Chronic idiopathic constipation (CIC) is a common functional gastrointestinal disorder characterized by difficult, infrequent, or incomplete passage of stool without any medical cause. It usually presents with symptoms such as fewer than three bowel movements per week, straining during bowel movements, a sense of incomplete evacuation, and hard or lumpy stools. CIC affects approximately 14% of the general population and is more common among women, elderly individuals, and immobile patients.
Causes of Chronic Idiopathic Constipation
The exact causes of Chronic Idiopathic Constipation (CIC) Treatment are unknown, which is why it is termed as "idiopathic". Some potential contributing factors include slow intestinal movement, high absorption of water in the colon, pelvic floor dysfunction, and lifestyle habits such as low fiber diet and inadequate water intake. Aging is also linked to reduced mobility of stool in the colon, which can lead to constipation. Rarely, CIC may be caused by endocrine disorders like hypothyroidism, neurological diseases like Parkinson's disease, or medications that slow intestinal motility
Evaluating Chronic Idiopathic Constipation
A medical history and physical examination are usually sufficient to diagnose CIC. However, laboratory tests and imaging studies may be performed to rule out other possible conditions causing similar symptoms. Stool tests evaluate stool consistency and rule out Clostridium difficile infection. Blood tests check electrolyte, renal and liver function which may be deranged in certain conditions presenting with constipation. Imaging includes abdominal x-ray and colonoscopy to examine for structural causes. Anorectal manometry evaluates pelvic floor and colonic transit studies assess motility in different segments of colon.
Non-pharmacological Treatment Options
Line of constipation treatment begins with non-drug approaches as they are easy and have minimal side effects. Increasing fiber intake through foods like whole grains, fruits and vegetables is recommended, along with staying hydrated. Regular physical activity also stimulates bowel motility. Biofeedback therapy trains pelvic floor muscles in patients with dyssynergic defecation. Laxatives should only be considered as short-term relief and not as maintenance therapy due to risks of dependency and electrolyte imbalances. Warm baths, massage and acupuncture may help in some cases.
Pharmacological Treatment of Chronic Idiopathic Constipation
For patients who fail to respond to lifestyle changes, over-the-counter laxatives are prescribed short-term to establish regular bowel habits. Bulking agents like psyllium improve stool consistency. Osmotic laxatives like lactulose and polyethylene glycol draw water into intestine to soften stools. Stimulant laxatives like bisacodyl and senna act locally to stimulate propulsive contractions. Lubricant laxatives like mineral oil coat stools for easy passage.
Long-term constipation treatment involves prescription medications. The first-line pharmaceutical option includes polyethylene glycol 3350, a stool softener. Other FDA-approved options include prucalopride, a serotonin receptor agonist, and linaclotide and plecanatide, guanylate cyclase-C receptor agonists. These drugs work by increasing intestinal fluid secretion and accelerating transit time. For patients with underlying slow transit constipation, tegaserod, a 5-HT4 receptor partial agonist, stimulates propulsive motility. Constella, an unnamed multi-acting agent is also being studied for chronic idiopathic constipation treatment.
Surgical Treatment of Chronic Idiopathic Constipation
Surgery is rarely considered for refractory CIC patients who fail conservative measures. Subtotal colectomy with ileorectal anastomosis involves removal of part of colon and reconnecting small intestine to rectum, performed for slow colonic transit. Antegrade colonic enema involves creation of a conduit from small intestine to colon to infuse fluid and promote evacuation. Sacral nerve stimulation implants electrodes near sacral nerves to electrically stimulate pelvic floor muscles and relieve constipation and incontinence in select cases.
Managing Chronic Idiopathic Constipation long-term
Once relief from constipation is achieved through treatment, key is to focus on long-term management through lifestyle modifications. A diet high in fiber and fluids should continue. Daily exercise and relaxation techniques assist motility. Consistent toileting habits reinforce regular bowel patterns. Tracking stool characteristics can help identify triggers for constipation recurrence. Follow-ups with physicians are necessary to monitor medication effectiveness and disease course over years. With multidisciplinary care, quality of life can significantly improve for majority of patients with chronic idiopathic constipation.
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