Constipation is defined as having a reduced bowel movement frequency, particularly less than three times per week. Constipation may occur over a short period of time (acute) or last much longer (chronic). Often times, constipation is associated with straining and painful stool excretion. Affected individuals may require manual removal of hardened and impacted stool, which may further lead to injury and bleeding of the tissues around the anus.
Epidemiology of chronic idiopathic constipation
It is estimated that as many as 35 million American adults suffer from chronic idiopathic constipation, with only about 12 percent eventually seeking medical attention for their symptoms. This condition is slightly more common in women and adults over the age of 35, with Caucasians being the most affected compared to other races and ethnicities.
What causes chronic idiopathic constipation?
The sole reason for labeling this form of constipation “idiopathic” is because there is no identifiable cause, however, there are several possible factors that may be associated with chronic idiopathic constipation. These may include:
Fluid absorption and muscle contraction: Due to a reduction in the contracting muscles found throughout the colon to the rectum. Due to the lack of movement of fecal matter, water from the stools is absorbed in greater amounts, leading the stool to become hard and dry.
Improper diet: Not consuming enough fiber in your diet can lead to chronic constipation. Eating more foods rich in protein and dairy instead is often a significant cause of chronic idiopathic constipation.
Brain and bowel connection: Your entire gastrointestinal system is controlled by an array of nerve cells that relay messages of urgency to defecate to your brain and back. If there are any changes to this nervous symptom, as in the case of nervous system damage, this line of communication can be disrupted, leading to a decreased urge to defecate, abdominal discomfort, and consequently lead to constipation.
Other possible causes of chronic constipation include:
- Pelvic floor dysfunction
- Endocrine or metabolic problems (diabetes and hypothyroidism)
- Neurologic problems (multiple sclerosis, Parkinson’s disease, spinal cord injury, and stroke)
- Tears in the anus and rectum
- Narrowing of the colon (bowel stricture)
- Mental health problems (depression, eating disorders, and anxiety)
- Bowel diseases (Crohn’s disease, colon cancer, diverticulosis, and irritable bowel syndrome)
- Physical disabilities that lead to immobility
What are the symptoms and risk factors of chronic idiopathic constipation?
Chronic idiopathic constipation symptoms are highlighted by infrequent bowel movements; however, the following may also accompany the diagnosis:
- Abdominal pain
- Bloating
- Severe cramping
- Excessive flatulence
- Hard stools
- Feelings of incomplete bowel movement
- Feeling your bowel are blocked
- Straining during bowel movements
- Pain caused by gas formation in intestines
IBS with constipation vs Chronic idiopathic constipation: How are they different?
Many find similarities between chronic idiopathic constipation and other bowel disorders. Irritable bowel syndrome (IBS), for example, is a functional gastrointestinal disorder characterized by abdominal pain along with altered bowel habits. However, while IBS may be associated with constipation, it can also be associated with c, or even both.
The most important defining feature of IBS is having abdominal pain that occurs at least three days a month for at least three months. This pain is improved by bowel movements and comes along with changes in frequency or appearance of bowel movements.
Similarities between the two conditions often include straining during bowel movements, incomplete bowel evacuation, hard stools, gas pain, abdominal discomfort, and bloating.
When to see a doctor
As with any serious health condition affecting your quality of life, seeing a doctor will always be in your best interest. The following complications with your bowel movements should prompt you to see your local doctor as soon as possible:
- Developing a high fever
- Severe constipation not remedies by any kind of medication
- Having blood in stool
- Unexplained weight loss
- Low blood count
- Experiencing symptoms related to inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
Diagnosis of chronic idiopathic constipation
Typically, the history of infrequent bowel moments is enough to suspect some form of constipation. A full medical history will also be taken to help determine the level of bowel movement infrequency and other related symptoms. This will lead to a physical exam of your abdomen and rectum, which will most likely be done to investigate for any kind of obstruction. Once these preliminary steps are done, your doctor will likely choose to do the following tests for further investigation depending on the circumstance. However, to be classified as “idiopathic,” none of these tests will show signs of abnormality.
Blood test: Looking for the signs of infection or checking thyroid function.
Ultrasound: Can give a good indication of the cause and site of your obstipation.
X-ray/CT: imaging studies to get a picture of your obstructed bowels.
Barium enema: Used in combination with an x-ray to get a detailed view of the bowel pathway, looking for obstruction of the dye.
Colonoscopy: Looking directly into the colon with a camera can help see if you have tissue damage. Biopsies may also be taken to be assessed for colon cancer.
Bowel function test: Used to check muscle tone and nerve sensitivity of the intestines and anus.
How to treat chronic idiopathic constipation
Once diagnostic testing has ruled out any potential underlying cause of constipation, therapy can be implemented to remedy the disorder. The following are common methods used for chronic idiopathic constipation treatment.
For severe impaction of feces:
- Cleaning out the bowels using polyethylene glycol taken in fluids over a two to three-hour period, along with stimulant purgatives such as Senna 25-30mg or Bisacodyl 10mg.
- A once daily dose of polyethylene glycol (17gms) may be given as maintenance along with Senna or Bisacodyl every other day.
- Bowel will also need to be cleared on a monthly basis with Polyethylene Glycol and bowel movement monitored for any abnormal changes.
- Note: Enemas may be started every other day with normal saline with castile soap, mineral oil, etc.
Laxatives: Agents to help pass stool more comfortably
Bulk-forming laxatives: Help to increase the size of stool and soften them to ease passage during excretion. They work by allowing the stool to retain more fluid. Commonly prescribed bulk-forming laxatives include ispaghula husk or psyllium, polycarbophil, methylcellulose, and sterculia. It is estimated that these treatments may take around two to three days to be effective.
Osmotic laxatives: Aims to soften stool by drawing water into the intestines. Lactulose is a commonly prescribed osmotic laxative.
Stimulant laxatives: Often reserved if the previously mentioned laxatives fail to be effective. Stimulant laxatives act by causing the muscles of the gut to contract and expel feces. Commonly prescribed stimulant laxatives include Senna, Bisacodyl, and sodium picosulphate, and they generally take around six to 12 hours to work.
Dietary and lifestyle changes:
Eat more fiber: Allows stools to retain more fluid, allowing them to be bulkier and softer for ease excretion. Fiber-rich foods can be found in fruits, vegetables, whole grain rice, whole wheat bread, whole wheat pasta, seeds, nuts, oats, and pulses. Healthy adults are recommended to get at least 18g to 30g of fiber daily.
Drink plenty of fluid: Preventing dehydration will ensure your stool remains soft. It is recommended to avoid substances that promote dehydration, such as caffeine and alcohol.
Getting regular exercise: Helps to stimulate the bowel organs and promote gut motility.
Practicing good toilet habits: It is not recommended to ignore the “call of nature” and to go to the bathroom when needed. The best time for passing stool is first thing in the morning or around half an hour after a full meal.
Related: What causes obstipation and how to treat obstructive constipation?