Functional constipation

Functional constipation, known as chronic idiopathic constipation (CIC), is constipation that does not have a physical (anatomical) or physiological (hormonal or other body chemistry) cause. It may have a neurological, psychological or psychosomatic cause. A person with functional constipation may be healthy, yet has difficulty 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.^[1] 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.^[1]

Functional constipation, as medically defined by the Rome III criteria, has many causes, including

• Anismus
• Descending perineum syndrome
• Other inability or unwillingness to control the external anal sphincter, which normally is under voluntary control
• A bad diet
• An unwillingness to defecate
• Nervous reactions, including prolonged and/or chronic stress and anxiety, that close the internal anal sphincter, a muscle that is not under voluntary control
• Deeper psychosomatic disorders which sometimes affect digestion and the absorption of water in the colon

Research

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.^[2] 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.^[3]

See also

• Functional symptom
• Sacral nerve stimulation

References

1. Americal College of Gastroenterology: Fuinctional Bowel Disorders
2. Fleisher, DR (November 1976). "Diagnosis and treatment of disorders of defecation in children". Pediatric Annals 5 (11): 71–101. PMID 980548. Retrieved 2014-02-08.
3. 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): 91–22. doi:10.1097/MPG.0b013e31826f2740. PMID 22922371. Retrieved 2014-02-08.