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I am a generally healthy and active 23 year old who has drawn the conclusion that I am suffering from IBS-C and I don’t know where to begin in terms of managing this/ healing myself. I believe my symptoms are related to stress and anxiety. (Especially as my dentist has recently noticed I am an intense teeth clencher ). I have never dealt with irregular bowel movements before. I first had a bout of terrible constipation and bloating in May of this year. I was terribly stressed and anxious over a final exam in my hardest course that would inevitably determine wether I’d make or break my Straight A streak. I had never felt more terrible. The bloating, the gas, the lack of appetite, the nausea. Though I still managed to pass at least one bowel movement a day I still didn’t feel great. Once the test was over, my grades came in and I walked across that stage excepting my diploma, all was well again. I dealt with mild bloating the months after but nothing Intense that weren’t self resolving very quickly. However, when august rolled around and I found myself under immense stress and anxiety once again my bowels locked up. I am preparing to move abroad to the UK to begin law school and the visa process was severely stressing me out. I had the same symptoms I did last may. Within a little over a week my ailments dissipated. And here I am again….almost exactly a month later. A week and a half out from making my big move to the UK and im dealing with this constipation, bloating, gas, nausea, and lack of appetite again. I don’t know what to do or where to begin to manage this. I don’t want to feel sick anymore. I have a bowel movement once a day but its never a complete elimination and I can feel as stressful events come up my body stops working. My mom has urged me to join these types of forums and groups just as she’s done to help heal her own gut health and thyroid. I also have a really great boyfriend, who I’m about be living with in the UK, who also deals with IBS, more specifically IBS-D, that he was diagnosed with back in our early teen years. I want to know where to begin in terms of diet and supplements and healing. I know I first and foremost need to manage my stress and anxiety and if anyone has any good tips on how to do this I would greatly appreciate it. I’m 23, I feel far too young to be dealing with the level of stress and anxiety I am enduring. I am crying out into the void of an uncertain world, I’m about to make a huge move across the globe, and I feel under immense pressure to “make it” in my adult life. I WANT TO FEEL GOOD AND HEALTHY AND NORMAL!!! This was a long post and probably more of a ramble than anything useful but I just need to break into a space where maybe I can seek out and find help. What I’m Currently doing to manage this all now: 1. Taking 2 types of magnesium supplements together 2. Peppermint tea 3. Beginning a process of elimination diet.

I have just been prescribed Linzess for my chronic C, it is so bad right now I can't eat without pain, seriously impacted throughout my colon. I do not want to take it during the day due to my work schedule. I am thinking I could take it when I get off work at 4pm since we don't eat till the earliest 5 but sometimes as late as 7. My stomach should be empty since I won't eat since lunch. I don't go to bed till around 10pm so should have plenty of time to clean out. Thoughts on whether this would be ok to do or not?

Nobody wants to be constipated. So, if you're wanting some natural ways to help yourself... um, get moving... you've come to the right place. Dr. Sameer Islam discusses natural remedies for constipation.

This past September I started feeling pain in the lower abdomen. Soon after, chronic constipation set in and never went away. The pain comes and goes, nothing excruciating yet. This month I reset my diet and began eating very simple clean foods, it helped some. The only way I can evacuate my bowels is by drinking magnesium citrate or castor oil, psyllium or pure Epsom salt does not work. I am a middle aged man who never had these health issues before. I saw an internal medicine doctor and she found nothing through abdominal ultrasound nor blood panels. A CT scan is scheduled in November. I know I need to see a Gastroenterologist who specializes in the digestion system. If anyone can walk me through the trials and errors of reaching there IBS conclusion, that would be greatly appreciated. Your insight is truly welcomed. Thanks

For 25 years I suffered from constipation almost daily. I tried everything that came down the road without success. Some days it was bad and on other days it was terrible. Most of you know. In 2006, in a conversation with a next door neighbor, I learned that there existed a prescription drug called Miralax, an osmotic. The neighbor, a retired pharmacy technician, highly recommended it and I got a prescription from my doctor. It worked. I couldn’t believe it. Then, in 2007 the FDA approved Miralax (polyethylene glycol 3350) for over-the-counter distribution. I’ve been on Miralax ever since and in those 13 years I’ve never experienced a single day of constipation. Sometimes, I experienced mild diarrhea, although rarely. Now, after those many years being free of the constipation, I’ve got it back. In spades. What caused it is this: A three-day regimen of an antibiotic named azithromycin also known as a Z-Pak. I was prescribed the drug by my oral surgeon following the extraction of an infected tooth. While the antibiotic did the job, it also did a job on my gastrointestinal system. It wiped out all the good flora in my gut and left me more constipated than ever before and with stool so hard and claylike that I was forced to dig it out. Not a lot of fun, to say the least. That was two month ago and my system still hasn’t recovered. Within a day or two after realizing what had happened, I went online and read everything I could lay hands on about this subject. Yes, it is true that many of these antibiotics can really screw up an individual’s gastrointestinal system, resulting in either diarrhea or constipation. And, yes, it can sometimes be long lasting. So, I set to work setting up a program that followed the advice of the experts. I start the day with a small serving of hot oat bran. In the bowl are fresh blackberries or raspberries along with milk. I drink a glass of water with Miralax followed by a second glass of water. I take a quality probiotic. Along with the second glass of water, I eat two dried prunes. For lunch my entire meal consists of a large mug of freshly made split pea soup and a cracker. At dinner, it’s usually seafood or chicken for the entrée, a vegetable (no starch) and a copious serving of bean salad made from cannellini beans with olive oil. I drink another glass of water with a half dose of Miralax (this is added as one should normally require only one dose per day) followed by a second glass of water and two dried prunes. For dessert, it’s a serving of natural Greek yogurt with blackberries or raspberries. If a person who isn’t given to constipation were on such a diet, they would never be able to leave the bathroom. For me, it’s hardly making a difference. Specifically, there’s a bowel movement waiting for me almost every day without fail. I get stirrings telling me I need to go. When I sit down, the urge is there. But, the fecal matter doesn’t want to come out. I strain and strain and sometime squeeze without any success. When I become exasperated, I will wet a folded facial tissue and insert it as a cover for my index finger and palpate. Sometimes that palpation will loosen up a small amount of fecal matter. However, this can go on for up to a half-hour before I’m emptied. It is very unsettling and to let it continue like this is unacceptable. What I need is what a pharmacist friend characterized years ago when he gave me medication for another type of disorder. “Rob,” he declared, “this is the atomic bomb.” I’m looking for an atomic bomb. Interestingly, the poop that emerges is not hard poop. It’s relatively soft and well formed. But getting it out is the challenge. If anyone has any suggestions for resolving or improving this situation, I would be very grateful. I would prefer a solution using natural foods or additives, etc., rather than a prescription medicine with all its side effects. All suggestions are welcome. Thanks very much. Rob in Arizona

Hello! I am a university student, just finished my final year of Journalism studies, which has been odd considering the current situation. I suffer from IBS-C, and have done so for a while now. I went gluten and wheat free over a year ago and now have cut out any flour products completely. Recently my IBS has gotten so bad, not so much constipation since that is just tempermental, but just severe persistent bloating that will not go away. I have been diagnosed with IBS at the docs, but has been difficult to get any form of treatment since coronavirus situation... I have done an intolerance and allergy test privately out of my own pocket, so I'm hopeful that the results will come back showing anything I can eliminate from my diet to hopefully reduce symptoms and get things under control. Currently, everyday is just suffering and mentally troubling. Just feel so self-concious about the way the bloating looks and how I feel inside. :-(

Zelnorm is a medication for constipation predominant IBS (IBS-C) that is returning to the market in the US after it was off the market for some years. It was re-approved early this year by the FDA and is now in pharmacies again. Zelnorm works differently than other medications for constipation. It increases the amount of serotonin in the gut in order to cause a bowel movement and relieve abdominal pain. More information about Zelnorm can be found here. Is there anyone who has been able to try Zelnorm (tegaserod) again for constipation predominant IBS (IBS-C)? I would be interested to know if it is working for you like it did when it was on the market before. or What was the perspective you had when you last used Zelnorm before it was removed from the market?

Mice study offers new insight on irritable bowel syndrome Sometimes the end of an intestinal infection is just the beginning of more misery. Of those who contract traveler's diarrhea, for example, an unlucky few go on to develop irritable bowel syndrome (IBS), a chronic inflammation of the intestinal tract. Scientists aren't sure exactly how this happens, but some think an infection may contribute to IBS by damaging the gut nervous system. A new Rockefeller study takes a close look at why neurons in the gut die and how the immune system normally protects them. Conducted with mice, the experiments described recently in Cell offer insight on IBS and could point toward potential new treatment approaches. Keeping inflammation in check In a healthy gut, the immune system must strike a careful balance between responding to threats and keeping that response in check to avoid damage. Full article >> https://www.news-medical.net/news/20200112/Mice-study-offers-new-insight-on-irritable-bowel-syndrome.aspx Source: Rockefeller University Matheis, F., et al. (2020) Adrenergic Signaling in Muscularis Macrophages Limits Infection-Induced Neuronal Loss. Cell. doi.org/10.1016/j.cell.2019.12.002. AZoNetwork, © 2000-2020

Medical Management of IBS is Improving With Time Healio Gastroenterology, October 2019 Mark Pimentel, MD In my clinic, it still feels like we get countless referrals for irritable bowel syndrome. We have gained so much knowledge and obtained so many new treatments in our arsenal over the years, but we are still going to need more solutions going forward if we are going to successfully serve all our patients. We need to build on this knowledge and keep making strides to ensure our patients are getting adequate care. Full story >> https://bit.ly/34d7Ziz

A Bug's World: The Microbiome in Gastrointestinal Conditions Chair: William Chey, MD, Nostrant professor of gastroenterology & nutrition, University of Michigan Health System Speakers: Mark Pimental, MD, asst professor of medicine & exec director, David Geffen School of Medicine & Cedars-Sinai; Mille Long, MD, associate professor of medicine , University of North Carolina; Brennan Spiegel, MD, professor of medicine & public health director, Cedars-Sinai Health System Supported by Salix Pharmaceutical Altered microbiome leads to 2 gases, CH4 (methane) which leads to constipation and H2S (hydrogen sulphide) which lets to diarrhea Proposed IBS Pathophysiologic Sequence related to altered microbiome

We recently became aware of a delay that has occurred with the decision at the FDA (Food and Drug Administration) as to whether to re-approve Zelnorm (tegaserod) following the meeting of the FDA Gastrointestinal Drugs Advisory Committee to discuss the reintroduction of Zelnorm (tegaserod) for Irritable Bowel Syndrome with constipation (IBS-C) and our testimony on October 17, 2018. On November 21, 2018 a Citizen Petition was submitted from Hyman, Phelps & McNamara, P. C. to the FDA requesting that the FDA "refrain from approving any new drug application (NDA) supplement (5NDA) to allow Zelnorm (tegaserod maleate) (“Zelnorm” or “tegaserod”) to be marketed unless the sNDA contains substantial evidence of safety and effectiveness for the proposed use in the proposed population under current applicable standards.". The FDA acknowledged the citizen petition on November 26, 2018. We have read through the Citizen Petition and our impression is that it is asking for Zelnorm to be re-submitted as a new medication under a NDA (New Drug Application) because the patient group has now changed from women to women who do not have a risk for a cardiovascular event. We have also read that pharmaceuticals have used a Citizen Petition to hinder a medication to enter the marketplace by slowing down the FDA decision process. This tactic had become so severe that in October 2018 the FDA cracked down on the "loophole" by issuing draft guidance to stop the use of the Citizen Petition. Where does this leave Zelnorm? We fully support access to Zelnorm (tegaserod) for patents with IBS-C and intend to submit a comment to the Citizen Petition to inform the FDA that patients are still demanding access to this medication and accept the risks associated with it. If you are inclined to submit your own comment, please follow this link at Regulations Gov for docket#FDA-2018-P-4490, https://www.regulations.gov/docket?D=FDA-2018-P-4490

I want to thank everyone again for their comments and support for my testimony at the FDA in Washington mid-October for two constipation medications namely Zelnorm and Prucalopride. The IBS Patient Support Group was the only patient voice at the meetings. While there was some excellent testimony by some doctors and medical associations, I was the only patient speaking about the patient perspective. My primary reason for going was not specifically to have drugs approved. Rather, it was for the FDA and industry reps to see that at the end of the day, a patient is looking for treatment options in order to live a better quality of life with IBS. The FDA advisory panel was not aware of how difficult it can be living with IBS. Your comments went a long way to inform and educate the panel. I would even go so far as to say that the patient voice moved the decision in a positive way. I believe that more treatment options help more people and encourage researchers and industry to keep working at solving the cause for IBS. This helps IBS patients all over the world. Thanks again. Jeff

We are heading to the US FDA in Washington DC/Bethesda on Wednesday and Thursday to testify on behalf of patients for IBS and constipation medications that could help some patients. Zelnorm was well loved by IBS-C patients. Prucalopride is widely used outside the US for constipation. Our presentations are posted. Thank you to those people that helped with some of the quotes and for completing the survey. Zelnorm: https://www.regulations.gov/document?D=FDA-2018-N-3223-0009 Prucalopride: https://www.regulations.gov/document?D=FDA-2018-N-0055-0013

There will be a joint meeting of the Gastrointestinal Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee at the Food and Drug Administration (FDA) on October 17, 2018. Agenda: The committees will discuss supplemental new drug application (sNDA) 021200, supplement 015, for ZELNORM (tegaserod maleate) tablets for oral administration, submitted by Sloan Pharma S.à.r.l, Bertrange, Cham Branch, proposed for the treatment of women with irritable bowel syndrome with constipation who do not have a history of cardiovascular ischemic disease, such as myocardial infarction, stroke, transient ischemic attack, or angina, and who do not have more than one risk factor for cardiovascular disease. The IBS Patient Group will be submitting a comment for the public docket for this meeting. If you have experience with Zelnorm for IBS-C or CIC when it was first marketed by Novartis Pharma in 2002 - 2007, we would like to hear from you. Please email us at [email protected] or add your comments below. https://www.federalregister.gov/documents/2018/09/11/2018-19669/joint-meeting-of-the-gastrointestinal-drugs-advisory-committee-and-the-drug-safety-and-risk

Synergy Pharmaceuticals Announces FDA Approval of TRULANCE® (Plecanatide) for the Treatment of Irritable Bowel Syndrome with Constipation (IBS-C) in Adults NEW YORK--(BUSINESS WIRE)--Synergy Pharmaceuticals Inc. (NASDAQ:SGYP) announced today that the U.S. Food and Drug Administration (FDA) has approved TRULANCE® (plecanatide) 3 mg tablet for the once-daily treatment of irritable bowel syndrome with constipation (IBS-C) in adults. This is the second indication for TRULANCE, which is already approved for the treatment of adults with chronic idiopathic constipation (CIC). TRULANCE is the only prescription medication for adults with CIC and now IBS-C that can be taken once-daily, with or without food, at any time of the day. TRULANCE is packaged in a unique, 30-day calendar blister pack. “Approximately 1 in 20 Americans are living with IBS-C, many of whom are not satisfied with currently available treatment options,” said William D. Chey, M.D., Professor of Medicine, Director of the GI Physiology Laboratory, and Co-Director of the Michigan Bowel Control Program at the University of Michigan. “With this second indication for TRULANCE, patients and physicians will have a much-needed, new treatment option with an established safety profile that can effectively address abdominal pain and constipation experienced by patients with IBS-C.” “The TRULANCE label reflects the strong and remarkably consistent efficacy and safety profile TRULANCE has demonstrated in treating over 4,700 patients across both CIC and IBS-C clinical trials,” said Patrick H. Griffin, MD, Chief Medical Officer of Synergy. “To-date, real world patient experience has supported the clinical trial data, highlighted by a post-marketing diarrhea rate of less than 0.5% and no reports of severe diarrhea requiring hospitalization since the launch of the TRULANCE CIC indication. The IBS-C approval today builds on the already strong CIC label and further establishes TRULANCE as the first and only uroguanylin analog.” With the exception of a single amino acid substitution for greater binding affinity, TRULANCE is structurally identical to human uroguanylin and is the only treatment thought to replicate the pH-sensitive activity of uroguanylin. TRULANCE Phase 3 IBS-C Program Design The Phase 3 IBS-C program included two randomized, 12-week, double-blind, placebo-controlled trials evaluating the efficacy and safety of TRULANCE in adult patients with IBS-C. Across the two trials, more than 2,100 patients received a once-daily tablet of TRULANCE (3 mg or 6 mg doses) or placebo. Both trials included a two-week, pre-treatment baseline period, a 12-week treatment period, and a two-week, post-treatment follow-up period. Patients who were enrolled in these trials fulfilled Rome III IBS-C criteria related to abdominal pain and stool changes. The company only sought approval for the 3 mg dose. Primary Endpoint The primary endpoint for both trials was the percentage of patients who are Overall Responders during the 12-week treatment period. An Overall Responder, as defined by the FDA, was a patient who fulfilled both ≥ 30% reduction in worst abdominal pain and an increase of ≥ 1 complete spontaneous bowel movement (CSBM) from baseline, in the same week, for at least 50% of the 12 treatment weeks. Results In both Phase 3 IBS-C trials, TRULANCE met the primary endpoint as compared with placebo (Study 1: 30.2%; 17.8% in placebo; p<0.001. Study 2: 21.5%; 14.2% in placebo; p=0.009). In both studies, patients who received TRULANCE experienced significantly reduced abdominal pain and improvements in stool frequency, stool consistency, and straining with bowel movements during the 12-week treatment period as compared to placebo. In both studies, the most common adverse event was diarrhea (4.3%; 1.0% at placebo), with severe diarrhea reported in 1% of patients. Overall discontinuation rates were low among patients treated with TRULANCE and placebo (2.5%; 0.4% at placebo) and the most common adverse reaction leading to discontinuation was diarrhea (1.2%; 0% in placebo). Indications and Usage TRULANCE (plecanatide) 3 mg tablets is indicated in adults for the treatment of Chronic Idiopathic Constipation (CIC) and Irritable Bowel Syndrome with Constipation (IBS-C). IMPORTANT SAFETY INFORMATION WARNING: RISK OF SERIOUS DEHYDRATION IN PEDIATRIC PATIENTS TRULANCE® is contraindicated in patients less than 6 years of age; in nonclinical studies in young juvenile mice administration of a single oral dose of plecanatide caused deaths due to dehydration. Use of TRULANCE should be avoided in patients 6 years to less than 18 years of age. The safety and efficacy of TRULANCE have not been established in pediatric patients less than 18 years of age. Contraindications TRULANCE is contraindicated in patients less than 6 years of age due to the risk of serious dehydration. TRULANCE is contraindicated in patients with known or suspected mechanical gastrointestinal obstruction. Warnings and Precautions Risk of Serious Dehydration in Pediatric Patients TRULANCE is contraindicated in patients less than 6 years of age. The safety and effectiveness of TRULANCE in patients less than 18 years of age have not been established. In young juvenile mice (human age equivalent of approximately 1 month to less than 2 years), plecanatide increased fluid secretion as a consequence of stimulation of guanylate cyclase-C (GC-C), resulting in mortality in some mice within the first 24 hours, apparently due to dehydration. Due to increased intestinal expression of GC-C, patients less than 6 years of age may be more likely than older patients to develop severe diarrhea and its potentially serious consequences. Use of TRULANCE should be avoided in patients 6 years to less than 18 years of age. Although there were no deaths in older juvenile mice, given the deaths in young mice and the lack of clinical safety and efficacy data in pediatric patients, use of TRULANCE should be avoided in patients 6 years to less than 18 years of age. Diarrhea Diarrhea was the most common adverse reaction in the four placebo-controlled clinical trials for CIC and IBS-C. Severe diarrhea was reported in 0.6% of TRULANCE-treated CIC patients, and in 1% of TRULANCE-treated IBS-C patients. If severe diarrhea occurs, the health care provider should suspend dosing and rehydrate the patient. Adverse Reactions In the two combined CIC clinical trials, the most common adverse reaction in TRULANCE-treated patients (incidence ≥2% and greater than in the placebo group) was diarrhea (5% vs 1% placebo). In the two combined IBS-C clinical trials, the most common adverse reaction in TRULANCE-treated patients (incidence ≥2% and greater than in the placebo group) was diarrhea (4.3% vs 1% placebo). Please also see the full Prescribing Information, including Box Warning, for additional risk information. About Irritable Bowel Syndrome with Constipation (IBS-C) Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by recurrent abdominal pain and associated with two or more of the following: related to defecation, associated with a change in the frequency of stool, or associated with a change in the form (appearance) of the stool. IBS can be subtyped by the predominant stool form: constipation (IBS-C), diarrhea (IBS-D) or mixed (IBS-M). Those within the IBS-C subtype experience hard or lumpy stools more than 25 percent of the time they defecate, and loose or watery stools less than 25 percent of the time. It is estimated that the prevalence of IBS-C in the U.S. adult population is approximately 4 to 5 percent. About Chronic Idiopathic Constipation (CIC) CIC affects approximately 14 percent of the global population, disproportionately affecting women and older adults. People with CIC have persistent symptoms of difficult-to-pass and infrequent bowel movements. In addition to physical symptoms including abdominal bloating and discomfort, CIC can adversely affect an individual’s quality of life, including increasing stress levels and anxiety. About TRULANCE® TRULANCE® (plecanatide) is a once-daily tablet approved for adults with CIC or IBS-C. With the exception of a single amino acid substitution for greater binding affinity, TRULANCE is structurally identical to uroguanylin, a naturally occurring and endogenous human GI peptide. Uroguanylin activates GC-C receptors in a pH-sensitive manner primarily in the small intestine, stimulating fluid secretion and maintaining stool consistency necessary for regular bowel function. About Synergy Pharmaceuticals Synergy is a biopharmaceutical company focused on the development and commercialization of novel gastrointestinal (GI) therapies. The company has pioneered discovery, research and development efforts around analogs of uroguanylin, a naturally occurring human GI peptide, for the treatment of GI diseases and disorders. Synergy’s proprietary GI platform includes one commercial product TRULANCE® (plecanatide) and a second product candidate - dolcanatide. For more information, please visit www.synergypharma.com. Contacts: Synergy Pharmaceuticals Inc.Gem Hopkins, 212-584-7610VP, Investor Relations and Corporate [email protected]

What's the expression, "You never truly know someone until you've walked a mile in their shoes". I wasn't clear if my Crohn's was flaring or what was going on, but I had been experiencing a very different set of symptoms over the last 10 weeks. I considered myself IBS-D; however, I was tending to IBS-C over the last 10 weeks. Turns out my Crohn's is flaring mildly; however, it doesn't explain the IBS-C - which is simply IBS-C on top of Crohn's vs. my usual IBS-D on top of Crohn's. So now I have a complete appreciation for IBS-C.... and it's rather awful.

Wondering if anyone had had good results with Miralax or CVSPurelax for constipation? How much dosage/ time to take it?

Recorded Webcast of a symposium for gastroenterologists about optimizing management of IBS-C and CIC. Originally presented at DDW 2017. Click to view the webcast at the bottom of the posting. Click here to view the webcast