Treatment of Irritable Bowel Syndrome with Constipation (IBS-C)

IBS with predominant constipation is a distinct clinical subtype of irritable bowel syndrome. Evidence-based guidelines support pharmacological treatment for this population, with multiple approved agents and defined response criteria.

Clinical Scenario

IBS with predominant constipation (IBS-C) is a recognised subtype of irritable bowel syndrome that accounts for more than one-third of all IBS cases. The constipation-predominant pattern distinguishes this group and guides treatment selection.

Treatment Approach

For IBS-C, pharmacological treatment is recommended over no drug treatment. Several specific agents — spanning different pharmacological mechanisms — have received regulatory approval for this indication, and professional gastroenterology guidelines address which to use and when.

Patient-specific eligibility criteria apply to certain agents. The complete selection approach, including sequencing and recurrence management, is in the full protocol.

Treatment Goals

Symptom relief defined as both a 30% reduction in average daily worst abdominal pain and an increase of at least 1 complete spontaneous bowel movement per week compared with baseline, sustained for 6 of 12 weeks.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1053/j.gastro.2022.04.016

IBS with predominant constipation (IBS-C) is a subtype of IBS that accounts for more than one-third of IBS cases.
The AGA recommends using linaclotide in patients with IBS-C.
The AGA suggests using tenapanor in patients with IBS-C.
The AGA suggests using plecanatide in patients with IBS-C.
The AGA suggests using tegaserod in patients with IBS-C.
The AGA suggests using lubiprostone in patients with IBS-C.
The AGA suggests using PEG laxatives in patients with IBS-C.
For IBS-C, the FDA responder end point was defined as a participant who reports both a 30% reduction in average daily worst abdominal pain scores and an increase of 1 complete spontaneous bowel movements (CSBMs) per week compared with baseline for 6 of 12 weeks.

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