Constipation Myths and Facts
Constipation is one of the symptoms often associated with irritable bowel syndrome (IBS). The key symptom of IBS is abdominal pain. The pain is associated with a change in the frequency or consistency of bowel habit. The altered bowel habit may be chronic or recurrent constipation, or diarrhea. Some people have both constipation and diarrhea, just at different times. Bloating or distention in the abdomen is also common.
The main bowel habit can change over time. In addition, symptom occurrence can fluctuate over time. There can be periods when symptoms flare-up as well as periods when they diminish or disappear.
Constipation means different things to different people – even doctors. Doctors usually define constipation as hard pellet-like stools. Individuals usually think of constipation as...
- infrequent stools
- difficulty or straining at stools
- feeling of being unable to completely empty during a bowel movement, or the sensation of wanting to go but not being able to.
There's a Difference between IBS and Chronic Functional Constipation
People with IBS have abdominal discomfort or pain associated with their bowel habit. They may have symptoms that overlap with functional constipation. People with functional constipation may not have the abdominal pain of IBS. Or they may have less pain than with IBS. They would not have intervals of normal bowel habit and diarrhea with loose stools that can occur in IBS.
IBS with constipation is sometimes referred to as IBS-C or constipation-predominant IBS.
Constipation-specific symptoms were varied and frequent. The most bothersome symptoms reported were…
- abdominal pain,
- straining,
- infrequent stools,
- bloating and/or gas.
Treating IBS Pain
There is no single treatment for pain, discomfort or other symptoms of irritable bowel syndrome (IBS). A number of therapies have been shown to be useful is some people. Always be sure to ask your doctor about possible side effects, which can occur with any treatment. Results for IBS pain management vary from person to person . . .
- Relaxation therapy, hypnosis, or cognitive behavioral therapy can help improve pain tolerance.
- Cognitive therapy and hypnotherapy, but not relaxation therapy, are more effective than usual care in relieving overall symptoms of IBS. There are no known serious adverse events associated with these therapies; however, their mechanisms of benefit remain unclear.
Anticholinergic agents (for example, hyoscine, cimetropium, pinaverium and some peppermint oil preparations) taken before meals may provide short-term reduction of abdominal pain after meals. [Note: Peppermint oil capsules must be swallowed whole because the raw oil can cause intense heartburn.]
- Probiotic products based on bifidobacteria and certain combinations of probiotics have shown some benefit to relieve pain and bloating.
- Try to improve sleep through better sleep hygiene: Patients with chronic pain report sleep as their number one problem.
- Prescription drugs aimed at reducing overall symptoms, including abdominal pain, for IBS with diarrhea (IBS-D) include alosetron and eluxadoline.
- Prescription drugs aimed at reducing overall symptoms, including abdominal pain, for IBS with constipation (IBS-C) include lubiprostone and linaclotide.
- For severe IBS, antidepressants, in low doses, may be prescribed. The use of the antidepressant drug class for treatment of IBS symptoms is not linked to depression, but rather likely to effects on the brain and the gut. Antidepressant medications can reduce the intensity of pain signals going from gut to brain.
Tips for an IBS-Friendly Diet
Meals may seem to trigger symptoms. It may be the process of eating and not a certain food that sets off your symptoms. Eating stimulates the digestive tract, which can over-respond because of IBS.
- Try eating smaller meals, more often, spread throughout your day. Instead of 3 meals, try 5 or 6 regularly scheduled small meals.
- Slow down; don't rush through meals.
- Avoid meals that over-stimulate everyone's gut, like large meals or high fat foods. If you are constipated, try to make sure you have breakfast, as this is the meal that is most likely to stimulate the colon and give you a bowel movement.
If you think a certain food is a problem, try cutting it out of your diet for about 12 weeks. (If you suspect more than one, cut out one at a time so you know which one causes you problems.) If there's no change, go back to eating it.
The foods most likely to cause problems are:
- Insoluble (cereal) fiber
- Coffee/caffeine
- Chocolate
- Nuts
