DEAR DR. ROACH: I’m a young adult male who has been diagnosed with irritable bowel syndrome with constipation (IBS-C). Until this diagnosis, I had never even heard of the condition. A colonoscopy and an MRI were both negative. The three worst symptoms are chronic constipation, bloating and stomach cramps.

I was referred to a gastroenterologist who first prescribed Amitiza, which provided relief for a while, then stopped working. Now I’m taking Motegrity for motility and Bentyl for the cramps, but neither of these medications fully relieves the symptoms.

From the research I’ve done on my own, the root cause of IBS is still unknown, although many people (more commonly women) suffer from this condition. I’ve also read that people who’ve had eating disorders or obsessive-compulsive disorder (OCD) are more susceptible to IBS, and I’ve suffered from both.

I have a therapist to help me cope emotionally, but the condition really does interfere with basic life activities. Are there any other medications or treatments I could try? I want to be sure that I’m receiving the most up-to-date care. — R.R.

ANSWER: IBS is a common disorder characterized by abdominal discomfort that is associated with a change in bowel habits. This can be diarrhea (IBS-D), constipation (IBS-C), or mixed (IBS-M). Some people’s predominant bowel classification changes over time.

As you say, it is more common in women, and the exact cause is unknown. Abnormal gut motility, hypersensitivity of the nerves to the gut, immune system activation, and changes in the microbiome (bacteria content of the gut) have all been studied and may each have a role in some cases.

As far as your medication goes, it sounds like your gastroenterologist is treating you very reasonably. I have patents who find that Motegrity works better, while other do better with Amitiza for constipation. Dicyclomine, an anticholinergic agent, helps some people with cramps. I don’t see it used as often any more, but I won’t argue against it if it’s helping you.

There is an area you haven’t mentioned, which is your diet. Given your history of eating disorders, I recommend a consultation with a nutritionist who has expertise in IBS (and ideally eating disorders as well). A diary of your food intake combined with a list of your symptoms and a bowel diary can provide excellent information.

I am glad you are getting help from a therapist. There are specific treatments therapists can use to help with the bowel and mental health symptoms that are associated with IBS, including stress-reduction techniques, cognitive-behavioral therapies, and brain-gut behavioral therapies. These specialized treatments sometimes require specially trained therapists.

Regular moderate exercise is an often-neglected component of IBS treatment, as is sleep hygiene.

DEAR DR. ROACH: I just wanted to comment on your recent column about a 64-year-old woman with a cold that wouldn’t go away after two months. She had fatigue, chills and sweats, and a persistent cough. This person’s story is almost identical to my 66-year-old sister’s. It turns out that my sister has stage three lymphoma. — C.P.

ANSWER: I am very sorry to hear about your sister. Most times, symptoms like these go away by themselves. If symptoms persist, it is absolutely time to see your doctor and for your doctor to consider further testing. On average, a person with lymphoma goes four to five months with symptoms before being diagnosed.

It’s estimated that a generalist will see lymphoma in about 1 in 24,000 cases, so it is hard to pick up. But persistent symptoms are a major clue that there may be something more serious going on.

I thank C.P. for writing and wish the best for her sister.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved