| Functional constipation | |
|---|---|
| Other names | Chronic idiopathic constipation |
| Specialty | Gastroenterology |
| Symptoms | Hard or lumpy stools, decreased frequency of bowel movements, a feeling of incomplete evacuation or obstruction, straining, stomach pain and bloating. |
| Diagnostic method | Rome criteria, history and physical examination. |
| Treatment | Education, lifestyle modification, faecal disimpaction, and maintenance therapy. |
| Medication | polyethylene glycol (PEG), milk of magnesia, senna, bisacodyl, plecanatide, linaclotide, and lubiprostone. |
Functional constipation, also known as chronic idiopathic constipation (CIC), is defined by less than three bowel movements per week, hard stools, severe straining, the sensation of anorectal blockage, the feeling of incomplete evacuation, and the need for manual maneuvers during feces, without organic abnormalities. Many illnesses, including endocrine, metabolic, neurological, mental, and gastrointestinal obstructions, can cause constipation as a secondary symptom. When there is no such cause, functional constipation is diagnosed.[1]
Functional constipation requires symptoms to be present at least a fourth of the time. Causes include anismus, descending perineum syndrome, inability to control the external anal sphincter, poor diet, unwillingness to defecate, nervous reactions, and deep psychosomatic disorders. Comorbid symptoms like headache may also be present, especially in children.
Functional constipation is diagnosed using the Rome criteria, a consensus of experts. The criteria include over 25% of defecations involving straining, 25% resulting in lumpy or hard stools, 25% requiring partial evacuation, 25% experiencing anorectal blockage or obstruction, and 25% using manual techniques. Less than three weekly spontaneous bowel movements are also considered. A thorough history and physical examination, including a digital rectal exam, is crucial for diagnosing constipation. Additional laboratory testing is typically used in cases of uncertainty or to rule out underlying medical conditions.
Functional constipation is a condition that requires nonpharmacological management, including education and lifestyle modifications. It begins with dietary guidelines, focusing on regular fiber and fluid intake. Children with functional constipation should consume a normal intake of fiber, as per ESPGHAN/NASPGHAN criteria. Parents and children should receive counseling about overflow incontinence and withholding behavior. An organized toilet-training program with a reward system can help reduce faecal impaction.
Pharmacological treatment for children with functional constipation consists of maintenance therapy and faecal disimpaction. High-dose oral polyethylene glycol (PEG) or enemas containing active substances can induce fecal disimpaction, while maintenance therapy is recommended after successful disimpaction to avoid reoccurring stool buildup. Glycerine or bisacodyl suppositories are also used for both adults and children. Maintenance treatment for functional constipation includes osmotic laxatives, milk of magnesia, and mineral oil. Stimulant laxatives like senna or bisacodyl are recommended for those with persistent symptoms.