Irritable Bowel Syndrome with Constipation

The primary cause of the formation of hemorrhoids is an increase in the pressure in the veins in the network called the hemorrhoidal plexus. They rest beneath the lining of the lower rectum as the internal hemorrhoidal plexus as well as below the dentate line as the external hemorrhoidal plexus. Straining causes an increase pressure in the veins and the formation of symptomatic hemorrhoids. This may be the result of physical activity and pregnancy but significantly with the persistent constipation or diarrhea of irritable bowel syndrome.

Irritable bowel syndrome or IBS – C has constipation as its dominant feature and IBS – D is associated with diarrhea predominant symptoms. Almost half of the patients have a mixed pattern of symptoms. Most patients have a chronic history with symptoms for more than 10 years and many with IBS – C with symptoms dating to their teen years or earlier.

The problem creates a significant impact on the quality of life of these patients. One scale to measure this is the  BEST scale:

  • How Bad are your bowel symptoms?
  • Can you still Enjoy the things you used to enjoy?
  • Do you feel like your bowel symptoms mean there's something Seriously wrong?
  • Do your bowel symptoms make you feel Tense?

IBS is responsible for many other conditions including headaches and muscle aches and patients consume more than 50% of healthcare resources as compared to patients without IBS and at considerable cost.

The cardinal features of IBS -C are abdominal pain and discomfort with constipation and the following (The current symptom-based (Rome III) criteria are (Longstreth et al, 2006a)):

  • Recurrent abdominal pain or discomfort for at least 3 days per month in the last 3 months, which is associated with 2 or more of the following:
    • Improvement with defecation
    • Onset associated with a change in frequency of stool
    • Onset associated with a change in form (appearance) of stool
  • Supportive symptoms include
    • Abnormal stool frequency (< 3 per week)
    • Abnormal stool form (lumpy-hard)
    • Straining
    • Urgency
    • A feeling of incomplete evacuation
    • Passing mucus and gas

Patients also often have associated problems with loss of appetite insomnia muscle aches and pain reflux and headaches.

The longer the interval between movements the larger and harder the stool. That results in straining leading to hemorrhoid complaints and sometimes injury to the fragile skin in the anal canal resulting in a painful fissure in ano.

Unfortunately, there is no test or other reliable method of making the diagnosis other than having a high index of suspicion based on the patient's symptoms. The most common treatment strategies are often only partially helpful. They include adding fiber and fluids to the diet laxatives and stool softners, bowel relaxing medication and special medications like Amitiza  or Linzess.

Dr. Shapiro is familiar with the care of patients with IBS-C and understands its impact on their daily life and its association with anorectal disorders. He treats patients across Florida, including Tampa, Clearwater, St. Petersburg, and nearby areas.

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