How Do You Know If You Have IBS-C (Irritable Bowel Syndrome with Constipation)?
You may have constipation or notice discomfort or difficulty with bowel movements from time to time. Most people do, and it usually goes away within a few days. What if it doesn’t go away? Is it irritable bowel syndrome with constipation (IBS-C)?
What Is IBS?
IBS is a common functional gastrointestinal (GI) disorder. With functional GI disorders, there are issues with how the GI tract works or functions. Doctors often refer to these disorders as gut-brain interactions because they are associated with problems with the brain-gut connection (i.e how the brain and gut interact).
Types Of IBS
There are 3 main types of IBS:
IBS with constipation (IBS-C)
IBS with diarrhea (IBS-D)
IBS with mixed symptoms (IBS-M), with both constipation and diarrhea.
Each type of IBS is determined by the type of stool that is most common.
Symptoms of IBS-C
IBS is characterized by a group of symptoms related to the large intestines, such as pain in your abdomen and changes in your bowel habits. Individuals may also experience other digestive symptoms seen with IBS, such as bloating, gas, and nausea.
Changes in bowel movements are taken into consideration when diagnosing IBS-C. They include:
Less than 3 bowel movements per week
Abnormal stool form (hard or lumpy)
Straining to have bowel movements
Urgency (the need to get to the toilet quickly) with bowel movements
A feeling of incomplete bowel movements
Bowel movements with mucus
Unrelated to GI symptoms, many people with IBS also have psychological problems like anxiety and depression.
Causes of IBS-C
Experts are unclear as to what causes IBS-C or any other form of IBS. As mentioned above, research suggests that IBS occurs due to an issue with the gut-brain connection - the interaction between the brain and gut, along with several other potential causes. Researchers believe that changes in the microbiome (bacteria or other microbes in the gut), issues with gut lining permeability (also known as "leaky gut"), inflammation in the body, activation of the immune system, and genetics all play an important role in the development of IBS.
Risk Factors for IBS
There are several risk factors for developing IBS. They include a family history of IBS, being a member of the female sex, being less than 50 years old, a history of mental health conditions, the use of antibiotics, and prior GI infections.
Diagnosis of IBS
Making a diagnosis of IBS or specifically IBS-C is challenging. That’s because IBS requires very specific criteria to be formally diagnosed. Your doctor will ask various questions and collect relevant health information, including a description of your symptoms. First, you must have symptoms for at least 6 months. You must also have belly (abdominal) pain at least 1 day a week in the last 3 months. The pain must be associated with at least 2 of the following:
Abdominal pain related to bowel movements
Changes in frequency of bowel movements
Change in appearance of stool
IBS-C requires additional criteria for diagnosis.n the days when you have at least one abnormal bowel movement, you have:
more than 1 out of 4 stools that are hard or lumpy
less than 1 out of 4 stools are loose or watery.
Your doctor will also look for an increasing number of days in a row without a bowel movement. There are no specific blood tests to diagnose IBS. If you have signs or symptoms of a different health condition, your doctor might evaluate you for different illnesses as the potential cause of IBS symptoms.
Other GI conditions could potentially be evaluated, including celiac disease and inflammatory bowel disease (Crohn's disease and ulcerative colitis). Non-GI related diseases can also have symptoms similar to IBS-C. Your doctor may test for and “rule out” other potential conditions.
IBS-C vs Chronic Constipation
You may think the constipation-related symptoms are unique to IBS-C. In fact, the symptoms are not that different from other GI conditions. IBS-C, for example, is similar to chronic constipation (CC). It may even be a challenge for doctors to know the difference. CC symptoms that are similar to IBS-C symptoms include difficult, incomplete, and infrequent bowel movements; straining to have bowel movements; hard stool; and lumps in the stool. Studies have compared the differences between symptoms of IBS-C and CC. Abdominal pain, discomfort, and bloating are primary symptoms in people with IBS-C. While people with CC can have some discomfort and bloating, they are not the main symptoms.
Treatment for IBS-C
While there is no cure for IBS-C, there are treatments to help relieve symptoms and improve quality of life. After an IBS-C diagnosis, your doctor will work with you to develop a treatment plan that consists of a combination of lifestyle and diet changes, supplements, over-the-counter and prescription medicines, and mind-body therapies.
Lifestyle Modification
While medications can be used to treat IBS-C, there are lifestyle changes that may improve symptoms without any side effects.
Increasing Exercise
Frequent and consistent exercise has been shown to lessen constipation. Increasing physical activity might be a recommended lifestyle modification for your IBS-C.
Stress Reduction
Since problems occur with the gut-brain connection in people with IBS-C, relieving stress can help. A few of the mind-body techniques and exercises that help manage stress are yoga, mindfulness or meditation, and journaling.
Improving Sleep
Sleep is a major part of your overall health, which in turn, affects your digestion. One way to improve overall well-being is to work on enhancing sleep. It has been shown that microbiome diversity is positively correlated with sleep efficiency and sleep length. In other words, getting proper rest can have powerful benefits when you’re dealing with IBS-C.
Nutrition for IBS
Some foods may trigger your IBS-C symptoms. Specific diets are part of many IBS-C treatment plans, and there is evidence that dietary changes can improve symptoms. Management of IBS-C can be greatly enhanced by focusing on nutrition.
Removing Trigger Foods
An elimination diet can help identify foods that are contributing to your IBS-C symptoms. Many people with IBS-C who switch to either a low-gluten or gluten-free diet have shown improvements in their symptoms. Dairy is another common trigger food for some people with IBS-C. Studies have shown that a low FODMAP diet, which removes specific carbohydrates that can be more difficult for some people to digest, can greatly improve symptoms. A low FODMAP diet also includes minimizing or eliminating gluten.
Increasing Fiber
Constipation can be a sign that your diet is lacking fiber. Foods high in fiber include fruits, vegetables, and whole grains.
Staying Hydrated
Dehydration can make constipation worse. Drinking water and other healthy fluids throughout the day and eating water-rich foods (e.g. fruits, vegetables, etc.), will help to ensure that your body stays well-hydrated.
Working with a Dietitian
When diagnosed with IBS-C, a dietitian can personalize your diet, help with meal planning, and give other personalized advice and tips on how to make these changes.
Supplements
There are a variety of nutritional supplements that can help you make improvements to your IBS-C symptoms.
Fiber Supplements
Many of us can find it difficult to get enough fiber in our diets. Constipation is a common symptom of not having enough fiber in the food we eat. Your doctor might recommend supplementing with fiber pills or a common fiber supplement like psyllium husk.
Probiotics
Often, in people with IBS-C, the gut bacteria in the digestive tract can be imbalanced. Probiotics are beneficial bacteria that balance the healthy vs. unhealthy bacteria and provide relief from IBS symptoms. Using probiotics can help restore that healthy balance.
Peppermint Oil
The use of peppermint oil has been studied as an effective way to relieve common IBS-C sysmptom, including abdominal pain, cramping, and bloating.
Over-the-counter (OTC) and Prescription Medication
There are many different types of medicines a doctor may prescribe to you or other patients with IBS-C.
Laxatives and Stool Softeners
These types of drugs help soften stool (stool softeners) or increase bowel movements (laxatives) to make going to the bathroom less painful. A common laxative is polyethylene glycol.
Antispasmodics
Antispasmodic medications work by relaxing the smooth muscle of the GI tract (i.e. the large intestine), helping to relieve pain and cramping.
Antidepressants
Some antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants have shown an ability to improve symptoms.
Lubiprostone
Lubiprostone (AmitizaⓇ), a prescription drug, acts like a laxative and helps increase fluid flowing into the large intestine or colon, easing constipation.
Mind-Body Therapies
As mentioned above, mood plays a role in the function of our digestive system, and our digestion can also affect our mental state. Mind-body techniques (see Stress Reduction) can help improve mental and GI health.
Psychotherapy
Several forms of therapies have been shown to benefit IBS-C patients, including cognitive behavioral therapy (CBT), mindfulness-based therapy, and psychodynamic therapy.
Hypnotherapy
Individuals with IBS-C may benefit from hypnosis that is specifically related to improving GI function. As with any disease management approach, you should receive care under the guidance of your doctor or another licensed medical professional.
When to See a Doctor
There are several situations for which you should see your doctor. If you:
Experience sudden, extreme changes or worsening of IBS-C symptoms
Don’t improve after 3 months with a prescribed treatment plan
Develop sudden, severe (acute) abdominal pain
If you have these or other concerning symptoms, you should seek help from a medical professional, such as your primary care physician or a GI specialist (gastroenterologist). Read more about when to see a doctor for IBS.
How Goodpath Can Help
Goodpath’s digestive health treatment helps relieve common IBS-C symptoms using an individualized, whole-person approach. Throughout your program, you’ll have the support of your dedicated health coach and care that considers contributing factors like sleep, nutrition, stress, and more. If you think you have IBS, complete our assessment and we’ll provide you with answers and a personalized program to help reduce your symptoms. If you want more information about IBS, Goodpath has it. Visit our Learn Center for IBS information from our medical team.