Irritable bowel syndrome with constipation (IBS-C)
- Diet/soluble fiber can be first step
- PEG improves stool frequency—not much pain
- Linaclotide/plecanatide improve pain + stool
- Lubiprostone/tenapanor are alternatives
- TCA is usually not ideal if constipation dominates
- Treat pelvic-floor dysfunction if present
- Avoid unnecessary chronic opioid exposure
Use at a glance
- Diet/soluble fiber can be first step
Practical pearls
- PEG improves stool frequency—not much pain
- Linaclotide/plecanatide improve pain + stool
- Lubiprostone/tenapanor are alternatives
Choosing treatment
- TCA is usually not ideal if constipation dominates
- Treat pelvic-floor dysfunction if present
Safety / pitfalls
- Avoid unnecessary chronic opioid exposure
Self-check
- What does PEG improve in IBS-C?
Stool frequency, not much pain. - Which chronic drug exposure is avoided in IBS-C?
Unnecessary chronic opioid exposure.
Drugs used for this (6)
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