OBJECTIVES: To assess the socio-economic burden of moderate-to-severe IBS-C in six European countries (France, Germany, Italy, Spain, Sweden and UK). Here we present the economic and quality of life (QoL) results from Germany. METHODS: Observational, retrospective-prospective (6 months each) study of patients diagnosed in the last five years with IBS-C (Rome-III criteria) and with moderate-to-severe disease at inclusion (IBS-Symptom Severity Scale [IBS-SSS] score ≥175). The primary objective was to determine annual direct and indirect costs. Secondary objectives included assessing QoL at baseline: IBS-QoL and EuroQoL-5D (EQ-5D) questionnaires. Work productivity was assessed using the Work Productivity and Activity Impairment:IBS-C questionnaire (WPAI:IBS-C). RESULTS: CONCLUSIONS: Moderate-to-severe IBS-C symptoms greatly impact German QoL and work productivity. Current management practices result in high direct and indirect costs. This results in significant cost to both the German national healthcare service and the patient, with the latter assuming one quarter of all direct medical costs.