Does your gut need a reset?

Yes, I'm Ready

Do you want to start feeling better?

Yes, Where Do I Start?

Do you want to start feeling better?

Yes, Where Do I Start?

How to Improve IBS-C Without Using Laxatives

IBS-C Causes and Solutions Beyond the Gut

Key Takeaways:

  • IBS-C stands for constipation-dominant IBS, which requires a different approach than “regular” IBS or IBS-D. 
  • While there are many gut-related causes of IBS-C, such as gut dysbiosis, there are also non-gut-related causes, such as dysregulation of the gut-brain axis and even uncoordinated muscle contractions in the pelvic floor. 
  • Gut-based treatment options include probiotics and adjusting fiber intake, while non-gut treatment options include walking, abdominal massage, and spinal adjustment. 
  • Laxatives may be useful in the short term, but long-term use is unreliable and may become less effective over time.
  • To address IBS-C, you may need a combination of different therapies. We hope this article provides a broader perspective on the different options available to treat IBS-C.

Many people assume that having irritable bowel syndrome, or IBS, means you’re running to the bathroom all the time. But for about a third of people with IBS, it’s actually the opposite—they deal with chronic constipation that doesn’t have a clear cause (such as a medication side effect). This is referred to as IBS-C. 

IBS-C brings with it a different set of questions than “regular IBS” or IBS-D. IBS-C may have gut-related causes like an imbalance or overgrowth of bacteria or leaky gut triggered by inflammation in the large intestine. But IBS-C often involves another type of root cause, such as a disconnect in the gut-brain axis, nervous system dysregulation, hormonal imbalance, or a combination of these—all causing slower gut motility and, therefore, fewer bowel movements. 

These issues might not seem obvious at first, or they might seem unrelated to IBS-C. But they are often at the root of the issue, and addressing them may be the key to resolving chronic constipation for good. 

Let’s take a closer look at IBS-C and what can be done to address both gut-related and non-gut-related causes behind chronic constipation. 

IBS Types: What is IBS-C?

Irritable bowel syndrome is typically divided into 3 different categories: IBS-D for diarrhea-dominant IBS, IBS-C for constipation-dominant IBS, and IBS-M for IBS that alternates between diarrhea and constipation [1]. Other symptoms of IBS (any type) can include abdominal pain, cramping, bloating, gas, and visceral hypersensitivity (a low threshold for pain or discomfort in the gut). Many people also report mental health challenges alongside IBS, including depression and anxiety [2]. 

If you’re experiencing any of these symptoms, it’s a good idea to visit your doctor and rule out any other gastrointestinal conditions like inflammatory bowel disease (ulcerative colitis and Crohn’s disease), celiac disease, gastroenteritis, or other functional gastrointestinal disorders. Your provider may want to run blood tests or order a colonoscopy to confirm your diagnosis.

Of those diagnosed with IBS, about a third are diagnosed with IBS-C [1]. The thing about any IBS diagnosis is that it’s not clear why the patient is having gastrointestinal symptoms (by conventional medicine standards), which means we have to investigate a little deeper into the root cause. Often, there are multiple factors at play causing symptoms of IBS-C, both directly related to the gut and indirectly related. 

Potential Causes of IBS-C

There are many possible causes of IBS-C, including:

  • SIBO, small intestinal bacteria overgrowth (usually methane dominant) [3, 4, 5, 6]
  • Bacterial, fungal, or parasitic overgrowth in the large intestine [7, 8]
  • Gut microbiome imbalance, where the bacteria aren’t pathogenic, but either there is too much or not enough of certain species [6]
  • Leaky gut [9, 10]
  • Neurotransmitter imbalance in the gut [11]
  • Disruption in the gut-brain axis, where the gut isn’t receiving signals from the brain to move food through the digestive system [12]
  • Nervous system dysregulation, such as operating too much in sympathetic “fight or flight” instead of parasympathetic “rest and digest” mode
  • Food triggers or sensitivities causing gut motility to slow down [13, 14, 15]
  • Eating too much or too little fiber or not eating the right type of fiber
  • Poor eating habits, such as always eating on the go or not chewing your food thoroughly

This is just a short list of potential IBS-C causes, and most people will have more than one they need to address. 

Take my patient Valerie as an example. Valerie was diagnosed with SIBO by her previous naturopathic doctor; her main symptoms included bloating and chronic constipation, as well as joint pain and brain fog. If the SIBO diagnosis had remained unknown (as most gastroenterologists don’t know to test for it), these symptoms could easily be labeled as IBS-C. 

As Valerie explains in her testimonial video, she was able to improve her symptoms, including chronic constipation, through diet and triple therapy probiotics, but it wasn’t quite enough. It was only when she later added our Intestinal Support Formula to address her aggravated immune system that her symptoms completely resolved. 

I’m not saying everyone needs to follow this exact strategy to resolve IBS-C or SIBO. Just know that there may be a few extra steps beyond standard diet and gut repair to make a full recovery, like calming the immune system or perhaps healing the vagus nerve for better gut-brain communication.

Gut-Based Remedies for IBS-C

First, let’s dig into some gut-related strategies for IBS-C. 


We have plenty of high-quality evidence showing that probiotics are effective for treating IBS as well as constipation in general [16, 17, 18]. If you’re not already, I always recommend switching to a whole food, anti-inflammatory diet first, such as Paleo, the Mediterranean diet, or the low FODMAP diet. This ensures that you’re starting with a foundation of healthy, nutrient-dense food that’s going to nourish your gut and support a healthy microbiome. It also removes common allergens and processed ingredients that could be contributing to your gut imbalance. Of the three of these options, low FODMAP is the most tricky to follow, so I recommend getting some professional support if you decide to go that route. 

 Then you can add in probiotics, either a multi-species LactobacillusBifidobacterium blend, a soil-based probiotic, Saccharomyces boulardii (a beneficial yeast), or a combination of all three types. The combination, which we call probiotic triple therapy, is what I recommend to the large majority of my patients.

Here’s another interesting data point on probiotics: One recent meta-analysis also found that a combination of Lactobacillus, Bifidobacteria, and soil-based probiotics with a motility drug improved constipation more so than the motility drug alone [19]. So even if your provider recommends one of these motility drugs, taking at least a multi-species probiotic alongside it will likely improve your results. 


Some people prefer to stick as close as possible to whole food-based therapeutics to resolve their health concerns. In terms of addressing constipation, we’re in luck here.

A recent clinical trial in multiple sclerosis patients found that taking a 500 mg ginger capsule 3 times per day significantly improved constipation severity and decreased bloating [20]. Ginger is also well known for its anti-inflammatory properties and has been used for centuries as a tonic for digestion. Incorporating ginger into your meals and drinking ginger tea can also be supportive as part of your diet.


Fiber is often the go-to solution for constipation recommended by primary healthcare providers, and there’s a good reason for this—soluble fiber, such as psyllium, can be helpful for improving digestion and increasing motility in the gut [21, 22, 23]. But for some people with IBS, fiber is an instant trigger for gas, bloating, and abdominal pain [24]. If you’re interested in increasing fiber intake, taking a small amount of psyllium powder, ½ teaspoon to 1 teaspoon, mixed in water in the morning before breakfast is a good place to start. 

Using Laxatives for IBS-C

Let’s address the elephant in the room: why not just use laxatives like Miralax, or even natural options like senna and aloe,  for dealing with IBS-C? There are a few reasons:

  1. It’s easy for your gut to become dependent on laxatives, and using them constantly may actually worsen the root cause of constipation over time [25]. 
  2. They can cause side effects like bloating, nausea, and abdominal pain. Laxatives are not intended for long-term use, and overuse has been linked to damage to the intestinal muscles [26]. 
  3. Constantly relying on laxatives is exhausting and can leave you feeling just as bad as if you were constipated [27]. 

As you can see from the gut-based remedies I mentioned, it’s not necessary to rely on laxatives for IBS-C. They can be useful as a temporary solution, but we always want to find and address the root cause. 

Remedies for IBS-C Beyond the Gut

Now, let’s switch our focus to some of those non-gut remedies I mentioned before. We’ll start simple and make our way to more specialized treatments like biofeedback that can have a really profound effect on “retraining” the gut to digest and move better.


Great news! A meta-analysis found that just 20–30 minutes of walking per day can significantly improve constipation compared to “normal care,” which may or may not involve prescription or over-the-counter laxatives [28]. The researchers specifically noted that walking improved gut transit time regardless of age, sex, or total body fat. This study is a really great reminder that sometimes it’s the simple lifestyle changes and habits that can make the biggest difference in our health. 

Abdominal Massage

Another recent study found that abdominal massage was equal to or more effective than usual care for relieving constipation, which is defined as lifestyle recommendations like consuming more fiber along with laxatives [29]. 

There are a couple of reasons for the efficacy of this treatment that come to mind. First, we all know the standard image of the digestive tract, but everyone’s individual digestive tract is a little different, and some may have more bends and turns than others. This creates more opportunities for food to slow down or get stuck along the digestive process. Abdominal massage can manually help move things along a little more efficiently, decreasing intestinal transit time. 

Another possibility is that if you’ve had a physical injury to your intestines or inflammation that caused scar tissue to form, you can run into the same issue with food not being able to pass as easily through that area. Once again, abdominal massage can help to keep things moving along in these areas. 

Chiropractic Adjustment

As someone with chiropractic training, I would be remiss not to discuss the therapeutic benefits of a chiropractic adjustment for improving functional constipation, especially when you keep up with it over time. 

Most of us spend a lot of time during the day sitting at a desk, on the couch at home, at the dinner table, and so on. Even if you have a good exercise routine in place or go for walks every day, you’re still spending a large majority of your time sitting. This puts pressure on the spine, which is effectively connecting your brain to your gut (and many other organs along the way). When the spine is compressed, the nerves that run along the spine (particularly the vagus nerve) connecting your brain to your different organs can not communicate as well as they could be, which could result in a number of different issues, constipation among them. 

Finding the right chiropractor who can help you loosen up the spine and structurally improve communication between the gut and the brain can be hugely supportive for those with IBS-C, as well as provide a foundation for other lifestyle methods to work even better, like walking.


Biofeedback is another fascinating treatment modality that I had the opportunity to discuss with Dr. Satish Rao a few years ago on my podcast. Sometimes IBS-C can be caused by pelvic floor dysfunction. In pelvic floor dysfunction, the muscles may be very tight and constantly contracting, or they may be uncoordinated, not contracting right when your brain commands them to. Both of these lead to chronic constipation that can be difficult to figure out because you often don’t even realize these muscles are dysregulated. Essentially, biofeedback helps retrain the pelvic floor muscles to contract and relax properly, improving transit time and bowel habits.  

This treatment method isn’t going to apply to everyone since only about a third of patients will have this type of muscle discoordination resulting in chronic constipation. But I think it’s important to mention for those who have found that other standard treatments, including diet modification, probiotics, and even structural adjustment, are not enough. 

To Address IBS-C, You May Need to Look Beyond the Gut 

There are plenty of direct gut-related causes of IBS-C and chronic constipation, but there are just as many, if not more, non-gut-related causes and treatment options. If you’re working on addressing IBS-C, you may find that you lean towards one or the other, or you need a combination of modalities to improve your gut motility. Either way, I hope this article provided a helpful springboard to get you started on your healing journey. 

Want to learn more about digestive health, a healthy (attainable!) lifestyle, addressing various gut conditions, and more? Check out my book Healthy Gut, Healthy You or dive into the latest research with me over on my YouTube channel.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
  1. Kurin M, Cooper G. Irritable bowel syndrome with diarrhea: Treatment is a work in progress. Cleve Clin J Med. 2020 Jul 31;87(8):501–11. DOI: 10.3949/ccjm.87a.19011. PMID: 32737051.
  2. Jandaghi G, Zia-Tohidi A, Firoozi M. Psychological Interventions for Irritable Bowel Syndrome: A Meta-Analysis of Iranian Randomized Trials. Arch Iran Med. 2021 Jun 1;24(6):496–504. DOI: 10.34172/aim.2021.71. PMID: 34488313.
  3. Chen B, Kim JJ-W, Zhang Y, Du L, Dai N. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jul;53(7):807–18. DOI: 10.1007/s00535-018-1476-9. PMID: 29761234.
  4. Schmulson M, Bielsa MV, Carmona-Sánchez R, Hernández A, López-Colombo A, López Vidal Y, et al. Microbiota, gastrointestinal infections, low-grade inflammation, and antibiotic therapy in irritable bowel syndrome: an evidence-based review. Rev Gastroenterol Mex. 2014 Jun;79(2):96–134. DOI: 10.1016/j.rgmx.2014.01.004. PMID: 24857420.
  5. Takakura W, Pimentel M. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front Psychiatry. 2020 Jul 10;11:664. DOI: 10.3389/fpsyt.2020.00664. PMID: 32754068. PMCID: PMC7366247.
  6. Liu H-N, Wu H, Chen Y-Z, Chen Y-J, Shen X-Z, Liu T-T. Altered molecular signature of intestinal microbiota in irritable bowel syndrome patients compared with healthy controls: A systematic review and meta-analysis. Dig Liver Dis. 2017 Apr;49(4):331–7. DOI: 10.1016/j.dld.2017.01.142. PMID: 28179092.
  7. Botschuijver S, Roeselers G, Levin E, Jonkers DM, Welting O, Heinsbroek SEM, et al. Intestinal fungal dysbiosis is associated with visceral hypersensitivity in patients with irritable bowel syndrome and rats. Gastroenterology. 2017 Oct;153(4):1026–39. DOI: 10.1053/j.gastro.2017.06.004. PMID: 28624575.
  8. Abedi SH, Fazlzadeh A, Mollalo A, Sartip B, Mahjour S, Bahadory S, et al. The neglected role of Blastocystis sp. and Giardia lamblia in development of irritable bowel syndrome: A systematic review and meta-analysis. Microb Pathog. 2022 Jan;162:105215. DOI: 10.1016/j.micpath.2021.105215. PMID: 34592369.
  9. Camilleri M, Gorman H. Intestinal permeability and irritable bowel syndrome. Neurogastroenterol Motil. 2007 Jul;19(7):545–52. DOI: 10.1111/j.1365-2982.2007.00925.x. PMID: 17593135.
  10. Barbara G. Mucosal barrier defects in irritable bowel syndrome. Who left the door open? Am J Gastroenterol. 2006 Jun;101(6):1295–8. DOI: 10.1111/j.1572-0241.2006.00667.x. PMID: 16771952.
  11. Jin D-C, Cao H-L, Xu M-Q, Wang S-N, Wang Y-M, Yan F, et al. Regulation of the serotonin transporter in the pathogenesis of irritable bowel syndrome. World J Gastroenterol. 2016 Sep 28;22(36):8137–48. DOI: 10.3748/wjg.v22.i36.8137. PMID: 27688655. PMCID: PMC5037082.
  12. Barbara G, Cremon C, Carini G, Bellacosa L, Zecchi L, De Giorgio R, et al. The immune system in irritable bowel syndrome. J Neurogastroenterol Motil. 2011 Oct 31;17(4):349–59. DOI: 10.5056/jnm.2011.17.4.349. PMID: 22148103. PMCID: PMC3228974.
  13. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010 Feb;25(2):252–8. DOI: 10.1111/j.1440-1746.2009.06149.x. PMID: 20136989.
  14. Catassi C, Alaedini A, Bojarski C, Bonaz B, Bouma G, Carroccio A, et al. The Overlapping Area of Non-Celiac Gluten Sensitivity (NCGS) and Wheat-Sensitive Irritable Bowel Syndrome (IBS): An Update. Nutrients. 2017 Nov 21;9(11). DOI: 10.3390/nu9111268. PMID: 29160841. PMCID: PMC5707740.
  15. Deng Y, Misselwitz B, Dai N, Fox M. Lactose intolerance in adults: biological mechanism and dietary management. Nutrients. 2015 Sep 18;7(9):8020–35. DOI: 10.3390/nu7095380. PMID: 26393648. PMCID: PMC4586575.
  16. Ford AC, Quigley EMM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547–61; quiz 1546, 1562. DOI: 10.1038/ajg.2014.202. PMID: 25070051.
  17. Chen M, Yuan L, Xie C-R, Wang X-Y, Feng S-J, Xiao X-Y, et al. Probiotics for the management of irritable bowel syndrome: a systematic review and three-level meta-analysis. Int J Surg. 2023 Nov 1;109(11):3631–47. DOI: 10.1097/JS9.0000000000000658. PMID: 37565634. PMCID: PMC10651259.
  18. Dale HF, Rasmussen SH, Asiller ÖÖ, Lied GA. Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients. 2019 Sep 2;11(9). DOI: 10.3390/nu11092048. PMID: 31480656. PMCID: PMC6769995.
  19. Luo M, Xiong L, Zhang L, Xu Q. Efficacy and safety of Bifidobacterium quadruple viable tablets combined with mosapride citrate in the treatment of constipation in China: a systematic review and meta-analysis. BMC Gastroenterol. 2023 Jul 18;23(1):245. DOI: 10.1186/s12876-023-02884-3. PMID: 37464298. PMCID: PMC10354982.
  20. Foshati S, Poursadeghfard M, Heidari Z, Amani R. The effects of ginger supplementation on common gastrointestinal symptoms in patients with relapsing-remitting multiple sclerosis: a double-blind randomized placebo-controlled trial. BMC Complement Med Ther. 2023 Oct 27;23(1):383. DOI: 10.1186/s12906-023-04227-x. PMID: 37891539. PMCID: PMC10605938.
  21. Moayyedi P, Quigley EMM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2014 Sep;109(9):1367–74. DOI: 10.1038/ajg.2014.195. PMID: 25070054.
  22. Furnari M, de Bortoli N, Martinucci I, Bodini G, Revelli M, Marabotto E, et al. Optimal management of constipation associated with irritable bowel syndrome. Ther Clin Risk Manag. 2015 May 30;11:691–703. DOI: 10.2147/TCRM.S54298. PMID: 26028974. PMCID: PMC4425337.
  23. Bellini M, Gambaccini D, Salvadori S, Tosetti C, Urbano MT, Costa F, et al. Management of chronic constipation in general practice. Tech Coloproctol. 2014 Jun;18(6):543–9. DOI: 10.1007/s10151-013-1093-9. PMID: 24272606.
  24. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). Int J Mol Med. 2017 Sep;40(3):607–13. DOI: 10.3892/ijmm.2017.3072. PMID: 28731144. PMCID: PMC5548066.
  25. Senna: MedlinePlus Drug Information [Internet]. [cited 2022 Nov 1]. Available from:
  26. Bashir A, Sizar O. Laxatives. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. DOI: 10.1016/B978-0-444-53717-1.00960-4. PMID: 30725931.
  27. Patel S, Doerfler B, Boutros K, Ng S, Manuel M, DeSimone E. Review of Treatment Options for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation. Int J Gen Med. 2021 Apr 21;14:1457–68. DOI: 10.2147/IJGM.S274568. PMID: 33907450. PMCID: PMC8071080.
  28. Gao R, Tao Y, Zhou C, Li J, Wang X, Chen L, et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scand J Gastroenterol. 2019 Feb;54(2):169–77. DOI: 10.1080/00365521.2019.1568544. PMID: 30843436.
  29. Gu X, Zhang L, Yuan H, Zhang M. Analysis of the efficacy of abdominal massage on functional constipation: A meta-analysis. Heliyon. 2023 Jul 7;9(7):e18098. DOI: 10.1016/j.heliyon.2023.e18098. PMID: 37496907. PMCID: PMC10366436.

Need help or would like to learn more?
View Dr. Ruscio’s, DC additional resources

Get Help


I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!