How to Treat and Manage IBS-C

CDHF

Written by: CDHF

Updated: November 29th, 2022

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Canada has one of the highest incidence and prevalence rates of irritable bowel syndrome (IBS) in the world – estimated 18% vs. 11% globally (Lovell et al. 2012).  Irritable bowel syndrome with constipation, also referred to as IBS-C, is a distressing condition that can significantly affect the quality of life of those affected.

A new IBS-C diagnosis can be intimidating and leave you feeling uncertain.  How will your quality of life be affected?  Is there a cure? What are the available treatment options?  

Treatment will depend on the severity of your IBS-C.  People with mild IBS-C can often treat and manage their symptoms without any prescription medication.  For more severe cases, there are several therapies that have been shown to help manage both constipation and abdominal pain symptoms.    

The key to managing your IBS symptoms is to educate yourself on the nature of this digestive condition so that you can recognize and manage your triggers.  You should consider tracking your food and symptoms to understand the relationship between your IBS and lifestyle, diet, and mental health.

We’ve put together a comprehensive guide on ways to manage IBS-C.

1. Diet

Adopting a balanced and healthy diet is one of the best ways to help manage your IBS-C symptoms.  There may be specific food triggers that have gone unnoticed or certain food groups that are not helping with your symptoms.  You are probably wondering, what are the best foods for IBS-C?

Dietary Fibre

Fibre is an important component of a healthy diet; however, it is generally lacking in our Western diets, which contain a large amount of red meat, fat, and processed carbohydrates.  Most Canadians only get about half their daily recommended fibre intake.

Inadequate fibre intake has been linked to inflammation and manifestation of several gastrointestinal conditions, highlighting the importance of incorporating it into your everyday diet. 

What does fibre do?

Fibre refers to the parts of food we consume that cannot be broken down and digested by our bodies.  Fibre can be divided into two categories:

  1. Soluble
  2. Insoluble

Soluble fibres dissolve in water and cannot be digested by our small intestine.  Instead, it passes to the large intestine where it is broken down by beneficial microbes.  Soluble fibres are the main source of energy for our gut microbiota and consuming it has been shown to have positive effect on overall gut health (McRorie & McKeown 2017).  In this way, soluble fibres act as a type of prebiotic, meaning that they promote the growth of beneficial microorganisms in the gut.

Soluble fibre also increases gut motility, meaning that it can help with constipation symptoms associated with IBS-C and make you more regular.  The Canadian Association of Gastroenterology recommends using soluble fibre as way to treat IBS-C (Moayyedi et al. 2019).

Foods that are high in soluble fibre include:

In contrast to soluble fibre, insoluble fibre is not broken down by microbes in our gut.  It passes through undigested and acts as a bulking agent for stool.  Insoluble fibre is not recommended as a treatment for people living with IBS-C and has even been shown to worsen symptoms (Ford et al. 2014). 

If you are modifying your diet to better manage your IBS-C, try limiting these foods:

If you have IBS-C, you may want to stay away from high protein, low carb diets, which have been shown to cause constipation because of inadequate fibre intake. CDHF recommends working with a registered dietitian to ensure that you are getting enough carbohydrates, protein, and fat so that you have a balanced diet.

Proper Hydration

Drinking enough water everyday will help things move along your digestive tract and help improve your constipation symptoms. 

According to the National Academy of medicine, women should consume about 2 litres and men should consume about 2.5 litres of water per day. 

Try keeping a water bottle with you or eat lots of fruits and vegetables, like cucumbers, spinach, apples, and strawberries.  Be mindful of how much coffee you drink, as caffeine can act as an irritant in the gut.

2. Lifestyle

Lifestyle changes can make a big impact on alleviating pain, stress, bloating, and regulating bowel movements.   In today’s world, it’s easy to forget about getting enough sleep, eating regularly, and prioritizing relaxation. Here are some areas you can pay more attention to:

Eating regularly and intentionally

Skipping meals, or multitasking while eating can be triggers for your IBS-C symptoms.  Many patients with IBS-C report feeling better when eating smaller more frequent meals at regular intervals (Cozma-Petrut et al. 2017).  This keeps your digestive tract moving throughout the day and reduces your chances of being constipated. 

Managing Stress

Another important factor to consider when managing IBS is stress management.  When we eat, our bodies are in a state of relaxation as they begin to digest our food.  Eating while driving, scrolling on your phone, or working can be stressful and provoke symptoms like bloating and gas later in the day.  Take some time for yourself and create a calm environment free of distractions to enjoy your meals.   

Exercise

Exercising can reduce stress, depression, anxiety, and GI symptoms like abdominal pain, and bloating (Levy et al. 2005).  Studies have shown that it is an effective long term treatment option for managing IBS symptoms (Johannesson et al. 2015; Lecy et al. 2005).  According to the Canadian Food Guide, adults need at least 150 minutes of moderate to vigorous physical activity per week.

If you feel like you aren’t getting enough exercise. try setting realistic goals and build from there.  Find something that you have fun doing, and give yourself time to form the habit.  It can something simple like taking a 30 minute walk every day after work, taking the stairs instead of the elevator, or going for a bike ride on the weekends.

Reducing alcohol consumption

Research on the effects of alcohol and IBS are limited.  While alcohol consumption is clearly harmful for some people living with IBS, others report no differences with or without alcohol, or only report feeling worse after having a certain amount or type of alcohol (Reding et al. 2013).

If you find your IBS-C is affected by alcohol and you’re having trouble quitting, there are some great resources you can check out here to get you to where you need to be.  

3. Medications and natural remedies

While lifestyle and dietary changes can play a role in helping manage mild IBS-C symptoms, if your symptoms do not improve or even worsen, you may require further intervention. Over the Counter (OTC) and prescription therapies are available for treating IBS-C. OTC medications are recommended for short term/occasional use. If your symptoms are still unresolved, you should consult with your health care provider. With the right medication, you should find relief and prevent IBS-C from inhibiting your everyday activities and quality of life.

Laxatives

Laxatives are a class of drugs that increase gut motility and therefore can help ease constipation.  While they are effective at increasing the frequency of your bowel movements, they have not been shown to help with abdominal symptoms. 

For this reason, laxatives may sometimes be prescribed along with another medication to fully treat the condition. Your doctor will come up with a treatment plan that is specific to your IBS-C that may or may not include laxatives.

Antispasmodics

Antispasmodics have been used for decades to treat IBS symptoms.  They belong to a class of drugs that relaxes the smooth muscles of our digestive tract and reduces sensitivity.  This can help alleviate abdominal symptoms like pain, bloating, and cramping in IBS patients (Ford et al. 2008; Triantafillidis & Malgarinos 2014). 

Your doctor may prescribe you hyoscine, pinaverium, or dicyclomine to manage your IBS symptoms if other medications have not worked for you. 

Peppermint oil

Like antispasmodic drugs, peppermint oil acts as a smooth muscle relaxant and can be used to treat abdominal symptoms associated with IBS-C (Ford et al. 2019).  The Canadian Association of Gastroenterology recommends taking peppermint oil for moderate cases of IBS-C, where lifestyle changes such as exercise and increased fluid intake are not enough to manage symptoms (Moayyedi et al. 2019). 

How do I take peppermint oil?

You can take peppermint oil in capsules to manage symptoms.  It’s important to take the dose that’s prescribed to you by your doctor, as taking more can interfere with absorption of nutrients and even make you feel worse. 

Plecanatide, linaclotide and lubiprostone

Plecanatide (Trulance) is a prescription medication used to treat IBS-C. It acts by increasing fluid secretion in the gut, thereby promoting gut motility (Ford et al. 2014; Kamuda & Mazzola 2018).  It also influences pain sensors in the digestive tract.

Plecanatide has been shown to be an effective treatment option for both abdominal symptoms and constipation in patients living with IBS-C.  In clinical trials, it significantly decreased abdominal bloating, cramping and improved frequency of bowel movements (Brenner et al. 2018).  The most common side effect of this medication is diarrhea, however it’s usually mild.

Like plecanatide, linaclotide is a medication that increases fluid secretion in the intestines, which helps stool pass and ease constipation (Peng et al. 2022; Johanson et al.2008; Drossman et al. 2009). 

Antidepressants

Antidepressants have been shown to be effective in managing symptoms in IBS-C and IBS-D.  Studies have shown that they significantly reduce IBS symptoms and improve overall quality of life in patients with IBS (Ford et al. 2019).  This may be because they improve gut motility and have anti-inflammatory and pain-relieving effects (Grover & Camilleri 2013; Verdu et al. 2008). 

If you have IBS-C, your doctor may prescribe you a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).  This class of antidepressant has been shown to increase gut motility and can also be helpful for treating abdominal symptoms (Vahedi et al. 2005). 

4.    Therapy

Seeing a professional who is specialized in Cognitive behavioural therapy (CBT) or hypnotherapy can help you process and manage some of the emotions you may have toward your diagnosis, or stress you may be dealing with in your everyday life (Ford et al. 2019; Simren et al. 2004). 

What is CBT?

Cognitive behavioural therapy (CBT) is a form of psychological treatment that focuses on the ways that people deal with their stress or problems. It aims to help people better cope with their problems by changing thinking and behaviour patterns.  Studies have shown that seeing a therapist specialized in CBT improves GI symptoms in IBS patients (Ford et al. 2014).  Because IBS is a gut-brain axis disorder, therapy can have a positive impact on both the psychological and physical symptoms associated with this condition (Moayyedi et al. 2019).     

One major limitation of this treatment option is availability and financial burden, making it inaccessible for many people living with IBS.  Alternative options include relaxation techniques, breathing exercises and meditation, however research on how effective they are is still quite limited. 

What treatment option is best for me? 

The best IBS treatment will depend on your situation.  Healthy lifestyle changes are important for long term management of this condition, but other treatment options listed may be beneficial in the short term while you get your IBS-C under control. In every situation, a personalized approach is important to consider.

Ultimately, it comes down to having patience, staying informed, having a strong physician-patient relationship, and staying in tune with your body so that you and your doctor can work together to find the best treatment for your IBS-C.


References:

Brenner, D. M., Fogel, R., Dorn, S. D., Krause, R., Eng, P., Kirshoff, R., Nguyen, A., Crozier, R. A., Magnus, L., & Griffin, P. H. (2018). Efficacy, safety, and tolerability of plecanatide in patients with irritable bowel syndrome with constipation: Results of two phase 3 randomized clinical trials: American Journal of Gastroenterology113(5), 735–745. https://doi.org/10.1038/s41395-018-0026-7

Chey, W. D., Lembo, A. J., Lavins, B. J., Shiff, S. J., Kurtz, C. B., Currie, M. G., MacDougall, J. E., Jia, X. D., Shao, J. Z., Fitch, D. A., Baird, M. J., Schneier, H. A., & Johnston, J. M. (2012). Linaclotide for Irritable Bowel Syndrome With Constipation: A 26-Week, Randomized, Double-blind, Placebo-Controlled Trial to Evaluate Efficacy and Safety. American Journal of Gastroenterology107(11), 1702–1712. https://doi.org/10.1038/ajg.2012.254

Cozma-Petruţ, A., Loghin, F., Miere, D., & Dumitraşcu, D. L. (2017). Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients! World Journal of Gastroenterology23(21), 3771. https://doi.org/10.3748/wjg.v23.i21.3771

Drossman, D. A., Chey, W. D., Johanson, J. F., Fass, R., Scott, C., Panas, R., & Ueno, R. (2009). Clinical trial: Lubiprostone in patients with constipation-associated irritable bowel syndrome – results of two randomized, placebo-controlled studies. Alimentary Pharmacology & Therapeutics29(3), 329–341. https://doi.org/10.1111/j.1365-2036.2008.03881.x

Fedorak, R. N., Vanner, S. J., Paterson, W. G., & Bridges, R. J. (2012). Canadian Digestive Health Foundation Public Impact Series 3: Irritable Bowel Syndrome in Canada. Incidence, Prevalence, and Direct and Indirect Economic Impact. Canadian Journal of Gastroenterology26(5), 252–256. https://doi.org/10.1155/2012/861478

Ford, A. C., Lacy, B. E., Harris, L. A., Quigley, E. M. M., & Moayyedi, P. (2019). Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. American Journal of Gastroenterology114(1), 21–39. https://doi.org/10.1038/s41395-018-0222-5

Ford, A. C., Moayyedi, P., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Quigley, E. M. M. (2014). American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation. American Journal of Gastroenterology109, S2–S26. https://doi.org/10.1038/ajg.2014.187

Ford, A. C., Quigley, E. M. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Moayyedi, P. (2014). Effect of Antidepressants and Psychological Therapies, Including Hypnotherapy, in Irritable Bowel Syndrome: Systematic Review and Meta-Analysis. American Journal of Gastroenterology109(9), 1350–1365. https://doi.org/10.1038/ajg.2014.148

Ford, A. C., Talley, N. J., Spiegel, B. M. R., Foxx-Orenstein, A. E., Schiller, L., Quigley, E. M. M., & Moayyedi, P. (2008). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: Systematic review and meta-analysis. BMJ337(nov13 2), a2313–a2313. https://doi.org/10.1136/bmj.a2313

Grover, M., & Camilleri, M. (2013). Effects on gastrointestinal functions and symptoms of serotonergic psychoactive agents used in functional gastrointestinal diseases. Journal of Gastroenterology48(2), 177–181. https://doi.org/10.1007/s00535-012-0726-5

Institue of Medicine, Food and Nutrition Board. (2004). Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington D.C: National Academics Press.

Johannesson, E. (2015). Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects. World Journal of Gastroenterology21(2), 600. https://doi.org/10.3748/wjg.v21.i2.600

Johanson, J. F., Drossman, D. A., Panas, R., Wahle, A., & Ueno, R. (2008). Clinical trial: Phase 2 study of lubiprostone for irritable bowel syndrome with constipation: CLINICAL TRIAL: LUBIPROSTONE FOR IBS WITH CONSTIPATION. Alimentary Pharmacology & Therapeutics27(8), 685–696. https://doi.org/10.1111/j.1365-2036.2008.03629.x

Johnston, J. M., Kurtz, C. B., MacDougall, J. E., Lavins, B. J., Currie, M. G., Fitch, D. A., O’Dea, C., Baird, M., & Lembo, A. J. (2010). Linaclotide Improves Abdominal Pain and Bowel Habits in a Phase IIb Study of Patients With Irritable Bowel Syndrome With Constipation. Gastroenterology139(6), 1877-1886.e2. https://doi.org/10.1053/j.gastro.2010.08.041

Kamuda, J. A., & Mazzola, N. (2018). Plecanatide (Trulance) for Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation. P & T: A Peer-Reviewed Journal for Formulary Management43(4), 207–232.

Lovell, R. M., & Ford, A. C. (2012). Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis. Clinical Gastroenterology and Hepatology10(7), 712-721.e4. https://doi.org/10.1016/j.cgh.2012.02.029

McRorie, J. W., & McKeown, N. M. (2017). Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber. Journal of the Academy of Nutrition and Dietetics117(2), 251–264. https://doi.org/10.1016/j.jand.2016.09.021

Moayyedi, P., Andrews, C. N., MacQueen, G., Korownyk, C., Marsiglio, M., Graff, L., Kvern, B., Lazarescu, A., Liu, L., Paterson, W. G., Sidani, S., & Vanner, S. (2019). Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). Journal of the Canadian Association of Gastroenterology2(1), 6–29. https://doi.org/10.1093/jcag/gwy071

Peng, L. H., Fang, J. Y., Dai, N., Shen, X. Z., Yang, Y. L., Sun, J., & Yang, Y. S. (2022). Efficacy and safety of linaclotide in patients with irritable bowel syndrome with constipation: Chinese sub‐cohort analysis of a phase III , randomized, double‐blind, placebo‐controlled trial. Journal of Digestive Diseases23(2), 99–110. https://doi.org/10.1111/1751-2980.13081

Reding, K. W., Cain, K. C., Jarrett, M. E., Eugenio, M. D., & Heitkemper, M. M. (2013). Relationship Between Patterns of Alcohol Consumption and Gastrointestinal Symptoms Among Patients With Irritable Bowel Syndrome. American Journal of Gastroenterology108(2), 270–276. https://doi.org/10.1038/ajg.2012.414

Simrén, M., Ringström, G., Björnsson, E. S., & Abrahamsson, H. (2004). Treatment With Hypnotherapy Reduces the Sensory and Motor Component of the Gastrocolonic Response in Irritable Bowel Syndrome. Psychosomatic Medicine66(2), 233–238. https://doi.org/10.1097/01.psy.0000116964.76529.6e

Triantafillidis, J., & Malgarinos, G. (2014). Long-term efficacy and safety of otilonium bromide in the management of irritable bowel syndrome: A literature review. Clinical and Experimental Gastroenterology, 75. https://doi.org/10.2147/CEG.S46291

Vahedi, H., Merat, S., Rashidioon, A., Ghoddoosi, A., & Malekzadeh, R. (2005). The effect of fluoxetine in patients with pain and constipation-predominant irritable bowel syndrome: A double-blind randomized-controlled study. Alimentary Pharmacology and Therapeutics22(5), 381–385. https://doi.org/10.1111/j.1365-2036.2005.02566.x

Verdu, B., Decosterd, I., Buclin, T., Stiefel, F., & Berney, A. (2008). Antidepressants for the Treatment of Chronic Pain: Drugs68(18), 2611–2632. https://doi.org/10.2165/0003495-200868180-00007

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