CARE GUIDE Chronic Idiopathic Constipation

Chronic Idiopathic Constipation

Chronic idiopathic constipation (CIC) is a common type of constipation, affecting about 14 percent of the population. Its name describes its characteristics. It's chronic, lasting for at least six months, and it's idiopathic, which means "without cause." There's no known abnormality or disease that causes CIC. Doctors also refer to it as functional constipation.

If you have CIC, symptoms you'll experience may include lower abdominal discomfort, bloating, straining to have a bowel movement and feelings of incomplete evacuation after a bowel movement. However, symptoms such as pain, diarrhea, nausea, fever and blood in the stool are not common in people with CIC.

CIC occurs more often in women than men and in those who are older than 70. Eating a low-calorie or low-fiber diet and having a high level of stress also put you at higher risk for CIC.

Doctors and Specialists

Your primary care doctor will probably be the first doctor you'll see if you're having problems related to constipation. This may be a family medicine doctor, a general practitioner or an internist. In most cases, a primary care doctor will be able to diagnose and treat CIC.

You may also see other specialists, such as:

Gastroenterologists: This medical doctor specializes in digestive disorder and problems that affect the gastrointestinal system. You may see this doctor if your primary care doctor suspects there may be a medical cause of your constipation, if you have complications from constipation or if your CIC is hard to manage.

Nurses or therapists (physical or occupational): One treatment for CIC is biofeedback, which involves learning to control body functions, including bowel functions. It does not involve medications or surgery. Another treatment therapy is bowel retraining, which involves your learning healthy bowel habits to lessen constipation. A nurse or a physical or occupational therapist can work with you on both of these treatments.

Dietitians: If a change in diet is part of your treatment, a dietitian can help you develop an eating plan that has the right amount of fiber, fluid, calories and nutrition to help reduce constipation.

Preparing for Your Appointment

Your doctor will want to know about your symptoms and lifestyle.

Start by compiling a list that includes:

  • Your medical history, including dates of any serious illnesses or surgeries
  • All medications you take, including over-the-counter medications or supplements you use for constipation
  • How often you have bowel movements
  • What your stools look like and how your bowel movements feel
  • Any symptoms you have along with constipation
  • Whether you have blood in your bowel movements
  • Your diet
  • The amount of fluids you drink
  • The amount of exercise you get
  • Anything you do to help you have a bowel movement

If there's time before your appointment, you might want to keep a diary of your bowel movements, symptoms and diet and then take that with you to your first appointment.

Questions to Ask Your Doctor

If you get a diagnosis of CIC, you'll probably have questions about your condition and care.

Review this list of common concerns before future appointments, or print it out to take with you:

  • What might be contributing to my CIC?
  • Do I need any further tests?
  • What complications could develop from CIC?
  • Will I have to live with CIC forever?
  • Are there lifestyle changes that can help relieve the condition?
  • Are there foods I should avoid?
  • Will medication help?
  • If I take medication, will I need to take it forever? Is that safe?
  • What are the side effects of medications?
  • Are there medications I could get at my local pharmacy that I should avoid?
  • Are there other treatments that might help?

Tests and Diagnosis

To determine if you have CIC, your doctor will start by reviewing your medical history and doing a physical examination. Your doctor will ask about such things as your symptoms, bowel movement habits, diet and lifestyle. During your physical exam, your doctor may do a digital rectal exam.

There are no blood tests or other diagnostic tests needed to diagnose CIC. Other tests—blood tests, imaging studies and colonoscopy—are sometimes used to rule out other causes of chronic constipation, but these are rarely needed.

Instead, it's likely that your doctor will be able to diagnose CIC based on certain criteria. For instance, you must have had signs or symptoms for at least six months and these signs or symptoms must have been active over the past three months.

You also must have had two or more of the following signs or symptoms at least 25 percent of the time:

  • Fewer than three bowel movements a week
  • Straining to have a bowel movement
  • Lumpy or hard stools
  • Feeling that you still have more stool after a bowel movement
  • Feeling that your anal canal is blocked
  • Needing to use your finger to spread your anus to have a bowel movement

Your doctor will also want to make sure that you don't have irritable bowel syndrome (IBS) rather than CIC. Loose stools, belly pain and relief from symptoms after having a bowel movement could indicate IBS.

Medications and Treatment

The goal of treatment for CIC is to reduce the frequency of constipation. However, treatment is not the same for everyone. The best treatment for you will depend on how severe your CIC is and how well it responds to different types of treatment.

Lifestyle Changes

Treatment often starts with lifestyle changes. This may include changing your diet, increasing fluid intake and adding exercise.

For instance, you might need to increase the amount of fiber you're consuming by adding more whole grains, vegetables and fruits to your daily diet. As you increase fiber, though, it's important to also increase your fluid intake. Try to drink six to eight cups of water every day. Also, adding fiber gradually should limit side effects like bloating. You may want to work with a dietitian to develop an eating plan that promotes bowel health.

As for exercise, being inactive is a risk factor for constipation. Ask your doctor what type and amount of exercise would be best for you.

Over-the-Counter Options

If CIC doesn't improve with lifestyle changes, your doctor may suggest you try supplements or laxatives that you can buy at your local pharmacy.

  • Bulk laxatives: These supplements are made from fibers that do not get digested. They also absorb water. They help your colon form more bulky and easy-to-pass stool. Research has shown these to be safe and effective, but it's important to drink sufficient amounts of water when using these. Side effects may include bloating and flatulence. Common types include psyllium and methylcellulose.
  • Osmotic laxatives: If a bulk laxative does not help, the next choice is usually an osmotic laxative. These laxatives draw water into the colon. They include molecular substances such as lactulose, polyethylene glycol and magnesium hydroxide. Side effects can include bloating, diarrhea and dehydration.
  • Stimulant laxatives: These are used less often than other laxatives because they can cause cramps and nausea. They work by increasing water absorption into the colon and stimulating muscle contractions of the colon. Common examples include bisacodyl, senna and sodium picosulfate.

If you have constipation that does not respond to a laxative, your doctor may suggest what's called a rescue treatment, such as a glycerin suppository or enema.

Prescription Medications

If lifestyle changes and laxatives don't help, the next step is usually prescription-strength drugs approved to treat CIC. These are oral medications that you'd take daily. The main side effect is diarrhea. These drugs work by increasing fluid in the colon. Common examples include lubiprostone, linaclotide and plecanatide, which was just approved in 2017.

Other Therapies

Along with lifestyle changes, laxatives and medications, some people with CIC benefit from such treatments as biofeedback and bowel retraining.

  • Bowel retraining: For this, you'll need to change some habits. For instance, you'll need to eat meals at about the same time every day. You'll also learn to plan a bowel movement at the same time every day—a time when you don’t have to rush. Often the best time is about 30 minutes after a meal. Some people find that drinking a hot liquid will stimulate a bowel movement. Your doctor, a nurse or a physical or occupational therapist will work with you to find what changes work best for you.
  • Biofeedback: Having a bowel movement involves coordination of your nervous system and muscle functions. This is something that's normally regulated automatically by your body, but biofeedback teaches you to consciously control the process. The treatment is painless and usually requires several weekly sessions. It uses a computer and video monitor to display graphs or sounds to represent bodily functions that it picks up from sensors on your body. A health care professional trained in biofeedback helps you use this information to change your response to these functions.