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 or discomfort with hard or lumpy stools more than 25 percent of the time and loose stools less than 25 percent of the time. 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. Gut motility is dose-responsive to movement.
  4. Try a 4-week low-FODMAP elimination under a dietitian if symptoms persist after the basics. Reintroduce systematically.
  5. Daily psyllium husk (5 to 10 g) or magnesium citrate (400 mg) at bedtime 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

  • Low-fibre diets long-term. They reduce stool bulk and worsen IBS-C in most people.
  • Senna or stimulant laxatives daily. Useful as rescue, but tolerance builds and they can worsen the cycle.
  • 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. About 30 percent of IBS patients change subtype within 5 years.
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 motility problem (food moves too slowly through the colon). IBS-C is a motility AND visceral sensitivity problem (the same gas and stool feels more painful). Diagnosis is clinical.

Sources