IBS - Constipation predominant

IBS can constantly rumble on with mild symptoms or flare up and cause fairly debilitating symptoms. Fortunately, IBS does not cause any serious health implications, but it can have an impact on peoples day to day lives. The predominant symptoms of irritable bowel syndrome vary from person to person. Some struggle with constipation, others with diarrhoea, and for some, pain and bloating, with others varying between episodes of a combination of these.

If the main or most common symptom you suffer from is constipation, then this is known as constipation-predominant IBS, where people suffer from episodes of hard stools and decreased frequency of passing. Painful or having to strain to pass stools can also be related symptoms to it. Around one-third of people with IBS suffer from constipation-predominant IBS.

There are ways to help improve the symptoms of constipation-predominant IBS. These include lifestyle changes such as doing regular exercise, staying well hydrated, and also increasing the amount of fibre in your diet, although you should do this slowly. Medication can also be used to treat constipation, and these are known as laxatives.

Some laxative medication can be brought over the counter, and your local pharmacist can give you advice on what is best for you; however, it is best to your doctor before you start taking it, especially if you do not have a confirmed diagnosis of IBS yet. There are also stronger laxative medications that can be prescribed by your doctor if it is deemed to be needed.

Which types of laxatives are best?

There are many types of laxatives, and they work in different ways, so choosing the right one to resolve your symptoms best both quickly and with the least side effects may require some advice from your pharmacist.

In general, many patients with constipation-dominant IBS who approach the pharmacy often have complex symptoms, which may include alternating episodes of constipation and diarrhoea, or who may have either feeling full or very "backed-up", bloating due to trapped gas or have not been able to pass a stool for days.

Scenario 1: "Not been able to go for more than 2-3 days"

In these cases, along with drinking plenty of fluids, and if other laxatives have not worked so far since transit through the gut is too slow, direct action is the best option to get things moving again. Using a rectal formulation such an enema (for example Phosphate enemas, or Micralax enemas), or glycerin (or glycerol) suppositories can help soften and hydrate, dry hard stools and aid lubrication to help pass them out very quickly, often with an hour of using or less. This is also the best option to prevent the risk of developing piles due to overstraining.

Scenario 2: "Having abdominal cramps or bloating alongside constipation"

Constipation typically involves having reduced bowel frequency due to slower gut transit and passing harder stools. Stimulant laxatives such as Senna or Bisacodyl although they have their advantages for constipation in general, by working quickly within 8-12 hours and stimulating the gut to get moving, they might not be the best option if your gut is sensitive to the side effects of abdominal cramps associated with IBS.

A more gentle option would be to use a stool softener such as Docusate Sodium capsules (brand name DulcoEase to break down hard stools, or a bulk-forming laxative such as Fybogel, or better still Fybogel Mebeverine which can help form more bulky and softer stools that are easier to pass and an antispasmodic.

Scenario 3: "Hard, dry or impacted stools and gas"

Faecal impaction is where stools have little form and often can pass as solid pieces alternating with gas. This is often due to a lack of fibre in the diet, lack of mobility, or not drinking enough. There are a few types of laxatives that would be best for helping with this. However, dietary issues for increasing fibre intake and fluids are also important for prevention.

Osmotic laxatives - work by drawing more water or fluids in the gut into the large bowel, thereby softening stools, making them easier to pass. Typical examples of these types of laxatives include Lactulose solution or using a soluble Macrugol-containing sachet such as Movicol or Cosmocol sachets that can be mixed into a drink and consumed.

Bulk-forming laxatives- such as Fybogel, often contain Ispaghula Husk or Psyllium Husk. They are a source of soluble fibre to complement the diet, and are taken mixed in a drink which helps to form bulky and airy stools that gently press against the intestinal walls to stimulate the gut and get contents to move down that gastric tract. These are great for relieving symptoms and a source of soluble fibre to maintain regularity and prevent constipation.

You should book a routine doctor’s appointment if you are experiencing symptoms of IBS. This is so that the doctor can help rule out any other causes of your symptoms and confirm IBS as the likely cause. There is no specific test for IBS and so it is what is called a diagnosis of exclusion, where other conditions are ruled out so that IBS can then be confirmed as the diagnosis. If you have any blood in your stools, have unexpectedly lost weight, have a prolonged change in bowel habit (2 weeks) or you have any other symptoms with it then you should see your doctor.

The doctor will ask you about your symptoms, your medical history, any relevant family medical history, and what medications you are currently taking. They will likely have a feel of your abdomen, listen to see if they can hear bowel sounds, and potentially do other tests such as a blood test or even if necessary what is called a PR examination, which is where the doctor has a feel of your back passage to see if they can feel any hard stool to confirm constipation. They will discuss with you a likely diagnosis, recommend lifestyle changes, and potentially prescribe medication if it is required.