IBS-C: How to Get Unstuck

Written by: Jessica Roocroft, RD

Updated: March 31st, 2025

Welcome to the world of IBS-C- which is quite possibly the most complicated of the IBS subtypes. Let’s dive into everything you need to know about managing IBS-C!

What is IBS-C?

IBS-C, or Irritable Bowel Syndrome with Constipation, is a subtype of IBS (the other subtypes being IBS Diarrhea, IBS Mixed and IBS Unclassified).

For people with IBS-C, when stools are abnormal (meaning when stools don’t look like a fairly smooth snake or sausage-like log) individuals experience less than 25% loose or watery bowel movements (diarrhea) and more than 25% hard or lumpy stools (which are usually difficult to pass).

Symptoms of IBS-C can also include bloating, gas, nausea, reflux, and of course, by definition, abdominal pain.

It’s important to note that while everyone’s symptoms are unique; there are red flags to be aware of:

Red Flags

Sometimes, IBS-C might not be the only player on the field. Some red flags that need be brought to the attention of your doctor include (but aren’t limited to):

Recurrent vomiting or fever
Blood in stool or anemia
Onset of symptoms after age 50
Family history of bowel disease
A mass in the abdomen that can be palpated (felt)
Skinny, pencil-like stools happening regularly
Not pooping for more than 5-7 days and/or not passing any gas at all

How is IBS-C Diagnosed Including the Rome Criteria

When diagnosing IBS-C, a doctor will take your health history into consideration, and may order certain blood and stool tests (and possibly other tests such as medical imaging, or scopes, such as a colonoscopy; usually depending on your age and the presence of any red flags).

If your tests return negative the Rome IV criteria comes next, which is recurrent abdominal pain at least one day a week in the last 3 months, plus at least two of the below:

Pain related to pooping
Changes in how often you have bowel movements. This is called stool “frequency”
Changes in the form of your stool, like being too hard or too watery. This is called stool “consistency”

Symptoms should have started at least six months before the diagnosis, as well- this ensures this isn’t an acute (temporary) condition for instance.

So, if your symptoms are putting on a show, it’s time to chat with your doctor.

Diet Tips for IBS-C

Managing IBS-C can be tricky, but there are some key dietary tips that seem to help most people with the condition:

Chew your food thoroughly and slow down during meals.
Stay hydrated– aim for at least 2 liters a day.
Move your body daily, like walking or yoga.
- The more we “jostle” the gut, the more the gut likes to move itself
Cook more meals at home to ensure a balanced diet
- This usually leads to meals lower in saturated fat, added sugars, and sodium, and higher in fibre (we need about 30g per day), plant foods, and lean sources of protein- and this in general tends to help aid in the digestion process
The (temporary) Low FODMAP Diet (guided by a FODMAP-trained Registered Dietitian)
- In particular if bloating is among your worst symptoms, as this diet aims to reduce the fermentable “gas-producing” foods in the diet
- More on this below! Or you can check out Jessica Roocroft, RD’s free IBS-C Mini Guide
- Note: Some people are not recommended to follow a low FODMAP Diet, such as those with a history of disordered eating, the elderly, the very young, or for those already on a restricted diet

If you’ve been cleared to trial a low FODMAP Diet by your Healthcare Provider, below is your cheat sheet for swapping high FODMAP foods with low FODMAP alternatives.

High FODMAP Foods (and their Top Low FODMAP Swaps)

Did you know that most people don’t need the “full/traditional” Low FODMAP Diet in order to feel symptom relief?

It’s true.

The “Gentle/modified” Low FODMAP Diet, which eliminates only the most concentrated sources of FODMAPs (or foods we tend to eat a lot of, volume-wise, in the typical diet, like wheat products) has been researched to be just as effective as the “full/traditional Low FODMAP Diet”, and this variation only kicks off a handful of foods as opposed to potentially hundreds of foods.

The below table lists the some of the most concentrated sources of FODMAPs that can make a big impact on one’s IBS-C symptoms, like bloating and gas:

FODMAP Category	High FODMAP (swap this)	Low FODMAP (for this)
Lactose	“Wet” Dairy: Milk Yogurt Cream Cottage cheese All the above are high FODMAP unless labeled “lactose-free”.	Lactose-free versions of these “wet”dairy foods, or a low FODMAP plant milk alternative, such as almond milk* or rice milk* *Note: these are lower in protein, so make sure you add protein elsewhere
Fructose	Honey Mango Apple Pear	Maple syrup Oranges Clementines Blueberries Pineapple Cantaloupe
Sorbitol	Stone fruits Blackberries Prunes & prune juice Apple Pear	The above fruits, plus barely ripe banana (no brown spots), passion fruit, papaya, lemonade, sweets made with regular sugar
Mannitol	Mushrooms Cauliflower Celery	Oyster mushrooms Broccoli florets Bok choy (the stems make a great sub for celery)
Fructan	Garlic Onion Regular bread Cashews Pistachios Dried fruit Inulin (found in packaged foods like some protein bars, granola bars, and certain protein powders)	Garlic infused oil Green onion (green parts only) Sourdough bread Peanuts, pecans, or walnuts Fresh fruit, like oranges & blueberries
GOSs	Black beans (and most beans in general) Peas Lentils Silken tofu	Butter beans or cannellini beans Edamame beans Lentils, ¼ cup, canned, strained, and rinsed Extra firm tofu, drained and pressed

The Best Apps for Low FODMAP Diet

Tech-savvy? Get the right apps to help manage your low FODMAP diet:

Monash FODMAP

Your go-to source for up-to-date low FODMAP foods and serving sizes. It’s like having a food scientist in your pocket.

FODMAP Friendly

Offers a wide range of tested foods to help you navigate your diet. It also has a “stacking” feature to help you assess if the level of FODMAPs in your meal might exceed a certain threshold (and thus lead to symptoms)

Spoonful

Great for scanning barcodes to identify hidden FODMAPs in packaged foods in your pantry or when you’re shopping at the store. Bonus: It can factor in your other dietary restrictions, such as gluten-free for those who may have both IBS and Celiac Disease

It’s important to talk to your doctor about the risks and benefits of using any over the counter or prescription medications, and/or supplements before starting, stopping or changing anything.

You might find that, while your friend/neighbour/colleague raves about this laxative, that medication, or this supplement, when you try them…nothing happens (or you may just wind up bloated or having diarrhea).

Why does IBS-C happen in the first place?

What trips most patients and practitioners up about IBS-C is the fact that constipation can keep happening, or become stubborn to treat, if we aren’t sure why it’s happening in the first place.

The reason why one person’s constipation can act so differently from another person’s constipation can boil down to the “toothpaste analogy”.

There is a good analogy about constipation that came from a gastroenterologist named Dr.Justin Brandler and how defining one’s constipation can be like investigating a tube of toothpaste:

First, we look at the “paste” itself- your poop consistency, in other words.

If using an osmotic laxative-type product such as magnesium citrate or PEG relieves your constipation by making stools softer and thus easier to pass, you could just have an issue with your “paste”.

Second, we look at the “tube”– your intestinal smooth muscle that wraps around your intestines.

It’s responsible for squeezing your stool through your “tube”- your bowel, in other words. If products containing senna or bisacodyl (which are “stimulant laxatives”) seem to work best for you, or certain medications that also stimulate the intestinal muscles, your constipation may be related to your “tube”.

There are prescription medications that can be helpful if your constipation stems from one or both of the above paste/tube issues such as linaclotide, prucalopride, and a new kid on the block medication called tenapanor.

Also, your gut-brain connection, and certain types of “gut bugs” (your gut microbes) can heavily influence the speed of your gut! More on that later…

Lastly, we look at the “cap” (the “way out”).

Sometimes someone with IBS can have perfect “paste” and a perfect “tube” but “the cap doesn’t come off” to let stool out. Or something is off about the system of ligaments, connective tissue, and/or muscles in general that support bowel function (hello pelvic floor!) that need to be in order to orchestrate the propulsion of stool through the rectum (your “poop storage pouch”) and out via a set of two anal sphincters.

A Pelvic Floor Physiotherapist is especially important to consult with in order to assess if you have a “cap” problem or any issues with your pelvic floor. They may be able to provide targeted exercises and several therapeutic options to address pelvic floor disorders that can lead to chronic constipation.

IBS-C OTC Medications and Supplements

If you have any additional IBS-C symptoms that are being stubborn, like gas or bloating, these OTC medication and supplement options could also warrant chat with your doctor:

Enteric-Coated Peppermint Oil

Aids in relieving abdominal pain…like a calming spa treatment for your tummy

Semithicone

Breaks up large gas bubbles into smaller ones, which helps disperse and absorb gasses in the gut

Probiotics

The composition of an IBS patients’ microbiota (gut bacteria) can vary significantly between someone with IBS Constipation compared to IBS Diarrhea. Probiotics may be trialed if there is a strain that has evidence that it can improve your particular symptoms, specifically for your subtype of IBS/primary bowel habit. Speak with their healthcare professional to ensure the right strain and dose is selected for their IBS subtype.

Addressing the Gut-Brain Interaction

Since IBS is now classified as a disorder of the gut-brain interaction (a DGBI), treatment options benefit at targeting this.

Gut Directed Hypnotherapy (GDH) addressed the miscommunication of the gut-brain axis causing the gut to move too fast or too slow (the latter being the case in IBS-C).

There are apps that can help with this, and unlike medication or diets, the effects can last long term.

Potential Masqueraders (or “Layers” of IBS-C)

Other conditions can be sneaky “Layers” of one’s IBS-C story. These issues include, (but are certainly not limited to):

Pelvic floor dysfunction

As described above, when there is a problem with the group of muscles, ligaments, and connective tissues that support the pelvic organs (which help control bladder and bowel function) there may be a need to call in a good Pelvic Floor Physiotherapist to save the day.

Intestinal Methanogen Overgrowth (IMO)

With IBS-C specifically, you may be growing more methane-producing gut bugs compared to other types of IBS

Essentially, when the gut has abnormal numbers of these gut bugs hanging out along the small or large intestine, and these “methanogen” gut bugs ferment FODMAPs, the resulting methane gas tells the nerves of the gut to slow down, resulting in…you guessed it: More constipation (and often increased sensations of bloat)! This is called IMO, and it can occur in about 50% of everyone with IBS-C

Constipation due to a lack of fibre (paired with ample hydration):

This may seem obvious, but North Americans do not meet their daily fibre needs

If you’re fibre intake is well under 30 grams per day, you may wish to enlist the help of your good ol’ nutrient facts table on food products (Nutrients Canada also has a great app) and aim to increase your daily fibre intake slowly, and disperse it evenly amongst meals and snacks while also ensuring adequate hydration

Hormonal factors

Your hormone levels greatly influence the speed of your gut, including (but not limited to) fluctuations in:

Peptide YY
Serotonin (5-HT)
GLP-1
Ghrelin
Thyroid hormones

Slow transit due to certain medications

There are so many medications whose labels bear the potential side effect of “constipation” that it would be impossible to list them here

Take a look at your medication regime, and ask your doctor if any of your meds might be playing a role in your ability to manage your IBS-C

If you are on medications with constipating side effects, you might wish to consider asking your doctor to discuss potential alternatives

Key takeaways:

IBS-C (Irritable Bowel Syndrome with Constipation) is a subtype of IBS characterized by hard or lumpy stools, with fewer than 25% of bowel movements being loose or watery.
Important symptoms that require medical attention include recurrent vomiting, blood in stool, onset of symptoms after age 50, family history of bowel disease, and prolonged periods without bowel movements, to name just a few
Diagnosis involves a thorough health history, medical tests, and meeting the Rome IV criteria, which includes recurrent abdominal pain and specific changes in bowel habits and stool consistency
Effective dietary tips for managing IBS-C include staying hydrated, eating home-cooked meals, and considering a temporary Low FODMAP diet under a dietitian’s guidance to reduce fermentable foods that may contribute to symptoms such as bloating
Treatment may involve over-the-counter laxatives, prescription medications for constipation, and considering gut-brain interaction therapies such as gut-directed hypnotherapy.
Conditions like pelvic floor dysfunction and intestinal methanogen overgrowth (IMO) can contribute to IBS-C symptoms. Consulting with healthcare professionals who focus specifically in these areas, including pelvic floor physiotherapists and Registered Dietitian is paramount to your success
Managing IBS-C can be challenging, but with the right support from healthcare professionals and self-advocacy, individuals can effectively manage their symptoms and improve their quality of life

Final Thoughts

IBS-C can be a tough ride, but with the right support and care from experienced healthcare professionals, it’s possible to not just manage, but to thrive.

Never give up advocating for yourself.

Download the ‘IBS-C How to Get Unstuck’ Infographic

References:

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