Living with constipation in IBS

Constipation is a common problem in irritable bowel syndrome (IBS) and thought to affect over half of all patients. We’ve asked one of our leading gastroenterologists Dr Aathavan Loganayagam about the symptoms and how someone can manage this condition alongside living with IBS.

What are the symptoms of constipation?

Common signs and symptoms of constipation include:

• Difficulty passing a bowel motion, including straining.
• A feeling of incomplete evacuation.
• Hard or lumpy stools.
• Infrequent bowel motions, usually less than three bowel movements per week.
• Feeling of blockage in the anus and/or rectum.
• Having to use fingers to remove stool during a bowel movement (digital evacuation).
• ​If you suffer constipation, this may exacerbate other IBS symptoms, such as abdominal pain, excessive wind (or gas), bloating and/or distension.
   

What are risk factors for IBS-related constipation?

A number of factors may contribute to constipation in IBS. These include:

• Slow movement of contents through the intestine - sometimes called delayed transit.
• Heightened sensitivity to pain - sometimes called visceral hypersensitivity.
• Problems with intestinal secretion - where not enough fluid is being released into the intestine.
• Problems with pelvic floor muscles during defecation - sometimes called dyssynergic defecation.
• Problems with the rectum during defecation - sometimes called inadequate rectal propulsion.

Other factors that may contribute to constipation include:

• Some medications, such as codeine for pain relief.
• Some nutritional supplements, for example, iron.
• Diet, particularly an inadequate fibre intake.
• Dehydration.
• Physical inactivity.
   

What are the treatment options for constipation with IBS?

Treatments that may improve constipation in IBS include:

• Increasing dietary fibre intake - choose low FODMAP, high fibre foods if following a low FODMAP diet.
• Fibre supplementation - try fibre supplements such as linseeds, oats, oat or rice bran, methylcellulose, sterculia and/or psyllium. Wheat bran should be avoided as it may worsen pain and bloating.
• Ensuring adequate, but not excessive fluid intake - additional fluid intake (above normal levels) does not appear to increase in stool output in healthy individuals.
• Low FODMAP diet - may reduce pain and bloat associated with constipation and some studies have shown improvements in constipation per se.
• Including caffeinated beverages.
• Regular exercise.
• Laxatives (polyethylene glycol) - under the advice of your doctor.
• Prescription medications – such as lubiprostone, linaclotide, prucalopride, selective serotonin reuptake inhibitors.

Your gastroenterologist will be able to guide you on the medications that might help with your individual case.


Visit Dr Loganayagam now at one of his London clinics if you would like to learn how to manage your IBS flare-ups.