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Functional constipation

From Wikipedia, the free encyclopedia
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]

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[edit]

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[edit]

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[edit]

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[edit]

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[edit]

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[edit]

References[edit]

  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. ^ a b "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. ^ a b c d e f g h i "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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