Digestive Health Irritable Bowel Syndrome Irritable Bowel Syndrome With Constipation (IBS-C) Overview How IBS-C Differs From IBS By Barbara Bolen, PhD Barbara Bolen, PhD Twitter Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome. Learn about our editorial process Updated on June 07, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Jay N. Yepuri, MD, MS Medically reviewed by Jay N. Yepuri, MD, MS Facebook LinkedIn Twitter Jay Yepuri, MD, MS, is a board-certified gastroenterologist and a practicing partner at Digestive Health Associates of Texas (DHAT). Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Risk Factors Diagnosis Treatment Frequently Asked Questions 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. Universal Images Group / Getty Images 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 monthSymptoms have persisted over the past three monthsAt 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: Abdominal pain Gas and bloating A feeling of incomplete evacuation Mucus on the stool A sensation of blockage in the anus or rectum Need to use fingers to remove stool (digital evacuation) 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 constipationIdiopathic 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 symptomsDo a medical examOrder blood workConduct 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 painAltered bowel habitsMinimum of six months of symptom durationThe absence of alarm features of other possible conditionsPossible 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 Cognitive behavioral therapy or gut-directed hypnotherapy: May help establish healthier habits and overcome emotional components of IBS Biofeedback: Recommended for those with dyssynergic defecation Not Recommended The ACG says some common IBS-C treatments don't have enough evidence of effectiveness to be recommended. These include: Antispasmodic drugs Probiotic supplements Polyethylene glycol (an ingredient in some over-the-counter laxatives) Fecal transplant 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) Learn More: The Different Sub-Types of IBS 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. Learn More: 6 Effective Strategies for Handling an IBS Attack 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 productsSugar-free chewing gumWheat-based products, like wheat bran, bread, and pastaCertain vegetables, such as artichokes, asparagus, onions, and garlicBeans and legumesYou 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. Learn More: High and Low-FODMAP Diet Foods to Eat 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. Learn More: Do Over-the-Counter Remedies for IBS Really Work? Was this page helpful? Thanks for your feedback! One of the most challenging aspects of having IBS is trying to figure out what's safe to eat. Our recipe guide makes it easier. Sign up and get yours now! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 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. Chandar AK. Diagnosis and treatment of irritable bowel syndrome with predominant constipation in the primary-care setting: focus on linaclotide. Int J Gen Med. 2017;10:385-393. doi:10.2147/IJGM.S126581 National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of constipation. Cash BD. Understanding and managing IBS and CIC in the primary care setting. Gastroenterol Hepatol (N Y). 2018;14(5 Suppl 3):3-15. Rao SS, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil. 2016;22(3):423-35. doi:10.5056/jnm16060 Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: Management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036 Jadallah KA, Kullab SM, Sanders DS. Constipation-predominant irritable bowel syndrome: a review of current and emerging drug therapies. World J Gastroenterol. 2014;20(27):8898-909. doi:10.3748/wjg.v20.i27.8898 Rome Foundation. Rome IV criteria. Monash University. FODMAPs and irritable bowel syndrome. American Society for Gastrointestinal Endoscopy (ASGE). Understanding irritable bowel syndrome with constipation (IBS-C). Bellini M, Gambaccini D, Usai-Satta P, et al. Irritable bowel syndrome and chronic constipation: fact and fiction. World J Gastroenterol. 2015;21(40):11362-11370. doi:10.3748/wjg.v21.i40.11362 Additional Reading Drossman DA. Functional gastrointestinal disorders: History, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016;S0016-5085(16)00223-7. doi:10.1053/j.gastro.2016.02.032 Schmulson MJ, Drossman DA, What is new in Rome IV. J Neurogastroenterol Motil. 2017;23(2):151-163. doi:10.5056/jnm16214