Living with constipation in IBS

Written by: Dr Aathavan Loganayagam
Published: | Updated: 05/03/2020
Edited by: Laura Burgess

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.

Green vegetables-fibre

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 from 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.

By Dr Aathavan Loganayagam

Dr Aathavan Loganayagam trained in medicine at Guy’s, King's and St. Thomas’ medical schools. He then underwent rigorous structured specialty training in gastroenterology and general internal medicine in the well respected South London training programme.

He then spent two years during postgraduate training as a research and endoscopy fellow at Guy’s and St Thomas’ Hospitals, London. His research was in the fields of pharmacogenetics, inflammatory bowel disease and gastrointestinal malignancy. He has received awards and grants for outstanding research work, including the prestigious NHS Innovation London Award.

Dr Loganayagam has numerous publications in peer reviewed journals on all aspects of gastroenterology. He is actively involved in clinical research. He has particular local expertise in the practice of personalised medicine and the utilisation of novel therapeutic agents in the treatment of complex inflammatory bowel disease. He is currently the lead clinician for endoscopy at Queen Elizabeth Hospital, Woolwich.

Diagnostic and advanced therapeutic endoscopy remains a major part of his clinical expertise, including assessment and treatment of inflammatory bowel disease, strictures, polyps and cancers.

Dr Loganayagam is an approachable doctor who takes pride in his communication skills with patients. He is keen to ensure that patients are fully informed and involved in all aspects of their care.

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