With as many as 1 in 5 Americans suffering with irritable bowel syndrome (IBS) and less than 20% seeking medical care, it is fair to say that IBS is a common bowel problem that remains largely untreated. IBS is not a serious condition that is linked to life-threatening complications like cancer. Nevertheless it can still be debilitating and adversely affect the lives of sufferers in various ways.
What is IBS-C?
IBS-C refers to irritable bowel syndrome with constipation, which is also known as constipation-predominant IBS. Abnormal bowel habit is one of the main features of irritable bowel syndrome and in IBS-C this alteration is mainly constipation. This means that a person may pass stool less than three times a week, experience difficulty when defecating and pass hard stools.
At the other extreme is IBS-D or irritable syndrome with diarrhea (diarrhea-predominant IBS). There is IBS-M (mixed diarrhea and constipation IBS) and IBS-A (alternating diarrhea and constipation IBS). All types of irritable bowel syndrome are marked by abdominal cramps or pain in addition to other symptoms like excessive gas, bloating and abdominal distension.
Read more on diarrhea IBS.
Causes of IBS-C
The exact cause of irritable bowel syndrome remains unknown. There are several theories as to why the symptoms arise and the nature of the disorder. However, this does not explain the exact cause of this condition. Irritable bowel syndrome is a functional bowel disorder, not a pathological condition. In simple terms this means that there is a disturbance in the normal functioning of the bowel rather than an actual disease of the bowels.
There are several theories as to why IBS occurs. This includes:
- Abnormal movement (motility) through the gut.
- Extreme sensitivity (hypersensitivity) of the bowels.
- Microscopic inflammation in the bowels.
- Alterations in the normal intestinal flora (naturally-occurring microbes in the bowels).
- Mental health conditions.
It is important to note that with regards to mental health conditions, there is no clear association between these conditions and irritable bowel syndrome (IBS). However, it has been observed that IBS tends to be more common among people with anxiety disorders and depression. This does not apply to every person with irritable bowel syndrome although most sufferes do report an aggravation of symptoms with psychological stress.
One of the more favored theories is that the movement of food and wastes through the bowels are abnormal. Under normal circumstances, the muscles in the bowel wall contract and relax in a rhythmic manner to move the gastrointestinal contents. However, this appears to be disordered in irritable bowel syndrome where movement is too rapid (IBS-D) or too slow (IBS-C).
Signs and Symptoms
All types of IBS share common symptoms to a similar degree. The two main symptoms are altered bowel habit and abdominal pain or cramps. Other symptoms may include mucus in the stool, abdominal distension, excessive gas and a bloated feeling. Many of these symptoms overlap with indigestion (dyspepsia). It is not uncommon for people with IBS to report indigestion as well, with heartburn, nausea and vomiting in conjunction with the other symptoms.
The alteration in bowel habit is the differentiating factor in the presentation. With IBS-C, constipation is the predominant alteration in bowel habit. Constipation is defined as having less than three bowel movements in a week with hard stool that is difficult to pass out and sometimes even painful to evacuate. However, not all these features may be present at the same time.
Another characteristic feature of irritable bowel syndrome is the abdominal pain or cramps and this applies to all types of IBS. The pain may vary among sufferes. It is often describes as being generalized abdominal pain and cannot be pinpointed to a specific location, while as other times it is more localized. Most often in these cases it is isolated to the lower abdomen and specifically the lower left quadrant (LLQ) pain.
Diagnosis of IBS-C
The tests and scans done for IBS-C is not significantly different as the investigations done for other types of IBS. Various diagnostic investigations may be conducted but this is usually to exclude gastrointestinal diseases that present with similar symptoms as IBS. Furthermore the symptoms present should meet with certain criteria to confirm a diagnosis of IBS, known as the Rome criteria or Manning criteria. The final diagnosis of irritable bowel syndrome of any type should be made by a medical professional.
Treatment of IBS-C
The choice of treatment of irritable bowel syndrome depends on the presenting symptoms. As there is no cure for IBS of any type, symptomatic relief and preventing acute flareups is the main treatment approach. However, many IBS sufferers manage the condition, even during flareups, without any medication. Diet plays an important role in both the management of symptoms and reducing the frequency of flareups.
- Lubiprostone, linaclotide and eluxadoline are IBS agents used to control the symptoms.
- Dicyclomine and hyoscyamine are anticholinergic agents used to reduce cramps.
- Imipramine and amitriptyline are tricyclic antidepressants to reduce pain.
- Methylcellulose and psyllium are bulk-forming laxatives used for constipation.
Probiotic supplements may be useful for some people with IBS. Some studies have shown that it improves symptoms. However, the exact dose and type of probiotics that may be helpful is unclear. Counseling, stress management programs and exercise may also be helpful in the management of IBS.
Diet for IBS-C
Dietary management is highly recomended to prevent flareups and minimize symptoms. It should be continued indefinitely, even after a flareup eases and when symptoms are very mild or absent for short periods. The dietary approach includes increasing the intake of fiber-rich foods, minimizing caffeine intake, consuming more water to ease constipation and possibly excluding gluten-rich foods may be useful.
A low FODMAP diet may also be helpful. Studies have shown promising results by excluding these carbohydrates in order to control the symptoms of IBS. Individual food triggers should be identified by keeping a food diary and with an elimination diet. These trigger foods varies among sufferers. Once identified, the trigger food should be avoided as far as possible or at least consumed in small quantities on an occasional basis.
Read more on low FODMAP diet.