Irritable Bowel Syndrome w/ Constipation Predominance (IBS-C)

What is IBS-C?

Irritable Bowel Syndrome (or IBS), not to be confused with Inflammatory Bowel Disease (or IBD), is a cluster of symptoms consisting most commonly of:

  1. Abdominal pain or discomfort, often described as cramping that comes and goes and improves after a bowel movement,
  2. Abdominal bloating or distention,
  3. Diarrhea and/or constipation, and
  4. A change in bowel habits from what had previously been normal for a patient, including altered stool frequency or form, increased straining with bowel movements, and/or urgency to have a bowel movement.
  5. With IBS-C, abdominal pain, discomfort, and bloating occur in connection with constipation. Constipation means that stools don’t pass often enough, or less than three times per week. Having hard stools that are difficult to pass, or the feeling of incomplete emptying following a bowel movement, are additional signs of constipation. 

In most cases, symptoms are longstanding and chronic, and may have been present for months or even years by the time of diagnosis.

What are the symptoms of IBS-C?

Typical symptoms of IBS-C include: abdominal pain or discomfort that comes and goes and improves with a bowel movement, bloating, gas, changes in bowel function such as straining with bowel movements, infrequent stools, hard or lumpy stools, and/or a feeling of incomplete emptying after a bowel movement.

What is the cause of IBS-C?

The exact cause of IBS-C is not known. It is believed to be multi-factorial and possibly related to GI motility, gut sensation, and communication malfunctions between the brain and gut. The muscles of the bowel may not be working properly, and bowel contractions may be slowed, affecting how quickly food is pushed along the digestive tract. Nerves in the gut may be more sensitive to pain and other stimuli. In some patients, symptoms can develop after an infection, known as post-infectious IBS. There is evidence that a change in normal gut flora may play a role in the development of the disease. Finally, researchers are looking into possible genetic and immunologic triggers.

How is the diagnosis made?

IBS-C is a functional disorder of the digestive tract, meaning there are no specific labs or imaging tests that will confirm the diagnosis. Often, all tests normally used to identify disorders of the GI tract will be normal including colonoscopy, upper endoscopy (EGD), capsule endoscopy, CT and MRI scans, ultrasound, blood tests, and stool studies.

Constipation may be a warning sign of a more serious problem such as colon cancer, diabetes, or hypothyroidism but when other disease have been ruled out, doctors will rely on a tool called the Rome criteria to help them make the diagnosis of IBS. These criteria require that patients have had recurrent abdominal pain, on average, at least 1 day per week during the previous 3 months associated with 2 or more of the following:

  1. The pain is related to defecation and may be increased or unchanged by defecation,
  2. The pain is associated with a change in stool frequency, and/or
  3. The pain is associated with a change in stool form or appearance.
  4. Subtypes are based on how frequently a patient experiences very loose or very hard stools. If a patient experiences very hard stools greater than 25% of the time and very loose stools less than 25% of the time, this classifies as IBS-C.

*Any patients with alarm symptoms including weight loss, bleeding, anemia, back pain, fevers, chills, sweats, or symptoms that started after the age of 50 need to be aggressively and promptly evaluated by a physician.

How is IBS-C treated?

  1. Dietary changes:
    1. Emphasizing a balanced diet to promote a healthy weight and overall feeling of health and wellbeing,
    2. Avoiding processed foods,
    3. Minimizing alcohol,
    4. Eliminating artificial sweeteners such as sucralose and sorbitol. These non-digestible sugars can act as laxatives and increase bloating.
    5. Increasing fluids so as to avoid dehydration, WATER, WATER, WATER!
    6. Patients are advised to avoid food triggers, which can vary between patients but most commonly include foods containing lactose and/or gluten (wheat, barley and rye).
    7. Some people are more sensitive to certain carbohydrates found in foods such as fructose, fructans, lactose and others, known as FODMAPs (or Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols). For some patients IBS symptoms may improve with following a strict low-FODMAP diet, then, reintroducing foods one at a time. If symptoms recur, patients will have a better idea which foods to avoid. Nutrition consultation may be helpful.
    8. Avoiding foods known to cause increased gas production including cabbage, broccoli, cauliflower, onions, celery, carrots, beans, prunes, wheat, alcohol, caffeine, carbonated beverages, soda, and raw fruit, may help. 
    9. Increasing dietary soluble fiber (such as oats, psyllium, plums, prunes and flaxseed)
  2. Lifestyle modifications:
    1. Reducing stress,
      1. Stress and anxiety play a major role in IBS symptoms. Nerves in the colon control bowel contractions and GI motility. In times of stress these nerves can become over-stimulated resulting in abdominal pain and discomfort. Reducing stress and anxiety may improve symptoms. Cognitive behavioral therapy (CBT) and medication management may be beneficial for certain patients.
    2. Participating in regular exercise, and leading an active lifestyle.
      1. Exercise helps by improving overall wellbeing and helping to keep the digestive tract working properly, potentially improving constipation. Always talk with your doctor first before beginning any exercise routine.
    3. Discontinuing tobacco

In addition to lifestyle and dietary modifications, medications are often used to treat symptoms. Call 980-788-8200 for a comprehensive medical evaluation to determine the cause of your symptoms and to establish a treatment plan that works for you.

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