Some patients with mild symptoms may find a slow increase in dietary fiber, a healthy amount of exercise and restful sleep, and education about IBS-C are adequate to improve their condition. The general approach to the treatment of IBS-C depends in large part on the type of symptoms the patient is experiencing and their severity. The goal of treatment is to improve symptoms of IBS-C such as abdominal discomfort, bloating, and constipation. Patients can be sub-typed as having IBS-C if they also experience 2 of 3 of the following: 1) 25% hard stools, and 3) > 25% spontaneous bowel movements associated with straining. 5 Identification of IBS-C can be made if abdominal pain or discomfort is present over at least 6 months and is active within the past 3 months, with 2 or more of the following: 1) relieved with defecation 2) onset associated with a change in frequency of stool and 3) onset associated with a change in form (appearance) of stool. These criteria are most useful for standardizing enrollment of patients into clinical trials, and less useful for clinicians in their clinical practice decisions about diagnosis and treatment of IBS-C. Several symptom-based criteria have been used to diagnose IBS-C, including the Manning Criteria and the ROME Criteria. 4 According to the American College of Gastroenterology, there is no need to perform routine sigmoidoscopy colonoscopy barium enema stool tests for occult blood, ova and parasite or culture or thyroid function tests in patients with IBS-C complaints who have no "alarm symptoms." 1 Alarm symptoms include items such as blood in the stool, a greater than 10-pound weight loss, family history of colon cancer, recurring fever, anemia, or chronic severe diarrhea. However, it can be easily diagnosed in the doctor’s office without additional testing. IBS-C has no biochemical or structural abnormalities associated with it, so there are no specific tests that can confirm the diagnosis. The diagnosis of IBS-C is made after a complete medical history is obtained and physical examination is performed. The prevalence of IBS in North America is approximately 10%-15% of these patients, about 20% suffer from IBS-C. 2 Other subtypes of IBS include IBS with diarrhea (IBS-D) and IBS with alternating diarrhea and constipation (IBS-A). IBS with constipation, or IBSC, is characterized by hard or lumpy stools 25% of the time or more, and loose or watery stools less than 25% of the time. IBS has been further classified into subtypes according to stool patterns. 1 Symptoms of IBS include abdominal discomfort, bloating, and altered bowel habits, which can include diarrhea, constipation, or alternating diarrhea and constipation. Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, generally defined as a group of symptoms resulting from changes in bowel function without intestinal structural or biochemical abnormalities. AMITIZA 8 mcg twice daily was approved by the FDA in April 2008 for the treatment of Irritable Bowel Syndrome with Constipation in women ≥ 18 years old.
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