk Factors

There is no known cause of IBS-C. The symptoms occur because the digestive system does not function as it should, but there is no identifiable cause for this.

Dyssynergic defecation, which is dysfunction of the pelvic floor muscles, is often present in people with IBS-C.

Diagnosis

IBS-C is traditionally a diagnosis of exclusion. This means that it's only diagnosed after ruling out other disorders that may cause your symptoms. However, diagnostic guidelines released in 2021 by the American College of Gastroenterology (ACG) aim to make it a "positive" diagnosis instead.

The ACG says its recommended diagnostic method will make the process faster and get you on proper treatments sooner. It's not clear how these guidelines will change your healthcare provider's IBS diagnostic process. Either method can diagnose you accurately.

Diagnosis of Exclusion

If your healthcare provider suspects IBS-C, they'll likely:

  • Ask for your symptoms
  • Do a medical exam
  • Order blood work
  • Conduct a stool sample analysis.

Other tests may be recommended depending on your symptoms and medical history. These include imaging tests and interventional tests such as colonoscopy.

If your symptoms match the diagnostic criteria for IBS-C, and there is no evidence of any red-flag symptoms or other illness, you can be diagnosed with IBS-C.

Positive Diagnosis

The ACG's recommended diagnostic method includes focusing on your medical history and physical exam in addition to key symptoms, including:

  • Abdominal pain
  • Altered bowel habits
  • Minimum of six months of symptom duration
  • The absence of alarm features of other possible conditions
  • Possible anorectal physiology testing if a pelvic floor disorder is suspected or if constipation doesn't respond to standard treatments

No further testing is recommended for IBS-C.

Treatment

The ACG treatment protocol for IBS-C includes diet modifications, supplements, prescription medications, and lifestyle and behavioral changes.

Diet and Supplements

  • Diet changes: A short-term trial of a low-FODMAP diet can help you identify foods that contribute to your symptoms so that you know which foods to avoid.
  • Fiber: Slowly increasing the amount of fiber, especially soluble fiber, in your diet (or through supplements) may promote more frequent bowel movements.
  • Peppermint oil: Enteric-coated capsules of peppermint oil may help your intestinal muscles relax, lower pain and inflammation, and eliminate harmful bacteria.

Prescription Medications

  • Amitiza (lubiprostone): Increases fluid secretion in the intestines
  • Linzess (linaclotide) or Trulance (plecanatide): Increase bowel movements
  • Zelnorm (tegaserod): Speeds digestion and reduces hypersensitivity in the digestive organs (recommended for women under 65 with no cardiovascular risk factors and no response to other medications)
  • Tricyclic antidepressants: Prescription medications that may affect the nerves of the GI system through changing activity of the neurotransmitters norepinephrine and dopamine

Behavior Changes

Not Recommended

The ACG says some common IBS-C treatments don't have enough evidence of effectiveness to be recommended. These include:

Frequently Asked Questions

  • What are the types of IBS?

    The four types of IBS include:

    • IBS with predominant constipation (IBS-C)
    • predominant diarrhea (IBS-D)
    • IBS with mixed bowel habits (IBS-M)
    • Unclassified IBS (IBS-U)
  • How long does IBS-C last?

    IBS-C is a chronic condition with periodic flare-ups. The flare-ups depend on various factors, but can last anywhere from a few days to several months.

  • What foods should I avoid with IBS-C?

    Some people find relief with IBS-C if they avoid high-FODMAP foods, such as:

    • Milk and dairy products
    • Sugar-free chewing gum
    • Wheat-based products, like wheat bran, bread, and pasta
    • Certain vegetables, such as artichokes, asparagus, onions, and garlic
    • Beans and legumes


    You can also try avoiding carbonated drinks, sodas, caffeine, and gas-producing foods like broccoli, Brussels sprouts, and beans.

    However, dietary triggers depend on the person. Some people are triggered by certain foods, while others aren't.

  • Should I take laxatives if I have IBS?

    Talk to your healthcare provider first, but laxatives are the most common medications used to improve bowel function in IBS-C patients.

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10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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