In this patient case study, JP, a 24-year-old male, presents with a yearlong history of lower abdominal pain, bloating, and infrequent, difficult-to-evacuate stools, following a stressful trip during which he experienced personal turmoil and restroom access issues. Given the chronicity, normal lab results (CBC, metabolic profile, thyroid tests, CRP, celiac serologies), and normal colonoscopy, JP meets the Rome IV diagnostic criteria for irritable bowel syndrome with constipation (IBS-C). Importantly, his history lacks alarm features such as significant weight loss, bleeding, or nocturnal symptoms, suggesting no serious underlying organic disease.

IBS-C is chronic, often persisting for many years if untreated, negatively impacting quality of life but not lifespan or cancer risk. Excessive diagnostic testing beyond initial screening (CBC, CRP, celiac serologies) is generally unnecessary and can lead to anxiety and unnecessary procedures. Dietary adjustments, such as increased fiber or low-FODMAP diets, offer limited benefits for IBS-C specifically. Instead, treatment typically involves FDA-approved medications like lubiprostone, linaclotide, plecanatide (secretagogues), or tenapanor (retainagogue), all of which target abdominal pain, stool consistency, and bowel frequency effectively. Patients should be advised of potential side effects, predominantly diarrhea, and understand that treatment response can occur quickly for constipation but more slowly for abdominal symptoms.

Reference: Lacy BE. Managing IBS-C: Focus on Symptom Control. Gastroenterol Hepatol (NY). 2024 Apr;20(4):216-226. PMID: 38682119; PMCID: PMC11047151.