IBS Constipation (IBS-C)
What it is exactly
And what are the possible causes

IBS Constipation, or IBS-C affects about a third of the IBS sufferers. It is one of the many possible causes of constipation.

In this article, we will first introduce what IBS, or Irritable Bowel Syndrome is.

We will then spend some time on IBS-C, a specific version of IBS with a constipation dominance.

IBS Constipation

We will then spend some time on IBS-C, a specific version of IBS with a constipation dominance. We will argue that there isn’t much of a difference between IBS constipation and chronic idiopathic constipation, i.e. chronic constipation without a defined cause. Bowel specialists may use different terminologies. For the rest of us, it is pretty much the same condition, with the same approach in terms of remedies.

Whether you have IBS constipation, or simply chronic constipation without a defined cause, please read on. This article will be relevant to you.

Note that this article does not list possible remedies yet. It is part of our educational series to present the different causes of constipation. We want to take it one step at a time – first understand our condition and what may cause it.

Based on this understanding, we will then be able to create a personalized approach to solve our problem. Remedies will be presented in details in a separate upcoming section of this website.

What is Irritable Bowel Syndrome?

IBS, or Irritable Bowel Syndrome, is a functional disorder of your gastrointestinal tract. Functional means that only the functions of your bowel are affected. There is nothing wrong with the organ itself (no organic cause). If a specialist looked at your bowel from the inside, there would not appear to be anything wrong compared to a healthy bowel. There are no specific biological markers or tests you can use to arrive at an IBS diagnosis.

There is however a clear malfunctioning of the muscles of your colon. They either operate too fast (causing diarrhea) or too slow (causing constipation). We will speculate on the why further down on this page.

IBS is diagnosed mainly through its symptoms. The main symptoms are a subset of:

  • Abdominal pain
  • Diarrhea
  • Constipation
  • Bloating and gas

If you have IBS, you will belong to one of the following 3 categories:

  • IBS-D if you predominantly suffer from diarrhea;
  • IBS-C if you predominantly suffer from constipation;
  • IBD-A if you alternate between the two.

How widespread is IBS?

In a study published in the World Journal of Gastroenterology in 2008(1), the authors mention that IBS accounts for up to 20% of all referrals to gastroenterologists.

I quote from the study: “IBS has widespread economic ramifications in terms of both healthcare utilization and indirect costs incurred as a result of absenteeism from work”.

Population-based studies assess that between 10% and 20% of the general population suffers from IBS. Quite an epidemic proportion you will admit.

In a nutshell, IBS is quite common in western civilized countries, and often goes undiagnosed. A lot of people just live with a chronic level of bowel cramping, bloating, diarrhea and/or constipation. Only 25% of sufferers seek medical help(2).

Who suffers from IBS?

What is the prevalence of the different types of IBS? It depends what study you look at. A large IBS study published in 2005(3) reports 12.7% of IBS-C sufferers, compared to 21.3% of IBS-D and 66% of IBS-A.

The study outlines a disproportionate number of women suffering from IBS (64%) compared to men (36%).

Most of the other IBS studies I am aware of report an equal proportion of IBS Constipation, IBS-D and IBS-A amongst IBS sufferers.

In my practice as a clinical herbalist, I definitely see a lot more women than men, with a prevalence of the IBS-D type. I also see a strong correlation between stress level and IBS crises. We will discuss stress as a cause of IBS further down.

IBS-C vs. chronic idiopathic constipation

As explained in the introduction, the distinction between what is called chronic idiopathic constipation (i.e. chronic constipation of unknown cause as concluded by your doctor) and IBS Constipation appears to be pretty slim and a bit unclear in practice.

The main distinguishing factors are:

  • Abdominal pain. In IBS Constipation (IBS-C) sufferers, the abdominal pain is acute and becomes the main complaint, whereas difficulty to defecate takes a second place. In non-IBS chronic constipation sufferers, the main complaint is a difficulty to defecate. There is abdominal discomfort, but not as bad as in IBS with constipation.
  • Persistence of some of the symptoms after successful defecation. In IBS constipation, some abdominal pain and bloating will usually remain after a full bowel emptying and between constipation crises. As opposed to the non-IBS chronic constipation sufferer will be relieved right away.

In practice however, an IBS constipation sufferer may feel much better after a bowel movement, and a non-IBS sufferer may have lingering bloating and distention between bowel movements. So the so called difference needs to be taken with a grain of salt.

Why should you care about the difference anyway? Rationally, the treatment approach will be very similar for both: constipation will need to be dealt with, period. If you have IBS constipation, it is true that we will also have to relieve the cramping and pain between the constipation crises. That would be the main difference.

So whether you have been diagnosed with IBS Constipation or chronic idiopathic constipation, keep on reading. This is all relevant to you.

What causes IBS with Constipation?

Overall, there is no clear consensus of what causes IBS. IBS is recognized as a complex condition that might be triggered by more than one causes. For IBS constipation specifically, the following causative factors should be considered:

1. Stress

Let’s face it. Even non-IBS sufferers sometimes get stomach cramps, diarrhea or constipation during periods of stress. If you do have IBS, you know how bad things can get when you get stressed out or overly anxious.

Stress is mediated by our nervous system. To communicate, our nervous system employs neurotransmitters, chemical compounds that transmit the message from one neuron to the next. Over the past several years, IBS research has focused on one particular neurotransmitters:serotonin.

Serotonin is not just involved in our central nervous system (nerves around the brain and spinal chord). It also plays a massive role in our enteric nervous system, a specific nervous system located around our gut and governing the motility and secretions of our gastrointestinal system.

So we are starting to see an interesting link here. The head, the brain – the origination of stress and anxiety, with a constant communication, an exchange of neurotransmitters and electrical signals with the enteric nervous system. There is also a nervous link back from the enteric nervous system to the brain via the vagus nerve.

What affects the brain affects the gut
What affects the gut affects the brain

This is often called the brain-gut axis phenomenon.

IBS constipation: brain-gut axis

Some argue that stress makes symptoms worse but is not the root cause of the problem. Others believe that stress is one of the main causes of IBS. Personally, I believe this argument is unimportant. Dealing with stress will relieve some of your symptoms and make the condition more manageable, end of the story.

As we will see in the remedies section, what appeases the brain appeases the gut. Lowering your stress, anxiety and depression level will be beneficial to your IBS Constipation condition. Calming down the central nervous system, and the enteric nervous system (the two being interrelated) will be beneficial. We will cover different techniques and natural remedies in the remedies section of this website.

2. Visceral hypersensitivity

IBS sufferers seem to be overly sensitive to distension in their gut. Some clinical experiments have shown that those people experience exaggerated pain and discomfort in response to abdominal palpation or stretching of the colon, during a colonoscopy for example(4).

Normal events happening in your colon may thus be over-amplified by your nervous system, and be sensed as significant pain by your brain. This explains why as an IBS sufferer, your have completely normal lab test and exams. This is all a matter of perception, with nothing wrong unfolding in your gut.

And note that I am not saying “it’s all in your head”. I know what pain is. Pain is pain. A painful, distended, crampy bowel is just that. Whether or not my brain is making this up, I need pain relief.

It is possible that some of the symptoms of IBS, such as constipation, may be triggered automatically by your gastrointestinal tract as a reflex to this perceived pain. Again, we are back to our brain-gut axis going through very complex adaptation mechanisms. Let me elaborate on that.

If you hurt your back, the muscles around the injured area tense-up to protect your back from further motion. You have no control over this. If your brain gets the signal that your gut is in pain, it makes sense to me that there would be a feedback loop telling the gut to adjust its muscle contractions, possibly affecting how fast food residues move through your colon.

Why an IBS sufferer may be overly sensitive to distention is not known today, although it is believed that stress, anxiety and depression may very well play a role (due to the strong link between the brain and the gut as explained previously).

So what do we do with this information?

First of all, knowledge is better than worry. We now understand that there is no contradiction between the doctor telling us “there is nothing wrong with your bowels” and the acute symptom of Irritable Bowel Syndrome with constipation.

Every IBS sufferer should try to worry less, as stress can greatly worsen the symptoms of IBS. I know that a lot of IBS sufferers speculate that they may have a more serious disease, which in itself is a significant source of worry. Not so in the case of Irritable Bowel Syndrome with constipation.

Second, it helps us to keep an eye open on new research and new potential remedies. Anything that affects the utilization of neurotransmitters in our gut for instance may hold promise. Medicinal plants and natural methods that help quiet the tension and stress in both central and enteric nervous system will be presented in the remedies section of this website.

3. Visceral motility

For some unexplained reason, the colon of IBS Constipation sufferers does not move as fast as the colon of a non-IBS person. The food residues spend too much time being dehydrated in the colon, causing constipation.

This functional abnormality, added to the visceral hypersensitivity presented above, explains the acute abdominal pain and distension. The gut is already hypersensitive to the distension of a normal gut. But slow motility causes further distention due to stools accumulation and gas. This creates further pain, which may further alter the functioning of the gut as an automatic adaptation reflex. Quite a vicious circle.

Any remedy will therefore need to address this abnormality. We will see in the remedies section that some medicinal plants can increase colonic motility.

4. Food

Food as a cause of IBS is debated within the medical community. Some medical practitioners are not very interested in nutrition, and tend to dismiss food sensitivities as a possible cause.

However, based on my own experience and the experience of many other naturopathic practitioners, eliminating certain types of food relieves a subset of IBS sufferers. Less cramping, less bloating, less constipation or diarrhea.

What is frustrating, as usual, is that:

  • Not every IBS sufferer will be relieved by a food elimination diet;
  • Discovering what food acts as a trigger will be a work of trial and errors, taking weeks and sometimes months. Rest assured that this is not a waste of time but an important step toward finding what remedies work for you.

We presented a list of possible food causes in a separate article.

Stay tuned, there will also be an article on how to keep a diet journal and go through an elimination program. That article will help you implement an IBS with constipation diet.

Conclusion

In this article, we talked about IBS constipation (IBS-C), a condition that we paralleled with chronic idiopathic constipation. Both have no detectable organic causes, and both come with acute symptoms that need to be dealt with – cramping, bloating and constipation.

We saw that the brain-gut axis of the nervous system likely plays a major role in IBS Constipation. First of all, based on experience, stress, anxiety and depression has a direct impact on making the symptoms worse.

Second, the nervous system is at the center of slow visceral motility and visceral hypersensitivity, two underlying causes of IBS Constipation symptoms. Healing the nervous system should be a priority.

The purpose of this article was to continue to build-up our knowledge on the possible causes of constipation.

Remedies are presented in details in a separate section of this website.


References

(1) Hammerle CW, Surawicz CM. "Updates on treatment of irritable bowel syndrome". World J Gastroenterol. 2008 May 7;14(17):2639-49. Review.

(2) Luscombe FA. "Health-related quality of life and associated psychosocial factors in irritable bowel syndrome: a review". Qual Life Res 2000; 9: 161–76.

(3) Hungin AP, Chang L, Locke GR, Dennis EH, Barghout V. "Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther. 2005 Jun 1;21(11):1365-75.

(4) Delvaux M. "Role of visceral sensitivity in the pathophysiology of irritable bowel syndrome". Gut. 2002 Jul;51 Suppl 1:i67-71. Review.


Return from IBS Constipation to the Causes of Constipation page

Return from IBS Constipation to the Constipation-remedies-for-all home

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