Functional constipation

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Functional constipation
Other namesChronic idiopathic constipation

Functional constipation, also known as chronic idiopathic constipation (CIC), is defined by less than three bowel movements per week, hard stools, severe straining, the sensation of anorectal blockage, the feeling of incomplete evacuation, and the need for manual maneuvers during feces, without organic abnormalities. Many illnesses, including endocrine, metabolic, neurological, mental, and gastrointestinal obstructions, can cause constipation as a secondary symptom. When there is no such cause, functional constipation is diagnosed. [1]

Contents

Chronic idiopathic constipation is similar to constipation-predominant irritable bowel syndrome (IBS-C); however, people with CIC do not have other symptoms of IBS, such as abdominal pain. [2]

Signs and symptoms

Individuals suffering from functional constipation often exhibit hard or lumpy stools, decreased frequency of bowel movements, a feeling of incomplete evacuation or obstruction, straining, and in some cases, stomach pain and bloating. [3] Generally speaking, symptoms are considered chronic if they have persisted for three months or more. [4]

Faecal incontinence, which is the involuntary loss of stools in the underwear during toilet training and is brought on by an overflow of soft stools passing around a solid faecal mass in the rectum (faecal impaction), is a common symptom in children. [5] Urinary symptoms, including urine incontinence and urinary tract infections, are frequently observed in children who suffer from functional constipation. [6]

Causes

To be considered functional constipation, symptoms must be present at least a fourth of the time. [2] Possible causes are:

There is also possibility of presentation with other comorbid symptoms such as headache, especially in children. [7]

Diagnosis

Functional constipation cannot be diagnosed with particular testing; instead, the Rome criteria, a consensus of experts, is used to make this diagnosis. [8] The Rome IV criteria define functional constipation as meeting at least two of the six requirements given below: [9]

  1. Over ¼ (25%) of defecations involve straining. [9]
  2. More than ¼ (25%) of defecations result in lumpy or hard stools (Bristol Stool Form Scale 1-2). [9]
  3. Sensation of partial evacuation for over ¼ (25%) of the defecations. [9]
  4. Sensation of anorectal blockage or obstruction during more than ¼ (25%) of bowel movements. [9]
  5. Manual techniques (such as pelvic floor support and digital evacuation) to assist in more than ¼ (25%) of defecations. [9]
  6. Less than three weekly spontaneous bowel movements. [9]
  7. Loose stools are rarely seen without the use of laxatives. [9]
  8. Not enough criteria met to diagnose irritable bowel syndrome. [9]

A thorough history and physical examination should be performed while evaluating constipation. [10] Along with push and squeeze maneuvers, a comprehensive digital rectal exam (DRE) is a crucial component of the clinical examination. [11]

Generally speaking, additional laboratory testing should be carried out only in cases of uncertainty or to rule out underlying medical conditions such as hypothyroidism or celiac disease. Abdominal radiography, with or without the introduction of radio-opaque markers to determine colonic transit time, and abdominal ultrasonography are frequently employed supplementary tests in the diagnosis of constipation. [12]

Treatment

Treatment options appear similar and include prucalopride, lubiprostone, linaclotide, tegaserod, velusetrag, elobixibat, bisacodyl, sodium picosulphate, [13] and most recently, plecanatide. In children and adolescents with functional constipation, the first line treatment is polyethylene glycol; while other treatments such as increasing fiber or water intake above daily recommended levels or probiotics have not been found to be helpful. [14]

Research

A 2014 meta-analysis of three small trials evaluating probiotics showed a slight improvement in management of chronic idiopathic constipation, but well-designed studies are necessary to know the true efficacy of probiotics in treating this condition. [15]

Children with functional constipation often claim to lack the sensation of the urge to defecate, and may be conditioned to avoid doing so due to a previous painful experience. [16] One retrospective study showed that these children did indeed have the urge to defecate using colonic manometry, and suggested behavioral modification as a treatment for functional constipation. [17]

See also

Related Research Articles

<span class="mw-page-title-main">Defecation</span> Expulsion of feces from the digestive tract

Defecation follows digestion, and is a necessary process by which organisms eliminate a solid, semisolid, or liquid waste material known as feces from the digestive tract via the anus or cloaca. The act has a variety of names ranging from the common, like pooping or crapping, to the technical, e.g. bowel movement, to the obscene (shitting), to the euphemistic, to the juvenile. The topic, usually avoided in polite company, can become the basis for some potty humor.

<span class="mw-page-title-main">Constipation</span> Bowel dysfunction

Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications from constipation may include hemorrhoids, anal fissure or fecal impaction. The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four bowel movements per day while young children typically have two to three per day.

<span class="mw-page-title-main">Fecal incontinence</span> Inability to refrain from defecation

Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred to as anal incontinence. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from a deficiency of multiple mechanisms. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery, altered bowel habits. An estimated 2.2% of community-dwelling adults are affected. However, reported prevalence figures vary. A prevalence of 8.39% among non-institutionalized U.S adults between 2005 and 2010 has been reported, and among institutionalized elders figures come close to 50%.

<span class="mw-page-title-main">Irritable bowel syndrome</span> Functional gastrointestinal disorder

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating and changes in the consistency of bowel movements. These symptoms may occur over a long time, sometimes for years. IBS can negatively affect quality of life and may result in missed school or work or reduced productivity at work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.

Functional abdominal pain syndrome (FAPS), chronic functional abdominal pain (CFAP), or centrally mediated abdominal pain syndrome (CMAP) is a pain syndrome of the abdomen, that has been present for at least six months, is not well connected to gastrointestinal function, and is accompanied by some loss of everyday activities. The discomfort is persistent, near-constant, or regularly reoccurring. The absence of symptom association with food intake or defecation distinguishes functional abdominal pain syndrome from other functional gastrointestinal illnesses, such as irritable bowel syndrome (IBS) and functional dyspepsia.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

<span class="mw-page-title-main">Small intestinal bacterial overgrowth</span> Medical condition

Small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowth, or small bowel bacterial overgrowth syndrome (SBBOS), is a disorder of excessive bacterial growth in the small intestine. Unlike the colon, which is rich with bacteria, the small bowel usually has fewer than 100,000 organisms per millilitre. Patients with bacterial overgrowth typically develop symptoms which may include nausea, bloating, vomiting, diarrhea, malnutrition, weight loss, and malabsorption by various mechanisms.

<span class="mw-page-title-main">Fecal impaction</span> Medical condition

A fecal impaction or an impacted bowel is a solid, immobile bulk of feces that can develop in the rectum as a result of chronic constipation. Fecal impaction is a common result of neurogenic bowel dysfunction and causes immense discomfort and pain. Its treatment includes laxatives, enemas, and pulsed irrigation evacuation (PIE) as well as digital removal. It is not a condition that resolves without direct treatment.

The Bristol stool scale is a diagnostic medical tool designed to classify the form of human faeces into seven categories. It is used in both clinical and experimental fields.

<span class="mw-page-title-main">Abdominal distension</span> Physical symptom

Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion. It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right. People with this condition often describe it as "feeling bloated". Affected people often experience a sensation of fullness, abdominal pressure, and sometimes nausea, pain, or cramping. In the most extreme cases, upward pressure on the diaphragm and lungs can also cause shortness of breath. Through a variety of causes, bloating is most commonly due to buildup of gas in the stomach, small intestine, or colon. The pressure sensation is often relieved, or at least lessened, by belching or flatulence. Medications that settle gas in the stomach and intestines are also commonly used to treat the discomfort and lessen the abdominal distension.

The Rome process and Rome criteria are an international effort to create scientific data to help in the diagnosis and treatment of functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia and rumination syndrome. The Rome diagnostic criteria are set forth by Rome Foundation, a not for profit 501(c)(3) organization based in Raleigh, North Carolina, United States.

<span class="mw-page-title-main">Lubiprostone</span> Medication used for constipation

Lubiprostone, sold under the brand name Amitiza among others, is a medication used in the management of chronic idiopathic constipation, predominantly irritable bowel syndrome-associated constipation in women and opioid-induced constipation. The drug is owned by Mallinckrodt and is marketed by Takeda Pharmaceutical Company.

<span class="mw-page-title-main">Anorectal manometry</span> Medical functional test of the anus and rectum

Anorectal manometry (ARM) is a medical test used to measure pressures in the anus and rectum and to assess their function. The test is performed by inserting a catheter, that contains a probe embedded with pressure sensors, through the anus and into the rectum. Patients may be asked to perform certain maneuvers, such as coughing or attempting to defecate, to assess for pressure changes. Anorectal manometry is a safe and low risk procedure.

Bile acid malabsorption (BAM), known also as bile acid diarrhea, is a cause of several gut-related problems, the main one being chronic diarrhea. It has also been called bile acid-induced diarrhea, cholerheic or choleretic enteropathy, bile salt diarrhea or bile salt malabsorption. It can result from malabsorption secondary to gastrointestinal disease, or be a primary disorder, associated with excessive bile acid production. Treatment with bile acid sequestrants is often effective. It is recognised as a disability in the United Kingdom under the Equality Act 2010

Solitary rectal ulcer syndrome or SRUS is a chronic, benign disorder of the rectal mucosa. It commonly occurs with varying degrees of rectal prolapse. The condition is thought to be caused by different factors, such as long term constipation, straining during defecation, and dyssynergic defecation. Treatment is by normalization of bowel habits, biofeedback, and other conservative measures. In more severe cases various surgical procedures may be indicated. The condition is relatively rare, affecting approximately 1 in 100,000 people per year. It affects mainly adults aged 30–50. Females are affected slightly more often than males. The disorder can be confused clinically with rectal cancer or other conditions such as inflammatory bowel disease, even when a biopsy is done.

<span class="mw-page-title-main">Anismus</span> Medical condition

Anismus or dyssynergic defecation is the failure of normal relaxation of pelvic floor muscles during attempted defecation. It can occur in both children and adults, and in both men and women. It can be caused by physical defects or it can occur for other reasons or unknown reasons. Anismus that has a behavioral cause could be viewed as having similarities with parcopresis, or psychogenic fecal retention.

Obstructed defecation syndrome is a major cause of functional constipation, of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of the rectum with or without an actual reduction in the number of bowel movements per week. Normal definitions of functional constipation include infrequent bowel movements and hard stools. In contrast, ODS may occur with frequent bowel movements and even with soft stools, and the colonic transit time may be normal, but delayed in the rectum and sigmoid colon.

Plecanatide, sold under the brand name Trulance, is a medication for the treatment of chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation. It is being launched in India under the brand name "Plecasoft". Plecanatide is an agonist of guanylate cyclase-C. Plecanatide increases intestinal transit and fluid through a buildup of cGMP.

Constipation in children refers to the medical condition of constipation in children. It is a functional gastrointestinal disorder.

<span class="mw-page-title-main">Neurogenic bowel dysfunction</span> Human disease involving inability to control defecation

Neurogenic bowel dysfunction (NBD) is the inability to control defecation due to a deterioration of or injury to the nervous system, resulting in faecal incontinence or constipation. It is common in people with spinal cord injury (SCI), multiple sclerosis (MS) or spina bifida.

References

  1. ↑ Shin, Jeong Eun (2022). "Functional Constipation". Sex/Gender-Specific Medicine in the Gastrointestinal Diseases. Singapore: Springer Nature Singapore. p. 259–272. doi:10.1007/978-981-19-0120-1_17. ISBN   978-981-19-0119-5.
  2. 1 2 "Americal College of Gastroenterology: Fuinctional Bowel Disorders" (PDF). Archived from the original (PDF) on 2011-09-27. Retrieved 2010-06-26.
  3. ↑ Lacy, Brian E.; Mearin, Fermín; Chang, Lin; Chey, William D.; Lembo, Anthony J.; Simren, Magnus; Spiller, Robin (2016). "Bowel Disorders". Gastroenterology. 150 (6). Elsevier BV: 1393–1407.e5. doi:10.1053/j.gastro.2016.02.031. ISSN   0016-5085.
  4. ↑ Black, Christopher J; Ford, Alexander C (2018). "Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management". Medical Journal of Australia. 209 (2): 86–91. doi:10.5694/mja18.00241. ISSN   0025-729X.
  5. ↑ Wald, Ellen R; Di Lorenzo, Carlo; Cipriani, Lynne; Colborn, D Kathleen; Burgers, Rosa; Wald, Arnold (2009). "Bowel Habits and Toilet Training in a Diverse Population of Children". Journal of Pediatric Gastroenterology and Nutrition. 48 (3). Wiley: 294–298. doi:10.1097/mpg.0b013e31817efbf7. ISSN   0277-2116.
  6. ↑ Burgers, Rosa E.; Mugie, Suzanne M.; Chase, Janet; Cooper, Christopher S.; von Gontard, Alexander; Rittig, Charlotte Siggaard; Homsy, Yves; Bauer, Stuart B.; Benninga, Marc A. (2013). "Management of Functional Constipation in Children with Lower Urinary Tract Symptoms: Report from the Standardization Committee of the International Children's Continence Society". Journal of Urology. 190 (1). Ovid Technologies (Wolters Kluwer Health): 29–36. doi:10.1016/j.juro.2013.01.001. ISSN   0022-5347.
  7. ↑ Inaloo S, Dehghani SM, Hashemi SM, Heydari M, Heydari ST (2014). "Comorbidity of headache and functional constipation in children: a cross-sectional survey". Turk J Gastroenterol. 25 (5): 508–11. doi:10.5152/tjg.2014.6183. PMID   25417610.
  8. ↑ Drossman, Douglas A. (2016). "Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV". Gastroenterology. 150 (6). Elsevier BV: 1262–1279.e2. doi:10.1053/j.gastro.2016.02.032. ISSN   0016-5085.
  9. 1 2 3 4 5 6 7 8 9 "Rome IV Criteria". Rome Foundation. 2023-03-06. Retrieved 2024-06-10.
  10. ↑ Jani, Bhairvi; Marsicano, Elizabeth (2024-03-14). "Constipation: Evaluation and Management". Missouri Medicine. 115 (3). Missouri State Medical Association. PMID   30228729 . Retrieved 2024-06-10.
  11. ↑ Tantiphlachiva, Kasaya; Rao, Priyanka; Attaluri, Ashok; Rao, Satish S.C. (2010). "Digital Rectal Examination Is a Useful Tool for Identifying Patients With Dyssynergia". Clinical Gastroenterology and Hepatology. 8 (11). Elsevier BV: 955–960. doi:10.1016/j.cgh.2010.06.031. ISSN   1542-3565.
  12. ↑ Tabbers, Merit M.; Boluyt, Nicole; Berger, Marjolein Y.; Benninga, Marc A. (2011-06-24). "Clinical practice". European Journal of Pediatrics. 170 (8). Springer Science and Business Media LLC: 955–963. doi:10.1007/s00431-011-1515-5. ISSN   0340-6199.
  13. ↑ Nelson, AD; Camilleri, M; Chirapongsathorn, S; Vijayvargiya, P; Valentin, N; Shin, A; Erwin, PJ; Wang, Z; Murad, MH (September 2017). "Comparison of efficacy of pharmacological treatments for chronic idiopathic constipation: a systematic review and network meta-analysis". Gut. 66 (9): 1611–1622. doi:10.1136/gutjnl-2016-311835. hdl: 1805/12164 . PMID   27287486. S2CID   206964065.
  14. ↑ Mulhem, E; Khondoker, F; Kandiah, S (1 May 2022). "Constipation in Children and Adolescents: Evaluation and Treatment". American Family Physician. 105 (5): 469–478. PMID   35559625.
  15. ↑ Ford, Alexander C; Quigley, Eamonn M M; Lacy, Brian E; Lembo, Anthony J; Saito, Yuri A; Schiller, Lawrence R; Soffer, Edy E; Spiegel, Brennan M R; Moayyedi, Paul (2014). "Efficacy of Prebiotics, Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic Constipation: Systematic Review and Meta-analysis". The American Journal of Gastroenterology. 109 (10): 1547–1561. doi:10.1038/ajg.2014.202. ISSN   0002-9270. PMID   25070051. S2CID   205100508.
  16. ↑ Fleisher, DR (November 1976). "Diagnosis and treatment of disorders of defecation in children". Pediatric Annals . 5 (11): 71–101. doi:10.3928/0090-4481-19761101-07. hdl: 10355/5155 . PMID   980548.
  17. ↑ Firestone Baum, C; John A; Srinivasan K; Harrison P; Kolomensky A; Monagas J; Cocjin J; Hyman PE (January 2013). "Colon manometry proves that perception of the urge to defecate is present in children with functional constipation who deny sensation". Journal of Pediatric Gastroenterology and Nutrition . 56 (1): 19–22. doi: 10.1097/MPG.0b013e31826f2740 . PMID   22922371. S2CID   46075633.
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