What Is Chronic Idiopathic Constipation?

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What Is Chronic Idiopathic Constipation (CIC)?

Chronic idiopathic constipation (CIC) is a health condition in which a person experiences chronic symptoms of constipation, yet no visible cause can be identified through standard diagnostic testing. The term idiopathic is used because it means there is no known cause. CIC is also referred to as functional constipation, as CIC is classified as one of the functional gastrointestinal disorders (FGDs), meaning that although testing does not show any visible physical abnormality, there is a problem in the way that the digestive system, or in this case, the large intestine, is functioning.

It is estimated that approximately 14% of the population experiences chronic constipation. People who are at higher risk include women, older individuals of all ages and genders, and those who have a lower socioeconomic status.

What Are the Symptoms of CIC?

The primary symptoms of CIC include:

Many people who have CIC also report experiencing the following symptoms alongside the constipation:

How Is CIC Diagnosed?

If you suspect that you have CIC, your doctor will most likely do a physical exam and run some bloodwork in order to rule out other illnesses. Other diagnostic tests may be recommended depending on your symptoms and medical history.

FGS are diagnosed according to the Rome III criteria. The Rome criteria refer to the disorder as functional constipation. For a diagnosis of functional constipation, there must be no sign of abnormality evidenced through the diagnostic workup. These criteria attempt to quantify CIC symptoms, for example, stating that there need to be less than three bowel movements per week and that other symptoms occur at least 25 percent of the time.

Loose stools must be a rarity without the use of laxatives. Symptoms must not meet the criteria for irritable bowel syndrome (IBS) and must be present for at least three months, with onset at least six months prior to diagnosis.

How Is CIC Treated?

There is no one specific treatment for CIC. But there are a variety of different treatment options that your doctor may discuss with you:

Dietary Fiber: Your doctor may recommend that you increase your intake of dietary fiber, as fiber can help to soften stools, making them easier to pass. Be sure to increase your fiber intake slowly to allow your body time to adjust. Too much fiber too soon could lead to symptoms of gas and bloating. You may find that soluble fiber is better tolerated. You can increase your intake of dietary fiber through the foods you eat or through the use of a fiber supplement.

Laxatives: There are a variety of laxatives that can provide short-term relief of constipation by increasing fluid levels within the large intestine (osmotic laxatives) or stimulating movement (stimulant laxatives).

Medications: Several medications are available that were designed to treat chronic constipation:

Biofeedback: If your doctor has determined that dyssynergic defecation (pelvic floor dysfunction) is playing a role in your CIC, they may recommend that you try biofeedback. This treatment has been shown to be helpful in improving the coordination of the muscles of the pelvic floor that are involved in the process of having a bowel movement.

What Is the Difference Between CIC and Irritable Bowel Syndrome?

Constipation predominant irritable bowel syndrome (IBS-C) shares many of the same symptoms as CIC. And in fact, by definition, CIC is only diagnosed if the criteria for IBS has not been met. The main difference between the two disorders is that the diagnostic criteria for IBS-C requires that there be the experience of chronic pain associated with bowel movements. In the real world, many doctors will tell their patients that they have IBS if they are experiencing chronic constipation without an identifiable cause, regardless of whether or not pain accompanies bowel movements.

Some researchers believe that the two disorders are not so distinct. Many people who have a diagnosis of CIC do experience abdominal pain and discomfort and there are many people who find themselves switching from one diagnosis to the other over time. It is possible that the two disorders actually fall upon the same continuum. One important distinction between the two may be related to treatment, as people with IBS-C appear to be more likely than those with CIC to respond to treatment options that are effective for pain relief, while those with CIC appear to be more likely to respond to certain medications or treatments that target the functioning of the muscles of the large intestine.

Sources:

Bassotti, G., et. al. "Cellular and molecular basis of chronic constipation: Taking the functional/idiopathic label out" World Journal of Gastroenterology 2013 19:4099-4105.

Ford, A., et.al. "American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation" American Journal of Gastroenterology 2014 109:S2-S26.

Heidelbaugh, J. "The Spectrum of Constipation-Predominant Irritable Bowel Syndrome and Chronic Idiopathic Constipation: US Survey Assessing Symptoms, Care Seeking, and Disease Burden" American Journal of Gastroenterology 2015 110:580-587.

Siah KTH, Wong RK, Whitehead WE. "Chronic Constipation and Constipation-Predominant IBS: Separate and Distinct Disorders or a Spectrum of Disease?" Gastroenterology & Hepatology 2016;12(3):171-178.

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