Treatment for IBS with Constipation (IBS-C)

There's no single, best approach to treating IBS-C. Often, people use a mix of therapies to get relief. They can include changes in diet, exercise, stress management, and medication.

The goal of treatment is more than just easing bowel problems. It's also to soothe the stomachaches, pain, and bloating that are also common symptoms of IBS-C.

Don't try to treat yourself without talking with your doctor. You need to be sure IBS-C is the cause of your symptoms. And there are health risks that come with taking laxatives and supplements regularly.

Here are some common treatment strategies to discuss with your doctor.

Changes in Diet

Many people manage their symptoms by changing what they eat.

Fiber reduces constipation by softening stool, making it easier to pass. Yet few of us come close to eating the daily 25 grams for women or the 38 grams for men that experts recommend.

Good sources of fiber include whole-grain bread and cereals, fruits, vegetables, and beans.

If you plan to add more high-fiber foods to your diet, do it gradually. Foods affect each person in different ways. Some people get diarrhea and gas when they eat too much fiber, especially all at once. And some high-fiber foods may not agree with you.

Dried plums, prune juice, ground flaxseed, and water also help loosen bowels.

Another good idea: Stay away from coffee, carbonated drinks, and alcohol. They can slow down your stools. So can processed foods such as chips, cookies, and white bread and rice.

Your doctor may suggest something called a low FODMAP diet. Basically, you cut down on carbohydrates that are hard for your body to digest.

The foods you'd scale back on or avoid can include:

• Apples
• Pears
Milk
• Rye and wheat breads
• Asparagus
• Artichokes
• Onions
• Garlic

Keep a symptom journal to figure out which foods your system can handle. Just jot down your IBS symptoms, then note the type and amount of foods you ate during the meals before the symptoms started.

Fiber Supplements

Some people use bulking agents, commonly known as fiber supplements, to treat IBS with constipation. They add soluble fiber to your stool, which makes it easier to pass by absorbing more water in your intestines. Make sure you drink plenty of water when you take one.

These supplements include:

• Wheat bran
• Corn fiber
• Calcium polycarbophil (Fibercon)
• Psyllium (Fiberall, Metamucil, Perdiem, and others)

These agents may help with constipation, but they don't seem to help with other IBS symptoms such as stomachaches, discomfort, and swelling. The extra fiber may make belly pain, bloating, and discomfort worse.

Laxatives

Many people with irritable bowel syndrome turn to laxatives to relieve constipation. But it’s important to understand exactly how much these treatments can help the condition.

Laxatives help you go to the bathroom and may work well for occasional constipation. But they can be harmful if you take them regularly. And they don't treat all IBS symptoms, such as stomachaches and bloating.

That doesn’t mean a laxative won’t help if you have IBS with constipation. There are different kinds of laxatives. It's important to be aware of what you're taking. Some are safer than others for long-term treatment of constipation, while others can be habit-forming and possibly harmful in the long run.

If you're thinking about taking one, talk with your doctor first. They can guide you to the one that will help you the most.

Stimulant laxatives: You can buy stimulant laxatives at the drugstore. They include bisacodyl (Correctol, Dulcolax), sennosides (Ex-Lax, Senokot), castor oil, and the plant cascara. With these laxatives, the active ingredient (usually a chemical called senna) triggers muscles in the bowels to contract, moving stool through. Talk with your doctor before you take these medications.

Side effects can include diarrhea, upset stomach, vomiting, and stomach cramping.

Osmotic laxatives: Some, such as lactulose, are prescribed by a doctor. You can buy others over the counter. These include milk of magnesia, polyethylene glycol, (Miralax), magnesium citrate, and sorbitol.

These laxatives pull water back into the colon to soften stool. That makes it easier to pass, but research has found that they only help with constipation. They may actually make other symptoms worse. Side effects include diarrhea, dehydration, and bloating. Osmotics are considered fairly safe for long-term use for some people with IBS-C, but talk it over with your doctor before you use them regularly. Make sure you drink plenty of water when you take them to avoid dehydration.

Prescription Medication

Linaclotide (Linzess) treats both men and women with IBS-C when other treatments have not worked. The drug is a capsule you take once daily on an empty stomach, at least 30 minutes before the first meal of the day. It helps relieve constipation by helping bowel movements happen more often. People aged 17 or younger shouldn’t take it. The most common side effect is diarrhea.

Lubiprostone (Amitiza) treats IBS-C in women who haven’t been helped by other treatments. Studies haven't fully shown that it works well in men. Common side effects include nausea, diarrhea, and belly pain.

Plecanatide (Trulance) is a prescription medication that has been shown to treat constipation without the usual side effects of cramping and abdominal pain. The once a day pill can be taken with or without food. It works to increase gastrointestinal fluid in your gut and encourage regular bowel movements.Doctors may suggest other medications to help relieve some symptoms of IBS, such as constipation, diarrhea, or belly cramping.

Antidepressants

Your doctor may prescribe you a low dose of antidepressants for your IBS. This doesn't necessarily mean that you are depressed. Antidepressants can block the brain's perception of pain in the gut.

For IBS-C, your doctor may prescribe small doses of an SSRI (selective serotonin reuptake inhibitor) antidepressant, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Their side effects may include nausea, loss of appetite, and diarrhea.

Antispasmodics

Antispasmodic drugs such as dicyclomine (Bentyl) and hyoscyamine (Levsin) relieve the stomach cramps brought on by IBS by relaxing the smooth muscle of the gut. But they also may cause constipation, so they aren't usually prescribed for people who suffer IBS-C. Other side effects are dry mouth, drowsiness, and blurred vision.

Stress Management for IBS

Studies have shown that reducing tension or worry can improve IBS symptoms.

You can reduce stress in many ways. Regular exercise effectively lowers stress. So do yoga and meditation. You can also ease pressure through simple activities such as getting a massage, listening to music, taking a bath, or even reading a good book.

Another stress-busting technique is behavioral therapy. This approach teaches you how to change the way your mind and body react to events. It can include cognitive behavioral therapy, psychotherapy, hypnosis, biofeedback, and relaxation therapy. Most of these therapies help people avoid overreacting to stressful situations and people. The American College of Gastroenterologists says behavioral therapy can work well for many IBS symptoms.

Alternative Treatments

Some people find alternative therapies such as acupuncture and herbs relieve their symptoms. But there isn't much scientific evidence that these therapies work for IBS.

If you want to try acupuncture or herbs for your IBS-C, talk with your doctors first. Some herbs can affect how other medications work.

What's Right for You

Work with your doctor to choose the right treatment plan for you. Not every treatment works for every person. You may need to try several different therapies, or different combinations, before you find what works.

Also, your symptoms may change with treatment. You may feel constipated and swollen now, have diarrhea and cramping in a few weeks, and then go back to being constipated.

With proper treatment -- and some patience -- you can manage your IBS-C symptoms and lead an active life.

Here are 10 questions to ask your doctor about IBS and constipation:

1. Is IBS with constipation linked to any other disease such as colon cancer?
2. How can I figure out what triggers my IBS symptoms?
3. Are there medications I can take for my IBS?
4. What dietary changes and exercise should I consider? Should I talk to a dietitian?
5. If certain foods make my constipation worse, should I eliminate them from my diet forever?
6. How long and how often can I safely take laxatives and other over-the-counter treatments?
7. How does stress contribute to my IBS? What can I do about it?
8. Could meditation, acupuncture, or herbal remedies help IBS symptoms?
9. How do I explain my condition to family, friends, and co-workers?
10. How long will I likely have IBS?

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