Irritable bowel syndrome (IBS) has several uncomfortable physical symptoms, one of which is constipation. But there are many ways you can find relief and get back to some sense of regularity.
Up to one-third of people with irritable bowel syndrome (IBS) have the subtype IBS with constipation (IBS-C), according to 2015 World Gastroenterology Organisation (WGO) data.
The diagnosis means people may have hard stools 25% of the time or more, but symptoms can change, and people with IBS can move between subtypes.
If you live with IBS-C, you can take steps to relieve constipation symptoms. Read on to find some common strategies for managing the condition.
Eating different foods may help decrease constipation symptoms from IBS. The American Society for Gastrointestinal Endoscopy (ASGE) notes that diet changes can help, but what works best depends on the person. You might try:
- avoiding foods that trigger constipation and other IBS symptoms
- increasing soluble fiber, such as flax, oats, and psyllium
- reducing food and beverages that cause gas, such as caffeine and soda
- following a low FODMAP diet
- following a gluten-free diet
increasingyour daily fluid intake by drinking water
The strength of evidence on each of these interventions varies. A 2018 review by the American College of Gastroenterology (ACG) found low quality evidence showing that FODMAP and gluten-free diets helped with overall symptom improvement. However, ACG weakly recommends both.
The organization strongly recommended soluble fiber, citing moderate quality evidence. The ACG reports that insoluble fiber, such as wheat bran, may increase pain and bloating in IBS and, therefore, should be avoided.
There was no one dietary intervention specific to IBS-C that the ACG recommended.
Fiber is a non-digestible material found naturally in food — fruits, vegetables, whole grains, and beans — that helps to move food through your colon. In this way, it can help get things moving and relieve your constipation.
You can get more fiber into your diet by eating foods containing fiber or with the help of a supplement. The ACG recommends eating fiber that contains psyllium over bran.
Though it can relieve constipation, sudden, large amounts of fiber can also increase gas, cramping, and pain. The best way to avoid this is to
The International Foundation for Gastrointestinal Disorders (IFFGD) has these suggestions for increasing fiber intake with IBS:
- eat fruit, such as raspberries, oranges, and kiwifruit
- add vegetables to meals, such as carrots with skins, potatoes with skins, green beans, and corn
- choose higher fiber bread and cereals, such as quinoa, brown rice, and oat porridge
- consume lentils and chickpeas
- eat nuts, such as almonds and peanuts
You can also try a fiber supplement if dietary interventions don’t work. Try to consult with a doctor, as too much fiber can increase gas and bloating with IBS, and a doctor or nutritionist may help you find the right balance.
Over-the-counter (OTC) laxatives can provide adequate temporary relief from constipation. Osmotic laxatives such as polyethylene glycol (Restoralax or Miralax) and lactulose (Generlac) can
Stimulant laxatives, such as bisacodyl (Dulcolax), can also help relieve constipation but are not indicated for long-term use. Stimulant laxatives can also make abdominal pain and cramping from IBS worse.
Consult with your doctor before trying a new product, and always start with the lowest recommended dosage. Ask your doctor which laxative is right for you, and only use them when necessary.
If diet changes don’t work, you may want to speak with your doctor about medications for IBS-C.
In 2022, the American Gastroenterological Association (AGA) released clinical guidelines for the pharmaceutical management of IBS-C. The AGA recommended or suggested eight possible medications for IBS-C based on research evidence.
The strongest recommendation was for linaclotide, with a high certainty of evidence. The remaining recommendations were conditional, based on moderate or low strength of evidence.
Here are the AGA recommendations:
- linaclotide (Linzess) (strong recommendation, based on high evidence)
- tenapanor (Ibsrela) (conditional recommendation, based on moderate evidence)
- plecanatide (Trulance) (conditional recommendation, based on moderate evidence)
- tegaserod (Zelnorm) (conditional recommendation, based on moderate evidence)
- lubiprostone (Amitiza) (conditional recommendation, based on moderate evidence)
- propylene glycol laxatives (conditional recommendation, based on low evidence)
- tricyclic antidepressants (conditional recommendation, based on low evidence)
- antispasmodics (conditional recommendation, based on low evidence)
The AGA also suggested not using selective serotonin reuptake inhibitors (SSRIs) for IBS-C.
Taking steps to reduce stress may help improve IBS-C symptoms. Chronic stress is a risk factor for IBS, although evidence is not yet established to show whether that’s because of IBS or other mental health conditions a person may experience.
People with IBS-C often have other diagnoses, such as post-traumatic stress disorder (PTSD), anxiety, and depression. Treatment for those conditions may help to relieve IBS-C.
The IFFGD recommends these techniques to relieve stress:
- write in a journal
- reframe negative experiences into positive ones, such as what you learned about yourself when you were sad
- practice deep, meditative breathing
Counseling or talk therapy can also help to relieve stress and learn strategies for mental health management. You may also want to try some practices that can contribute to a sense of calm and well-being, such as:
Physical activity can also not only relieve stress but may help relieve IBS-C symptoms. The 2018 ACG recommendations included a weak recommendation for regular exercise to help with overall IBS symptoms.
Alternative treatments may provide some relief from constipation. Although it hasn’t been definitely proven to be effective, acupuncture may reduce some of the pain associated with your condition.
Again, these have not been proven to help, but there is usually no harm in trying them. At the very least, they may reduce your stress.
You might also try eating probiotics. These are bacteria and yeasts that naturally live in your intestines and help you process food.
It’s possible that you’re lacking the right combination of these organisms. In this case, eating yogurt with active cultures may provide some relief from gas and bloating. The 2018 ACG recommendations had a weak recommendation for taking probiotics.
Here are answers to some of the most frequently asked questions about getting relief for IBS constipation.
How do I get rid of IBS constipation?
Diet changes, increasing soluble fiber intake, and reducing stress may help. Over-the-counter (OTC) laxatives and prescription medications can also relieve IBS-C symptoms. If you have another diagnosis, such as anxiety, treating that condition may also help with your IBS symptoms.
What’s the best laxative to take for IBS?
The American Gastroenterological Association (AGA) suggests a propylene glycol laxative for IBS-C. In general, osmotic laxatives, such as propylene glycol, are better than stimulant laxatives. Stimulant laxatives aren’t meant for long-term use and can cause side effects, such as abdominal cramping.
Is Miralax good for IBS constipation?
Miralax is a laxative made from propylene glycol. It is, therefore, the preferred laxative for IBS-C. However, laxatives are only one option to treat IBS-C. You may also want to try adding more fiber to your diet and reducing stress for symptom improvement.
What makes IBS constipation worse?
Some people find specific foods trigger IBS constipation. Chronic stress can also make IBS symptoms worse. Eating a low fiber diet can also contribute to IBS-C.
About one-third of people with IBS have constipation as a primary symptom. Managing IBS-C can include changing to a gluten-free or low FODMAP diet, increasing fiber intake, and lowering stress.
Several medications may also help with the condition, including over-the-counter (OTC) osmotic laxatives and prescription medications. Yoga, meditation, and talk therapy can also help reduce stress levels, which may help with IBS constipation.