IBS and IBD

IBS-C

Also called: IBS with constipation, constipation-predominant IBS

IBS-C is the constipation-predominant subtype of irritable bowel syndrome. People with IBS-C have abdominal pain related to defecation, with more than 25 percent of bowel movements hard or lumpy and less than 25 percent loose. About a third of all IBS cases sit in this subtype. The fix is usually a combination of soluble fibre, hydration, movement and (sometimes) targeted medication.

How IBS-C is diagnosed

IBS-C is a clinical diagnosis using the Rome IV criteria: recurrent abdominal pain at least 1 day a week for 3 months, related to defecation, with a stool-form pattern that is mostly hard or lumpy (Bristol stool types 1 to 2) and rarely loose (types 6 to 7). Coeliac disease, inflammatory bowel disease, and other organic causes are ruled out with blood tests, faecal calprotectin and (in some cases) colonoscopy.

What it feels like

  • Bloating that builds through the day and eases overnight.
  • Hard, lumpy or pellet-like stools, often with strain.
  • A feeling of incomplete emptying after a bowel movement.
  • Cramping that improves after going.
  • Fewer than 3 bowel movements a week, often.
  • Symptoms cluster around stress, hormonal cycles, and certain foods (FODMAPs).

What helps

  1. Add 25 to 30 grams of fibre a day, mostly from oats, kiwi, flax, chia, psyllium, beans and pulses.
  2. Drink 2 litres of water across the day. Hydration is what makes fibre useful, not harder.
  3. Walk 30 minutes daily. NICE advises increasing physical activity in people with IBS.
  4. Try a 4-week low-FODMAP elimination under a dietitian if symptoms persist after the basics. Reintroduce systematically.
  5. Daily psyllium husk (ispaghula, around 5 to 10 g) if the basics aren't enough.
  6. Consider prescribed laxatives (linaclotide, plecanatide, prucalopride) under specialist care if lifestyle and OTC options have failed.

What does not help

  • Insoluble fibre such as wheat bran. NICE advises people with IBS be discouraged from it because it can worsen symptoms.
  • Senna or stimulant laxatives daily. Useful as rescue, but routine long-term use is not advised.
  • Cutting all fermented foods. Most IBS-C patients tolerate them fine; the problem is FODMAPs in specific foods, not fermentation generally.
  • Probiotics without a strain target. Some strains (especially B. infantis 35624) help; most don't move the needle.

Common questions

What's the difference between IBS-C and just being constipated?
IBS-C requires abdominal pain that is related to defecation. Functional constipation can have hard stools without that pain pattern. The treatment overlaps but IBS-C also benefits from low-FODMAP and gut-brain therapies that don't change ordinary constipation.
Can IBS-C turn into IBS-D?
Yes. IBS subtypes can switch over time, often around stress, illness, or after antibiotics. Subtype changes are common over time. In a 1-year follow-up study only about a third of patients kept the same bowel habit throughout, with most shifts to or from mixed or unsubtyped IBS.
Does IBS-C affect women more than men?
Yes, by about 2 to 1. Hormonal influence on gut motility (especially in the luteal phase) is part of the reason. Many women find their IBS-C cycles with their periods.
Is IBS-C the same as slow transit constipation?
Related but not identical. Slow transit constipation is mainly a colonic transit problem. IBS-C more often involves visceral hypersensitivity (the same gas and stool feels more painful), though the two overlap and the physiological differences are not clear-cut. Diagnosis is clinical.

Sources

The Book of Suna is general information, not medical advice. It is not a substitute for talking to a qualified healthcare professional about your own situation.