Irritable Bowel Syndrome or IBS is a chronic intestinal disorder that affects 7-21% of the general population. Common symptoms of IBS include abdominal pain, bloating, cramping, gas, diarrhea and constipation. Sometimes symptoms alternate between both diarrhea and constipation. IBS with Constipation (IBS-C) is when abdominal pain, discomfort and/or bloating is accompanied by constipation. In IBS-C, bowel frequency is less than 3 times per week and stool is hard and is difficult to pass. Patients may also feel the need to strain and they may have incomplete emptying of their colon. Often the abdominal discomfort or pain is improved with defecation. A diagnosis of IBS-C is made based on clinical symptoms and physical exam. There is no blood test or radiologic studies to confirm the diagnosis.

IBS PainThe definite cause of IBS-C is unknown. However, several hypotheses exist. One is that the muscle contractions that help move food through the digestive tract is weak, leading to delayed transit, and subsequent hard, dry stools. Another is that the nerves in the wall of the colon are hypersensitive, and signal greater pain in response to colon distension from gas or stool. Sometimes, IBS-C symptoms begin after an intestinal infection. In some people, the pelvic floor muscles do not relax during bowel movement, making stool evacuation difficult. Finally, it is thought that immune system and inflammation may play a role in IBS-C. 

Treatment for IBS-C includes regular exercise, reducing or avoiding alcohol and tobacco, increasing fluids and dietary fiber (e.g. oats, psyllium, and flax), reducing gas producing foods and drinks (e.g. caffeine, and soda). Probiotics may help with IBS symptoms by promoting healthy gut flora, and naturally occurring intestinal bacteria. Biofeedback can help with pelvic muscle training during defecation.

Psychological stressors can trigger IBS symptoms, and post-traumatic stress disorder, anxiety and depression, can all be found in patients with IBS. Therefore, treating problems can help symptoms of IBS.

Medications used for IBS-C include laxatives and stool softeners, which improve stool frequency and stool form. These are often the first to be used. Antispasmodics help to relax intestinal muscle and therefore may help ease abdominal pain; however, it is necessary to use caution since these may worsen constipation. Newer medications increase fluid secretion into the intestine, and therefore are called secretory agents. These agents help soften stool and increase frequency of bowel movements. Secretory medications can also reduce abdominal pain.