Constipation-Predominant Irritable Bowel Syndrome (IBS-C)

Last Updated: February 15, 2023

Constipation-predominant irritable bowel syndrome (IBS-C) is a subtype of irritable bowel syndrome (IBS) that leads to abdominal pain, bloating, and straining. The exact causes are unknown, but research suggests that multiple factors — such as the gut-brain axis, abnormal muscular contractions, gut microbes, and genetics — could play a role in the disease. IBS-C can be managed with dietary modifications, supplements, and prescription medications.

What is IBS-C?

IBS-C is a subtype of IBS characterized by abdominal pain, bloating, and straining to pass stool. Approximately one-third of IBS sufferers have IBS-C, and women are much more likely than men to fit the criteria of IBS-C.[1] IBS-C is associated with anxiety, but unlike IBS-D, it isn’t linked to depression.[2]

What are the main signs and symptoms of IBS-C?

IBS-C shares some symptoms — including abdominal pain and bloating — with the other IBS subtypes, but in IBS-C, constipation is the most common bowel habit, and people with IBS-C also often report straining to pass stool. Symptoms often temporarily subside after a bowel movement.[3][1]

How is IBS-C diagnosed?

There is no test to diagnose IBS-C, so doctors often use blood and stool tests to rule out other diseases before reaching an IBS-C diagnosis. Rome IV criteria can be used to diagnose IBS-C based on the proportion of bowel movements rated as constipation compared to those rated as normal.[4] Symptoms need to occur at least once per week for at least three months to be considered IBS.[5]

What are some of the main medical treatments for IBS-C?

Medications for IBS-C include osmotic laxatives and guanylate cyclase-c agonists, both of which can increase water retention in the bowel and stimulate intestinal motility. Antidepressants and antispasmodics may also be used to reduce abdominal pain.[5]

There’s some evidence that methane could slow intestinal transit, and antibiotic treatment of methane-positive small-intestinal bacterial overgrowth (SIBO) improved constipation in a small number of studies.[6]

Have any supplements been studied for IBS-C?

A number of probiotic strains have been shown to reduce abdominal pain, bloating, and intestinal transit time while improving stool consistency. However, the effects appear to be temporary, with most benefits seen around six to eight weeks of supplementation even though some participants continued to take the probiotics for twelve weeks.[7][1]

Doctors might also recommend over-the-counter fiber supplements if increasing dietary fiber doesn't help. Psyllium husk appears to be effective for normalizing stool in both IBS-C and IBS-D.[8] Additionally, peppermint oil can ease IBS-associated abdominal pain.[5]

One study found that a traditional Persian blend of herbal extracts had a laxative effect greater than placebo; interestingly, the British Pharmacopoeia simple syrup used to compound the blend, which served as placebo, itself also had a noticeable laxative effect.[9] This could be due to the high concentration of sugar causing water retention in the intestine and easing stool transit.

Flixweed (Descurainia sophia), a common weed also known as tansy mustard, was as effective as figs for improving pain, distension, and bowel movement frequency.[10]

How could diet affect IBS-C?

Although a low-FODMAP diet isn’t recommended for IBS-C, some people with IBS-C report greater abdominal distension after eating foods high in FODMAPs. Dietary fiber is only weakly associated with bloating or distention after eating.[11]

Both kiwis and dried, rehydrated figs have been shown to improve IBS-C symptoms at reasonable serving sizes of two kiwis per day or 45 grams of dried figs twice per day.[12][10]

Are there any other treatments for IBS-C?

Electroacupuncture — a form of acupuncture that uses electrodes in place of needles — was more effective for constipation and abdominal pain relief compared to sham treatment in a four-week study, but participants were able to use a laxative if they had less than three bowel movements per week. Since the researchers didn’t disclose information about laxative use during the study, it’s unclear whether the improvements were due to the electroacupuncture or the laxative.[13]

Although traditional Chinese medicine appears to be as effective as pharmaceutical drugs, most studies are of low quality with a high risk of bias due to a lack of blinding and participant randomization.[14]

What causes IBS-C?

Though the cause of IBS-C is still unknown, research suggests that multiple factors — such as the gut-brain axis, abnormal muscular contractions, gut microbes, hormones, and genetics — could play a role in the disease. IBS is twice as common in women compared to men, which could be explained, in part, by hormonal changes during the menstrual cycle.[15][5]

Some studies have found a higher prevalence of methane-positive small-intestinal bacterial overgrowth (SIBO) in people with IBS-C and other forms of constipation, suggesting that this form of SIBO could be linked to symptoms via excess methane production (which could slow intestinal transit.) However, it’s unclear whether methane production is a cause or consequence of slow transit.[6]

Supplements Demystified: Get Our Unbiased, Evidence-Based Guide

Don't miss out on the latest research

  1. ^Shang X, E FF, Guo KL, Li YF, Zhao HL, Wang Y, Chen N, Nian T, Yang CQ, Yang KH, Li XXEffectiveness and Safety of Probiotics for Patients with Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials.Nutrients.(2022-Jun-15)
  2. ^Fond G, Loundou A, Hamdani N, Boukouaci W, Dargel A, Oliveira J, Roger M, Tamouza R, Leboyer M, Boyer LAnxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysisEur Arch Psychiatry Clin Neurosci.(2014 Dec)
  3. ^Howell CA, Kemppinen A, Allgar V, Dodd M, Knowles CH, McLaughlin J, Pandya P, Whorwell P, Markaryan E, Yiannakou YDouble-blinded randomised placebo controlled trial of enterosgel (polymethylsiloxane polyhydrate) for the treatment of IBS with diarrhoea (IBS-D).Gut.(2022-Dec)
  4. ^Max J Schmulson, Douglas A DrossmanWhat Is New in Rome IVJ Neurogastroenterol Motil.(2017 Apr 30)
  5. ^Irritable Bowel Syndrome: National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD: National Institutes of Health, USA; cited January 2023
  6. ^Arjun Gandhi, Ayesha Shah, Michael P Jones, Natasha Koloski, Nicholas J Talley, Mark Morrison, Gerald HoltmannMethane positive small intestinal bacterial overgrowth in inflammatory bowel disease and irritable bowel syndrome: A systematic review and meta-analysisGut Microbes.(Jan-Dec 2021)
  7. ^Yoon JY, Cha JM, Oh JK, Tan PL, Kim SH, Kwak MS, Jeon JW, Shin HPProbiotics Ameliorate Stool Consistency in Patients with Chronic Constipation: A Randomized, Double-Blind, Placebo-Controlled Study.Dig Dis Sci.(2018-Oct)
  8. ^Ford AC, Moayyedi P, Chey WD, Harris LA, Lacy BE, Saito YA, Quigley EMM, ACG Task Force on Management of Irritable Bowel SyndromeAmerican College of Gastroenterology Monograph on Management of Irritable Bowel SyndromeAm J Gastroenterol.(2018 Jun)
  9. ^Pazhouh HK, Hosseini SMA, Taghipour A, Hamedi S, Noras MAnti-irritable Bowel Syndrome Syrup Improves Constipation-Predominant Irritable Bowel Syndrome: A Randomized, Placebo-Controlled Trial.Chin J Integr Med.(2020-Oct)
  10. ^Pourmasoumi M, Ghiasvand R, Darvishi L, Hadi A, Bahreini N, Keshavarzpour ZComparison and Assessment of Flixweed and Fig Effects on Irritable Bowel Syndrome with Predominant Constipation: A Single-Blind Randomized Clinical Trial.Explore (NY).(2019)
  11. ^Wright-McNaughton M, Ten Bokkel Huinink S, Frampton CMA, McCombie AM, Talley NJ, Skidmore PML, Gearry RBMeasuring Diet Intake and Gastrointestinal Symptoms in Irritable Bowel Syndrome: Validation of the Food and Symptom Times Diary.Clin Transl Gastroenterol.(2019-Dec)
  12. ^Bayer SB, Heenan P, Frampton C, Wall CL, Drummond LN, Roy NC, Gearry RBTwo Gold Kiwifruit Daily for Effective Treatment of Constipation in Adults-A Randomized Clinical Trial.Nutrients.(2022-Oct-06)
  13. ^Huang Z, Lin Z, Lin C, Chu H, Zheng X, Chen B, Du L, Chen JDZ, Dai NTranscutaneous Electrical Acustimulation Improves Irritable Bowel Syndrome With Constipation by Accelerating Colon Transit and Reducing Rectal Sensation Using Autonomic Mechanisms.Am J Gastroenterol.(2022-Sep-01)
  14. ^Li DY, Dai YK, Zhang YZ, Huang MX, Li RL, Ou-Yang J, Chen WJ, Hu LSystematic review and meta-analysis of traditional Chinese medicine in the treatment of constipation-predominant irritable bowel syndrome.PLoS One.(2017)
  15. ^Adeyemo MA, Spiegel BM, Chang LMeta-analysis: do irritable bowel syndrome symptoms vary between men and women?Aliment Pharmacol Ther.(2010-Sep)