Functional constipation, known as chronic idiopathic constipation (CIC), is
constipation
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 ...
that does not have a physical (anatomical) or
physiological
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
(hormonal or other body chemistry) cause. It may have a
neurological
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
,
psychological
Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between t ...
or
psychosomatic
A somatic symptom disorder, formerly known as a somatoform disorder,(2013) defecating.
Symptoms and diagnosis
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.Americal College of Gastroenterology: Fuinctional Bowel Disorders /ref> Diagnosing CIC can be difficult as other syndromes must be ruled out as there is no physiological cause for CIC. Doctors will typically look for other symptoms, such as blood in stool, weight loss, low blood count, or other symptoms.
To be considered functional constipation, symptoms must be present at least a fourth of the time.
Possible causes are:
*
Anismus
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 (although it is more common in women). It can be caused ...
*
Descending perineum syndrome Descending perineum syndrome (also known as levator plate sagging) refers to a condition where the perineum "balloons" several centimeters below the bony outlet of the pelvis during strain, although this descent may happen without straining. The syn ...
* Other inability or unwillingness to control the
external anal sphincter
The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus.
Anatomy
The external anal sphincter measures about 8 ...
, which normally is under voluntary control
* A poor diet
* An unwillingness to defecate
* Nervous reactions, including prolonged and/or chronic stress and anxiety, that close the
internal anal sphincter
The internal anal sphincter, IAS, (or sphincter ani internus) is a ring of smooth muscle that surrounds about 2.5–4.0 cm of the anal canal; its inferior border is in contact with, but quite separate from, the external anal sphincter. It is ...
, a
muscle
Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
that is not under voluntary control
* Deeper
psychosomatic
A somatic symptom disorder, formerly known as a somatoform disorder,(2013) digestion and the
absorption
Absorption may refer to:
Chemistry and biology
* Absorption (biology), digestion
**Absorption (small intestine)
*Absorption (chemistry), diffusion of particles of gas or liquid into liquid or solid materials
*Absorption (skin), a route by which ...
of
water
Water (chemical formula ) is an inorganic, transparent, tasteless, odorless, and nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known living organisms (in which it acts as a ...
in the colon
There is also possibility of presentation with other comorbid symptoms such as headache, especially in children.
Treatment
Treatment options appear similar and include prucalopride,
lubiprostone
Lubiprostone (rINN, marketed under the trade 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 constip ...
,
linaclotide
Linaclotide, (sold under the brand name Linzess in the US and Mexico, and as Constella elsewhere) is a drug used to treat irritable bowel syndrome with constipation and chronic constipation with no known cause. For label updates seFDA index page ...
plecanatide
Plecanatide, sold under the brand name Trulance, is a medication for the treatment of chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation. Plecanatide is an agonist of guanylate cyclase-C. Plecanatide increases i ...
.
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.
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. 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.
Sacral nerve stimulation
Sacral nerve stimulation, also termed sacral neuromodulation, is a type of medical electrical stimulation therapy.
It typically involves the implantation of a programmable stimulator subcutaneously, which delivers low amplitude electrical sti ...