A review article on the Patient Burden and Therapeutic Landscape of Irritable Bowel Syndrome with Constipation gives a wealth of helpful information.
It details how IBS is a common disorder of the gut-brain axis associated with a substantial societal burden in terms of tremendous health care costs, opportunity costs, and decreased quality of life.
This article is lengthy and dense but well worth the slog if you have IBS constipation.
Some high points:
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Constipation-predominant IBS (IBS-C) is a common IBS subtype, accounting for approximately one-third of all IBS cases.
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Treatment of IBS-C typically begins with lifestyle interventions and nonpharmacologic options, such as soluble fiber supplements and osmotic laxatives.
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In patients with inadequate response to these therapies, there are 4 currently available, US FDA-approved prescriptions - lubiprostone, linaclotide, plecanatide, and tenapanor - that may relieve IBS-C symptoms.
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In patients with IBS-C who have persistent abdominal pain and/or psychological symptoms such as symptom-related anxiety, depression, or maladaptive coping behaviors despite treatment with the US FDA-approved prescription medications, consider the addition of or switch to low-dose tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and brain-gut behavioral therapy (BGBT).
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Although the use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of IBS-C alone is not recommended, appropriate treatment of concomitant depression and anxiety has led to global improvement in the management of disease in patients with IBS-C. They can be combined with other therapies and are crucial for integrated care of IBS. They typically complement medical treatment but can also be offered as standalone alternatives.
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Brain-gut behavioral therapy need not have condition-specific effects because they act on central or gut-brain systems of symptom control.
The article concludes that “the future may be brighter for patients with IBS-C if progress is made to increase health care provider awareness of the issues patients deal with, and the potential benefits the totality of the treatment landscape may offer them.”
(Which sounds to me like a very long-winded way of saying doctors need to better understand what their IBS-constipation patients are going through. And they need to better convey all the treatment options that could help them. I completely agree!)
And more help for IBS constipation...
You are not alone.
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XOXO
Heather
Heather Van Vorous
40+ years of IBS advocacy
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