Sometimes I don't know when I am constipated. It will come on suddenly out of nowhere where I am having to go NOW and then am in there forever due to being so constipated. Sometimes I will get slight cramping off and on the day before an attack. That is a clue to me that something is going on. I also get D.. it alternates.... and I will get the cramping with that also. I also feel "full" and bloated and really gassy. I rely on my gas-x when I am feeling that way and will take immodium for the D sometimes, if it is really bad.