Constipation with bloating: (Coclusion)

 Ref

Ann Med. 2026 Jun 19;58(1):2684172. doi: 10.1080/07853890.2026.2684172

Constipation with bloating: a clinical approach to evaluation and management

David J Cangemi a,✉, Adam P Laitman b, Orit Faiman b, Bianca W Chang 

Conclusions

Constipation and bloating are common GI symptoms that frequently occur together. While the etiology for constipation and bloating is diverse, specific GI causes that should be considered in the evaluation of bloating and constipation include CIC, IBS-C, IBS-M, PFD, and IMO. In cases for which food intolerance is suspected, a 2-week trial of dietary restriction to assess response (e.g. low FODMAP diet) can be considered, ideally with the assistance of a qualified dietician. Furthermore, soluble fiber and polyethylene glycol are safe and reasonable first-line treatment considerations. Among pharmacologic options, secretagogues indicated for the treatment of IBS-C and CIC have demonstrated significant improvements in constipation and bloating symptoms in robust RCTs. Other treatments that may have a role for patients with constipation and bloating include antibiotics (bacterial overgrowth), psychotherapeutic approaches (IBS-C), and pelvic floor physical therapy with biofeedback (PFD); however, data are relatively limited, and more well-designed RCTs are needed. An individualized approach, based on available evidence, is advised to best address the common and frequently bothersome symptoms of constipation and bloating.

Looking ahead, additional research is needed to better understand the prevalence of SIBO and IMO in patients with bloating, as these remain popular and oft-debated topics in the field of gastroenterology and the true prevalence of these conditions remains unclear. Further studies are needed to establish the most effective treatment strategies for microbial overgrowth conditions, such as SIBO and IMO. In addition, clinical trials evaluating new therapeutic approaches for bloating – particularly dietary interventions, neuromodulators, and psychologically based therapies – would be valuable, as these modalities are likely to play an increasingly prominent role in managing bloating and constipation in the future.