# As CBT begins to be effective...



## lachmcleod101 (Feb 10, 2010)

Does any know what happens with IBS-D if CBT begins to become effective? At the moment I am on a number of anti-diarrheal medications (immodium, TCA) and have been doing CBT. I have been experiencing a strong sensation of constipation for the past couple of days (although I have still been having a BM in the morning and so am not truly constipated). Is this just my gut getting used to a slower transit or is it a sign that I should stop the immodium? Or is it just (yet) another symptom of IBS?


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## Kathleen M. (Nov 16, 1999)

If the CBT is helping the medications to stop up the diarrhea may constipate you.Those drugs don't know how to stop at "normal" they just constipate. So it is easy for them to overshoot.I would see if you are at a point you can back off some of the medication. When I was doing CBT as part of a clinical study we monitored my use of an antispasmodic and as I got better the number of pills per day went down substantially.


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## lachmcleod101 (Feb 10, 2010)

Is the sensation of constipation different to actual constipation? I am still having at least 2 BM every day – will reducing the Imodium just increase the amount that comes out each time or will it also increase the frequency?


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## Kathleen M. (Nov 16, 1999)

I'm not sure constipation causes a specific sensation.But a lot of people even with severe diarrhea can have all sorts of pains, distension, bloating, and feeling like something (gas or stool) is stuck. I'm not sure how much any of that caused by the hard dry stool that takes too long to pass.Unfortunately I don't know at what point you would need to back off medication. It is kind of a trial and error thing. Hopefully the idea is eventually the CBT will control enough of the symptoms you can reduce or stop the medications. But how to know when that is...I don't have a good guideline.You might talk this over with the therapist and see if they have a suggestion. All I know about is me and I went from having to take an antispasmodic the second one wore off to only needing one or two a day and then not needing even that. I realized I was much better when I stopped knowing exactly where that pill bottle was every moment of every day.


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## IBStinks (Sep 25, 2010)

lachmcleod101 said:


> Is the sensation of constipation different to actual constipation? I am still having at least 2 BM every day - will reducing the Imodium just increase the amount that comes out each time or will it also increase the frequency?


My IBS swings from D to C, and when you're constipated, you know. When you're really constipated, there's lots of pain. If you're still going 1-2 times a day, you're not constipated. Drink lots of water either way, though.


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