Irritable bowel syndrome with constipation (IBS-C) is a condition characterized by chronic constipation accompanied by abdominal pain.

This is a subtype of irritable bowel syndrome (IBS). Approximately one-third of IBS patients have type IBS-C.

IBS-C is a functional gastrointestinal disorder. These are gastrointestinal (GI) disorders that cause symptoms, but the cause cannot be determined despite standard diagnostic tests. These disorders can cause significant suffering.

Dietary changes, fiber supplements, medications, and behavioral changes may reduce IBS symptoms associated with constipation. Some people try a low FODMAP diet to learn which foods to avoid to reduce symptoms.

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Symptoms of IBS-C

The main symptom of IBS-C is frequent constipation with abdominal pain during defecation.

standard

It is normal to have one or two bowel movements a day, or no bowel movements every day. The characteristics of constipation are:

Having bowel movements less than 3 times a week
lumpy or hard stools
The need to strain during defecation

The Rome IV criteria define IBS based on specific signs and symptoms. According to these criteria, IBS-C is specifically defined as the following conditions:

Painful constipation occurs at least 3 days per month
Symptoms have persisted for the past 3 months
At least 25% of stool is hard, while less than 25% is soft.

Associated symptoms

In addition to the Rome IV criteria for IBS-C, other symptoms may occur in cases of constipation-predominant IBS.

Common symptoms of IBS-C include:

IBS-C rarely causes loose stools unless laxatives are used.

IBS-C and chronic idiopathic constipation (CIC)

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

According to the Rome IV standard, the biggest differences are:

IBS-C It causes abdominal pain and discomfort along with constipation.
idiopathic constipation It is usually painless.

Gastroenterologists wonder if these two symptoms are symptoms of the same disease along a single disease spectrum, rather than two separate diseases.

However, the two conditions respond to different treatments. This suggests that these may be two different conditions for her. At this point, the answer is not clear.

Causes of IBS-C

The cause of IBS-C is unknown. This condition occurs because the digestive system is not working properly, but there is no specific cause.

Cooperative defecation, a dysfunction of the pelvic floor muscles, is common in IBS-C patients.

How is IBS-C diagnosed?

IBS-C is traditionally a diagnosis of exclusion. This means that it is only diagnosed after ruling out other diseases that may be causing the symptoms. However, diagnostic guidelines released by the American College of Gastroenterology (ACG) in 2021 aim for a “positive” diagnosis instead.

ACG says the recommended diagnostic method will speed up the process and get you the right treatment sooner. It is unclear how the guidelines described below will change the IBS diagnosis process for healthcare providers. Both methods provide accurate diagnosis.

Diagnosis of exclusion

If your health care provider suspects IBS-C, they may do the following:

I would like to ask about your symptoms.
Please do a health check
request a blood test
Perform stool sample analysis.

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

IBS-C can be diagnosed if the symptoms match the diagnostic criteria for IBS-C and there are no red flags or evidence of other illnesses.

positive diagnosis

The ACG-recommended diagnostic method involves focusing on the following key symptoms, as well as the medical history and physical exam, rather than extensive testing:

abdominal pain
Changes in bowel habits
Symptoms last for at least 6 months
No alarm function for other possible conditions
Possibility of anorectal physiology test if pelvic floor disease is suspected or constipation does not respond to standard treatments

No further testing is recommended for IBS-C.

Treatment of IBS-C

ACG treatment protocols for IBS-C include dietary modifications, supplements, prescription medications, and lifestyle and behavioral changes.

diet and supplements

dietary changes: Trying a low FODMAP diet for a short period of time can help you identify which foods are causing your symptoms and learn which foods to avoid.
fiber: Slowly increasing the amount of fiber, especially soluble fiber, in your diet (or supplements) may encourage more frequent bowel movements.
peppermint oil: Enteric-coated peppermint oil capsules help relax intestinal muscles, reduce pain and inflammation, and eliminate harmful bacteria.

Prescription drugs

Amitiza (lubiprostone): increases fluid secretion in the intestines
Linzess (linaclotide) or Torlans (plecanatide)：Increase the amount of defecation
Zelnorm (Tegaserod): Promotes digestion and reduces gastrointestinal hypersensitivity (recommended only for women under 65 years of age without cardiovascular risk factors and unresponsive to other medications)
Tricyclic antidepressants: Prescription drugs that can affect nerves in the digestive system through changes in the activity of the neurotransmitters noradrenaline and dopamine

behavioral changes

Not recommended

The ACG states that some common IBS-C treatments do not have enough evidence of effectiveness to recommend them. These include:

FAQ

What types of IBS are there?
There are four types of IBS:
- IBS with predominant constipation (IBS-C)
- IBS with predominant diarrhea (IBS-D)
- IBS with mixed bowel habits (IBS-M)
- Uncategorized IBS (IBS-U)

How long does IBS-C last?

IBS-C is a chronic disease with periodic flare-ups. Flares can last anywhere from a few days to several months, depending on a variety of factors.

What foods should I avoid with IBS-C?
Some people find relief from IBS-C by avoiding high FODMAP foods, such as:
- milk and dairy products
- sugar free chewing gum
- Wheat-based products such as wheat bran, bread, and pasta
- Certain vegetables such as artichokes, asparagus, onions, and garlic
- Beans and legumes
You can also avoid carbonated drinks, soda, caffeine, and gas-producing foods such as broccoli, Brussels sprouts, and beans.

However, the triggers for eating vary from person to person. Some people are triggered by certain foods, while others are not.

Do I need to take laxatives if I have IBS?

Please consult your health care provider first. However, the most common drugs used to improve bowel function in IBS-C patients are laxatives.

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

Chandar AK. Diagnosis and treatment of constipation-predominant irritable bowel syndrome in the primary care setting: focus on linaclotide. International J Gene Medicine. 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 primary care settings. gastrointestinal roll hepatol (new york). 2018;14(5 Supplement 3):3-15.
Rao Guards, Patcharatrakul T. Diagnosis and treatment of defecation dysfunction. J Neurogastrointestinal Role Motil. 2016;22(3):423-35. doi:10.5056/jnm16060
Lacey BE, Pimentel M, Brenner DM, et al. ACG Clinical Guidelines: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036
Jadara KA, Crabbe SM, Saunders DS. Constipation-predominant irritable bowel syndrome: a review of current and new pharmacotherapies. World J Gastroenterol. 2014;20(27):8898-909. doi:10.3748/wjg.v20.i27.8898
Rome Foundation. Criterion of Rome IV.
Monash University. FODMAP and irritable bowel syndrome.
American Society of 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 Resources

Drosman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Department of Gastroenterology. 2016;S0016-5085(16)00223-7. doi:10.1053/j.gastro.2016.02.032
Schmalsson MJ, Drosman DA, New features in Rome IV. J Neurogastrointestinal Role Motil. 2017;23(2):151-163. doi:10.5056/jnm16214

Written by Dr. Barbara Bolen

Dr. Barbara Bolen is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.

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Tagged Bowel, constipation, IBSC, irritable, syndrome

Irritable bowel syndrome with constipation (IBS-C)