Stools are typically soft and easy to push out. When stools are hard to pass, it can feel like you haven’t fully emptied your bowels. This could be a sign of irritable bowel syndrome with constipation (IBS-C).
IBS is a digestive disorder that affects 7%–21% of people in the United States. It includes symptoms such as belly pain, constipation, and diarrhea. IBS-C is the type of IBS that causes bloating and constipation.
Constipation means having hard stools that are difficult to pass and having bowel movements less than three times a week. Hard stools may not pass fully, leading to incomplete bowel movements or feeling like you haven’t had a complete bowel movement.
Incomplete bowel movements happen for a couple of reasons — one of which is constipation.
There are a few possible causes of constipation:
- a problem with the way stool moves through the intestines
- a problem with messages from the brain to the intestines
- a change in the types of bacteria that live in the gut
- environmental triggers, such as stress, food sensitivity, and infections
Straining to push can eventually damage the muscles and nerves that help with bowel movements, worsening the problem. Researchers are also investigating whether genes or immune system changes might also play a role in triggering IBS-C.
Pelvic floor dysfunction is another possible cause. The pelvic floor muscles support abdominal organs, such as the bladder, uterus, and rectum. These muscles need to relax to allow stool to pass. In people with pelvic floor dysfunction, the pelvic floor muscles tighten instead of relaxing.
Sometimes the rectum bulges forward in people assigned female at birth. This is called a
The treatment for incomplete bowel movements depends on the cause. IBS-C and constipation each have their own set of treatments.
Sitting in the correct position on the toilet is one general way to help the bowels empty more easily. Try the following steps to achieve the correct position:
- Lean forward with your forearms resting on your thighs and your feet propped up on a small stool.
- Relax your body and breathe normally.
- Use your belly muscles to push gently.
- Stop after 10 minutes if you’re still unable to have a bowel movement. Try again when you feel the urge to go.
Muscle relaxants may help by preventing the pelvic floor muscles from contracting during bowel movements.
Treatments for IBS-C relieve constipation. A combination of lifestyle changes and medications make stools softer and easier to pass, which helps prevent incomplete bowel movements.
Staying active is good for the whole body, including the gastrointestinal (GI) tract. Exercise helps to speed the movement of digested food through the intestines.
Eating more fiber and making other dietary changes may be enough to relieve mild constipation. Whole grains, fruits, and vegetables are good sources of fiber.
Some people find that FODMAPs aggravate their IBS-C symptoms. FODMAPs are short-chain carbohydrates that are hard to digest. They’re found in wheat products, fruits, vegetables, dairy foods, and the sweetener sorbitol.
A low FODMAP diet may help with constipation and other symptoms.
Dietary fiber keeps stools soft. It comes in two types: soluble and insoluble. Soluble fiber dissolves in water. Insoluble fiber doesn’t dissolve in water.
Insoluble fiber helps food move more easily through the digestive system and helps to prevent constipation. Leafy greens, whole grains, and fruit with edible skins (apples, pears) are high in insoluble fiber.
People who don’t get enough fiber from diet alone may benefit from taking a fiber supplement, such as:
- methylcellulose (Citrocel)
- polycarbophil (FiberCon)
- psyllium (Metamucil, Konsyl)
Drinking plenty of water helps these products work most effectively.
Laxatives and stool softeners
Laxatives stimulate bowel movements. Stool softeners make stool softer and easier to pass. These products can help relieve acute (short-term) constipation.
Osmotic laxatives (MiraLax) work by pulling fluid into the colon. Stimulant laxatives (Dulcolax, Senecott) stimulate the muscles of the intestines. Stimulant laxatives work quickly, but they can cause cramping.
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are mainly prescribed to treat depression. These antidepressants can help regulate the digestive process and relieve pain from IBS-C.
Medications for IBS-C
Three prescription drugs are approved specifically to treat IBS-C:
- linaclotide (Linzess)
- lubiprostone (Amitiza)
- plecanatide (Trulance)
These medications work by adding fluid to the stool and improving the movement of stool through the intestines.
When IBS-C causes fecal incontinence, treatments are aimed at reducing the number of uncontrolled bowel movements.
Loperamide (Imodium) reduces the frequency of bowel movements, and methylcellulose (Citrucel) thickens loose stool. They also reduce the frequency of bowel movements.
This treatment teaches you how to strengthen the pelvic floor and abdominal muscles that control bowel movements. A nurse or physical therapist can help you find the right muscles to work.
When other treatments aren’t enough, surgery may be an option. The goal of surgery is to fix the rectal sphincter, which controls the release of stool.
Sacral nerve stimulation is an implantable device that reduces symptoms of fecal incontinence by helping the anal sphincter stay closed.
It may be time to see a doctor if your constipation doesn’t go away or you’re consistently having a feeling of incomplete bowel movements.
Let your doctor know if you have any of the following symptoms:
- a change in your bowel habits that has lasted more than 3 weeks
- a lump or pain in your belly or rectum
- bleeding from your rectum
- blood in your stool
- unexplained weight loss
There is no cure for IBS-C, but with the right treatment plan, symptoms can be managed. Lifestyle changes, medications, and other treatments help with symptoms such as constipation and make bowel movements more complete.
If you need help managing IBS-C, the American Gastroenterological Association (AGA) is a good resource for information and advice. The IBS Patient Support Group is an education and advocacy group that offers online support groups for people with IBS.