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.

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. These 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.

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Laxatives

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.

There are different kinds of laxatives. It's important to be aware of what you're taking. Some can be habit-forming and possibly harmful in the long run.

Stimulant laxatives include bisacodyl (Correctol, Dulcolax), sennosides (Ex-Lax, Senokot), castor oil, and the plant cascara. With these laxatives, the active ingredient triggers muscles in the bowels to contract, moving stool through. Talk with your doctor before you take these medications. Over time, senna can damage nerves in the colon wall, and the drugs may stop working.

Osmotic laxatives include lactulose, which is prescribed by a doctor, and polyethylene glycol (Miralax), which you can buy over the counter. They 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.

Prescription Medication

Linaclotide (Linzess) treats both men and woman 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 age 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.

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.

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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.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on March 09, 2016

Sources

SOURCES:

Philip Schoenfeld, MD, professor of medicine, University of Michigan.

Jeanine Blackman, MD, PhD, Bethesda, MD.

The National Center for Complementary and Alternative Medicine: "Acupuncture."

Mayo Clinic: "Irritable Bowel Syndrome."

About.com: "Herbs and Supplements for IBS."

Medscape: "Probiotics Significantly Reduce Symptoms of IBS, Ulcerative Colitis," "Highlights from Digestive Disease Week: An Expert Interview with Lawrence R. Schiller, MD."

FDA.

Harvard Health Publications: "Understanding and treating an irritable bowel."

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