One of the most common conditions often occurring in elderly people is chronic idiopathic constipation. Despite its frequent occurrence, there is no fixed definition to this gastrointestinal complaint worldwide. Patients frequently visit the doctors as they suffer from chronic idiopathic constipation and doctors often prescribe various treatments for this. But, different over-the-counter remedies are often considered more useful than prescribed medicines.
What is Chronic Idiopathic Constipation?
Chronic idiopathic constipation or CIC is a gastrointestinal motility disorder in which you have infrequent bowel movements. If the difficulty of passing stool through bowels persists for 6 months or more or keeps coming back, it is deemed as 'chronic'. Chronic idiopathic constipation is a chronic condition in which the cause of constipation is unknown.
Symptoms of Chronic Idiopathic Constipation:
The common symptom of chronic idiopathic constipation is infrequent bowel movement. However, along with this symptom, there are other symptoms too that can be seen in patients with chronic idiopathic constipation. These include –
- Hard and lumpy stool
- Incomplete bowel movement
- Feeling like bowel is blocked
- Straining while passing stool
- Pain caused by gas formation in stomach
- Abdominal pain
- Severe cramping
- Less than 3 times of weekly bowel movement
- Excessive flatulence
- Poor social and physical condition
When to See a Doctor – Possible Gradual Complications:
In more severe cases, there are signs that differ from the general symptoms. These include –
- Blood in stool
- Severe constipation that cannot be treated with any kind of bowel movement easing medication
- Fever in some cases
- Conditions leading to inflammatory bowel diseases like Crohn's disease and ulcerative colitis
- Unexplained and radical weight loss
- Low blood count
These are signs that you must not delay and seek medical attention at once. If you are above the age of 50 and have had chronic idiopathic constipation in the family, then delaying may result in worse conditions.
Epidemiology of Chronic Idiopathic Constipation:
An average estimate indicates that more than 35 million people, alone in the United States of America, suffer from chronic idiopathic constipation or CIC. This is the number of patients that is registered and hence, the number can be quite more than this as there are patients suffering from chronic idiopathic constipation, who do not seek medical help. It has come up in studies that only 12% of the patients suffering from chronic idiopathic constipation seek medical help. However, at the present moment 40% of patients with chronic idiopathic constipation are under medication.
Chronic idiopathic constipation is common in adults, who are above the age of 35 years. More than 84% people of this age suffer from chronic idiopathic constipation. However, chronic idiopathic constipation is slightly more common in women with 56% of women suffering from this condition. It is also seen that chronic idiopathic constipation occurs in the Caucasians, with 82% of people of this race suffering from the condition. In other ethnicities and races, the number of occurrence of chronic idiopathic constipation is lesser.
Causes of Chronic Idiopathic Constipation:
Chronic idiopathic constipation, the very name of the condition refers to the fact that there is no identified and confirmed cause of this condition and hence, it is 'idiopathic'. But there can be different reasons or causes behind this condition.
Chronic Idiopathic Constipation Caused Due to Changes in Motility – Fluid Absorption and Muscle Contraction:
This is the change that is caused in the rate and contractility in the colon muscles that help in passing the faecal matter through the colon to the rectum, by contracting the muscles. When there is a change or rather a reduction in the movement, more water from this faecal matter is absorbed. Hence, the stool becomes hard and dry and absolutely painful and difficult to move. If this condition persists, it can cause in the reduction of the size or volume of the stool, resulting in a reduced urge to defecate. As the stimulation is decreased due to the reduced bulk, it can cause infrequent bowel movement.
Chronic Idiopathic Constipation Caused Due to Improper Diet:
If you continue to consume a diet that does not include enough of the fibrous foods, it will lead to constipation that can be chronic. Food that is rich in 1st class proteins such as meat and large amounts of dairy products can be a significant cause of Chronic idiopathic constipation.
Brain and Bowel Connection:
If the enteric nervous system experiences some changes, causing visceral sensory abnormalities, then it can cause chronic constipation. As it is a significant reason behind decreasing the rectal sensation, it can be a cause behind abdominal discomfort, decreased urge to defecate and consequently leading to constipation.
Diagnosis of Chronic Idiopathic Constipation:
Physical examination of the signs and symptoms is the very basic way of diagnosing chronic idiopathic constipation. In this, the family history is regarded as a much important factor of consideration. If the patient has had symptoms such as hard and infrequent stool passing, bloating, straining etc. it is a clear sign of chronic idiopathic constipation. However, for further confirmation colonoscopy, MRI scans, as well as anal manometry are also performed.
Treatment of Chronic Idiopathic Constipation:
Cleaning The Bowel With Medication to Treat Chronic Idiopathic Constipation:
Depending on the severity and the symptoms of chronic idiopathic constipation, a patient is referred the treatment procedure. In the very first cases, to clean out the bowel movement, PEG or Polyethylene glycol is prescribed to be taken in the form of fluid. Bisacodyl 10 mg or Senna 25-50 mg is the stimulant purgatives that are also prescribed along with PEG to be taken in a gap of 2 to 3 hours. This technique should be continued occasionally to clean out the bowel.
Laxatives to Treat Chronic Idiopathic Constipation:
Once the bowel is cleaned out, to make sure that the further bowel movement is normal and smooth, laxatives are prescribed. These are agents that can contribute in helping to pass stool smoothly. There are different kinds of laxatives like bulk-forming, stimulant and also osmotic laxatives. Depending on the condition of the patient, the doctor will prescribe the type.
Medications for Chronic Idiopathic Constipation:
Linaclotide (a guanylate cyclase C receptor agonist), serotonin agonists like Tegaserod and Cisapride, Naloxone (opioids antagonist), Prucalopride and ubiprostone are some of the medicines that are very useful in making the constipation go away and help in moving bowel easily.
Surgical Intervention for Chronic Idiopathic Constipation:
As an alternative therapy, it is considered quite useful in some cases to go for colostomy, subtotal or total colectomy. If the pharmacological therapies are not effective, this method is opted for treatment.
Diet and Lifestyle Changes to Treat Chronic Idiopathic Constipation:
This is probably the most important and effective, as well as easy way to manage and control chronic idiopathic constipation.
- Eating whole grain rice, whole wheat pasta, pulses, whole wheat bread, fruits, seeds, vegetables, nuts, oats and other foods that are rich in fibre, is the best way to increase the mobility of the stool.
- To soften the stool and to resist the absorption of water from the stool in colon, as well as to resist dehydration of the body, intake of water and fruit juices should be increased. However, caffeine, fizzy drinks, alcohol etc. should not be consumed as they can aggravate the condition.
- A good toilet habit is a must to prevent and cure chronic idiopathic constipation. Ignoring the urge or suppressing the urge may cause constipation, making it chronic.
- Engaging yourself in a bit of physical exercise always helps in treatment.
- Chronic idiopathic constipation is not a life threatening condition. It can be treated with proper methods and with determination. However, it is always recommended that you prevent it and not lead to a condition that can cause much pain.