What does IBS-C feel like? How do I know If I have IBS-C?

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This resource was made possible due to a sponsorship from Bausch Health. 

What does IBS-C feel like? How Have you been experiencing bloating, cramping, or abdominal pain for the past few months?  Have your bowel movements felt more difficult or less frequent than usual? You may be living with either chronic constipation or irritable bowel syndrome with constipation (IBS-C). 

Both are digestive conditions that affect many people worldwide, but often go undiagnosed because of lack of resources or reluctance to describe symptoms (Scott et al. 2021).  

Talking about your bowel movements, or bloating can seem embarrassing, but it’s an important step toward building a strong physician-patient relationship and can be beneficial for your overall quality of life.  Abnormal bowel movements can be caused by a number of medical conditions, such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), infections like C. difficile, or even colon cancer.  

If you’ve been constipated for a prolonged period of time and are experiencing painful bloating or gas, you may be wondering: What does IBS-C feel like? How do I know I have IBS-C?  We have the answers so keep reading to find out!  

First things first, what is constipation? 

If you have been spending more time and effort than usual on the toilet, you aren’t alone. Constipation (also called functional constipation) is a very common, but uncomfortable condition that affects up to 27% of Canadians (Senchez & Bercik 2011).  It becomes more common with age and affects women more than men (Scott et al. 2021). 

Constipation is caused by a dysfunction of gut motility, which means that your intestines are not moving food along your digestive tract as they should be. This can be due to a number of factors including: 

  • Not drinking enough water 
  • Unhealthy diet and poor consumption of fibre 
  • Lack of exercise 
  • Stress  
  • Age 
  • Pregnancy 
  • Travelling  
  • Certain medications 
  • Metabolic diseases (like diabetes) 
  • Certain neurological diseases (like Parkinson’s disease) 

How is constipation treated? 

Constipation can be treated by changes in lifestyle or diet, proper hydration, or over-the-counter medications such as laxatives (Scott et al. 2021; Sanchez et al 2011).  Because there are many facets that impact this condition, a personalized approach is recommended, meaning that treating constipation isn’t a one size fits all approach. If you’ve noticed that constipation has been affecting your everyday life for more than a few weeks, it may be worth finding out if you have chronic (long-lasting) constipation.  

When is constipation considered chronic? 

According to the Rome IV criteria, someone is considered to have chronic constipation if they meet at least two of the below criteria and have been experiencing symptoms for at least 3 out of past 6 months:  

  • Having less than three bowel movements per week,  
  • Straining while on the toilet for at least 25% of the time 
  • Hard or lumpy stools at least 25% of the time 
  • Feeling of an incomplete bowel movement at least 25% of the time 
  • Increased time spent trying to defecate at least 25% of the time 
  • Failed attempts to defecate at least 25% of the time  
  • Manual manoeuvres to complete bowel movements more than 25% of the time 
  • Absence of loose stools when not taking laxatives 

Once a diagnosis is made, your doctor may recommend a change in diet or lifestyle, or prescribed laxatives. Changes in lifestyle can include incorporating physical activity into your everyday life, as it is an important and effective step you can take to manage your constipation.   

If your constipation is associated with symptoms like abdominal pain, bloating, or cramping when you have a bowel movement, your doctor may want to determine whether you have irritable bowel syndrome with constipation (IBS-C), a digestive condition that has symptoms that overlap with chronic constipation.  It’s important to talk to your doctor about all your symptoms, as these two conditions are not treated in the same way.   

What is IBS? 

Irritable Bowel Syndrome (IBS) is a common digestive disorder that affects about 10% of people worldwide and over 5 million Canadians (Moayyedi et al. 2017; Lacy et al. 2016b).  It is more common in women and people under the age of 50.  IBS is a complex disease that is still not fully understood and can be frustrating to manage.  Symptoms can be debilitating and have a significant impact on quality of life. The most common symptoms are: 

  • Bloating 
  • Cramping 
  • Abdominal pain 
  • Increased gas and flatulence  
  • Mucus in feces  
  • Changes in the number of bowel movements you have 
  • Changes in the texture or smell of your stool 

Symptoms can be triggered unexpectedly and place a large burden on those living with them.  A simple dinner out with friends, or a weekend away can be a major source of anxiety for someone with IBS, often leaving them feeling powerless or isolated.  People with IBS are more likely to miss work and face uphill battles on most days due to the persistent symptoms they live with (Ballou, Bedell & Keefer 2015). 

Although the cause of IBS has not been pinpointed, it’s a condition affected by many factors (Bonetto et al. 2021), including: 

  • Motility (movement of substances through the digestive tract) 
  • Sensitivity (how the brain processes signals from abdominal nerves) 
  • Brain-gut dysfunction 
  • Past infections (like gastroenteritis)  
  • Emotional trauma, especially early in life 

IBS and the Brain 

While IBS is a digestive condition, it was also recently classified as a gut-brain axis disorder (Fagoonee & Pellicano 2019).  The gut and brain influence each other, meaning our emotions affect the mobility of our digestive tract, and our gut can similarly affect our emotions.  Dysfunction of this pathway can have a detrimental effect on overall mental health and gut health and contribute to IBS symptoms (Chojnacki et al. 2018). 

Now that we know the differences between IBS and chronic constipation, the question remains, how do you know which one you have? 

IBS-C vs Chronic Constipation 

In contrast to irritable bowel syndrome (IBS), chronic constipation generally does not cause symptoms such as abdominal pain or bloating (Scott et al. 2021; Sanchez & Bercik 2011).  If you have been constipated for a while, but are also experiencing some of these other symptoms when it’s time to go to the bathroom, you may have irritable bowel syndrome with constipation, also called IBS-C.   

It’s important to communicate your symptoms to your physician accurately so that you can be diagnosed and treated to manage IBS. If you suspect you have IBS or often experience these symptoms, it’s helpful to keep a diary to track their frequency, intensity, and duration.  To find out more about symptoms tracking for IBS, click here to check out CDHF’s myIBS app to track your digestive health.  

How is IBS-C Diagnosed?  

Irritable bowel syndrome is diagnosed in several stages.  The first is a symptoms-based approach where your doctor will ask you about how you feel when you have a bowel movement (Moayyedi et al. 2019).   

You may have IBS if you have abdominal pain at least one time per week in a period of 3 months and at least two of the following criteria apply to you:   

  1. The abdominal discomfort related to a bowel movement 
  1. A change in the number of bowel movements you have 
  1. The appearance of your stool has changed  

If these criteria are met, your doctor will perform a careful medical history and physical exam to rule out any other causes of the symptoms.   

If present, your physician will want to assess the following higher risk symptoms to ensure that you do not have a more serious condition: 

  • Unintentional weight loss 
  • Anemia (iron deficiency) 
  • Fatigue 
  • Blood in your stool  
  • Diarrhea at night 
  • Vomiting 
  • Pain that is not relieved following a bowel movement or passing gas 
  • Onset of symptoms after the age of 50  

Your doctor may also order the following tests (Bonetto et al. 2021) to rule out any other underlying conditions: 

  • A complete blood workup:  Your doctor will want to get a general picture of your blood counts and check for other conditions such as anemia and inflammation. These could indicate a more serious condition, such as ulcerative colitis or Crohn’s disease
  • A stool test: your physician may have a stool test performed to determine whether your symptoms are due to an infection, like C. difficile. They may also collect a sample to test for other markers of intestinal inflammation, such as fecal calprotectin.   
  • Hydrogen breath test:  In certain cases, your doctor may order a hydrogen breath test to rule out a food intolerance, specifically to different types of sugars, as the cause of your symptoms.  For example, they may test for lactose intolerance. 
  • A colonoscopy: Your physician may order this test if you have a family history of colon cancer, if you start experiencing symptoms after the age of 50, or if you have any of the more serious symptoms mentioned above. 

IBS Subtypes 

Once other conditions have been ruled out, a diagnosis can be made your doctor will determine what subtype of IBS you have: 

  1. IBS with diarrhea (IBS-D) 
  1. IBS with constipation (IBS-C
  1. IBS with mixed bowel habits (IBS-M
  1. IBS Unclassified (IBS-U) 

These subtypes are differentiated based on the appearance of your stool using what’s called the Bristol stool scale. The classifications of stool appearance are separated into 7 types (Chumpitazi et al. 2015): 


Constipated
Type 1“BristolSeparate hard lumps,
like nuts (hard to pass)
Type 2Bristol Chart Type 2Sausage-shaped but
lumpy
Normal
Type 3Bristol Chart Type 3Like sausage but with
cracks on its surface
Type 4Bristol Chart Type 4Like a sausage or
snake, smooth and
soft
Diarrhea
Type 5Bristol Chart Type 5Soft blobs with clearcut 
edges (passes
easily)
Type 6Bristol Chart Type 6Fluffy pieces with 
ragged edges, a
mushy stool
Type 7Bristol Chart Type 7Water, no solid pieces.
Entirely liquid.

Types 1 and 2 correspond to constipation, while types 6 and 7 indicate diarrhea.  Types 3,4, and 5 are considered normal.  This is an important step of the diagnostic process because treatment plans will vary greatly depending on the subtype.    

The following criteria must be met to be diagnosed with IBS-C (Shmulson & Drossman 2017): 

  • More than 25% of your bowel movements correspond to Bristol stool types 1 or 2 
  • Less than 25% of your bowel movements correspond to Bristol stool types 6 and 7 

What comes after your IBS-C diagnosis?  

Once you’ve received your formal diagnosis for IBS-C, you and your doctor can start discussing what that means and the best approach to managing your symptoms.  Treatment for IBS-C include lifestyle changes like not skipping or eating large meals, staying hydrated, exercising, and consuming soluble fibre to promote gut motility (Liu & Brenner 2021; Black & Ford 2021). 

You may be referred to a dietitian to trial the FODMAP diet.  FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are groups of sugars and sugar alcohols present in certain foods.  To date, the Low FODMAP diet is one of the most well-researched diets that shows significant symptom improvement for ~50-80% of those with IBS.    

The low FODMAP diet  involves significantly reducing intake of these carbohydrates for a short period of time, followed by strategic reintroduction to see which FODMAPs trigger which IBS symptoms. 

It is important to pay attention to when symptoms arise and if there are identifiable triggers in your diet, lifestyle, or emotions.  If lifestyle changes are proving ineffective, your doctor may also prescribe medications used to treat IBS, such as:  

  • Laxatives: help increase movement in the intestines but do not treat abdominal symptoms.   
  • Antidepressants: used to manage pain and treat GI symptoms  
  • Plecanatide (Trulance): helps improve constipation symptoms of IBS-C by increasing fluid secretion and motility in the gut, and decreases the activity of pain-sensitive nerves in the intestines (Bausch Health, Canada, TRULANCE Product Monograph dated March 17, 2021, Mechanism of Action, p. 11-12.) 
  • Antispasmodics: relax the smooth muscle in the intestines and relieve abdominal cramping 

Our understanding of IBS is still incomplete, and there is a lack of universally effective treatment options.  The goal is to find a long-term treatment plan and lifestyle that works for you and leaves you feeling empowered. It can take time to figure out what works, especially following your initial diagnosis.  Educating yourself on your condition is an invaluable tool for helping you navigate living positively with IBS.  


References

Ballou, S. (2015). Psychosocial impact of irritable bowel syndrome: A brief review. World Journal of Gastrointestinal Pathophysiology, 6(4), 120. https://doi.org/10.4291/wjgp.v6.i4.120 

Black, C. J., & Ford, A. C. (2021). Best management of irritable bowel syndrome. Frontline Gastroenterology, 12(4), 303–315. https://doi.org/10.1136/flgastro-2019-101298 

Chojnacki, C., Błońska, A., Kaczka, A., Chojnacki, J., Stȩpień, A., & Gasiorowska, A. (2018). Evaluation of serotonin and dopamine secretion and metabolism in patients with irritable bowel syndrome. Polish Archives of Internal Medicine, 128(11), Article 11. https://doi.org/10.20452/pamw.4364 

Chumpitazi, B. P., Self, M. M., Czyzewski, D. I., Cejka, S., Swank, P. R., & Shulman, R. J. (2016). Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations. Neurogastroenterology & Motility, 28(3), 443–448. https://doi.org/10.1111/nmo.12738 

Fagoonee, S., & Pellicano, R. (2019). Does the microbiota play a pivotal role in the pathogenesis of irritable bowel syndrome? Journal of Clinical Medicine, 8(11), Article 11. https://doi.org/10.3390/jcm8111808 

Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016b). Bowel disorders. Gastroenterology, 150(6), Article 6. https://doi.org/10.1053/j.gastro.2016.02.031 

Liu, J. J., & Brenner, D. M. (2021). Review article: Current and future treatment approaches for IBS with constipation. Alimentary Pharmacology and Therapeutics, 54(S1), Article S1. https://doi.org/10.1111/apt.16607 

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 Gastroenterology, 2(1), 6–29. https://doi.org/10.1093/jcag/gwy071 

Moayyedi, P., Mearin, F., Azpiroz, F., Andresen, V., Barbara, G., Corsetti, M., Emmanuel, A., Hungin, A. P. S., Layer, P., Stanghellini, V., Whorwell, P., Zerbib, F., & Tack, J. (2017). Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterology Journal, 5(6), Article 6. https://doi.org/10.1177/2050640617731968 

Sanchez, M. I. P., & Bercik, P. (2011). Epidemiology and burden of chronic constipation. Canadian Journal of Gastroenterology, 25(SUPPL.B), Article SUPPL.B. https://doi.org/10.1155/2011/974573 

Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of Neurogastroenterology and Motility, 23(2), 151–163. https://doi.org/10.5056/jnm16214 

Scott, S. M., Simrén, M., Farmer, A. D., Dinning, P. G., Carrington, E. V., Benninga, M. A., Burgell, R. E., Dimidi, E., Fikree, A., Ford, A. C., Fox, M., Hoad, C. L., Knowles, C. H., Krogh, K., Nugent, K., Remes-Troche, J. M., Whelan, K., & Corsetti, M. (2021). Chronic constipation in adults: Contemporary perspectives and clinical challenges. 1: Epidemiology, diagnosis, clinical associations, pathophysiology and investigation. Neurogastroenterology and Motility, 33(6), Article 6. https://doi.org/10.1111/nmo.14050