Chronic Idiopathic Constipation

By Dr. Shrey Lakhotia, BDS

Chronic Idiopathic Constipation (CIC) describes constipation not caused by the taking of medications or by an illness.

Idiopathic means it arises spontaneously and the cause has not been directly identified.

See below for a discussion on various causes. CIC is:

• More common in women, the elderly, and those with lower income
  
  
• Associated with a reduced quality of life
  
  
• A common condition affecting the GI tract. It is estimated that upwards of 20% of Americans have this condition.
  
  

There are three categories under which Primary (idiopathic) constipation is usually classified:

1. Normal Transit Constipation: This is where a physical examination generally finds nothing abnormal.
   
   
2. Slow Transit Constipation, where you might see a slight distension of the abdomen or when you feel the sigmoid colon, stool is bulky enough to be touched or felt.
   
   
3. Abnormalities of the Anorectal Outlet: This describes the condition of patients who experience the following:
   

• Straining that is excessive or prolonged
  
  
• Feelings that evacuation is incomplete
  
  
• A feeling of downward pressure just in front of the anus
  
  

There are various tests for chronic idiopathic constipation. However, these are not usually done until dietary and lifestyle changes have been put in place.

If increasing fiber in the diet and the use of laxatives have produced no improvement, then physiologic studies (defecography, balloon expulsion tests, anorectal manometry and colonic-transit tests) can be used to further evaluate the constipation.

Causes

The word "Idiopathic" implies that the cause is unknown

However, when Chronic Idiopathic Constipation develops it may be the result of a number of things.

• The first factor that may result in CIC is when stool is too dry because too much water is absorbed by the colon. Dry stool means hard stool that's not easily passed.
  
  
• The colon contains muscles that contract in a wave-like motion to move waste matter along. When these muscles contract less frequently, stool moves more slowly through the bowel, making bowel movements less frequent.
  
  
• It has been shown that some individuals don't have as much sensitivity, meaning that they are not as likely to sense the urge to defecate.
  
  
• On the other hand, the nerves of others tend to be more sensitive, magnifying the intensity of the urge to go.
  
  
• Lack of fiber in the diet
  
  
• Good gut flora needs re-established, usually through some type of probiotic.
  
  
• Dehydration
  
  
• Eating large meals can sometimes trigger symptoms.
  
  

Remedies

Here are some ways to try and overcome CIC

Dietary Changes: Consuming more fiber may result in stools that are softer and more easily passed. Whole grain products and bran cereals, vegetables, fruits and many beans are all great sources of fiber.

Eating less at each meal and eating more often can help to keep the digestive system from being overloaded.

Stay hydrated. Drinking a lot of water, at least  6 to 8 glasses a day, is helpful.

It has been demonstrated that exercising more and reducing the amount of stress in one's life are effective ways of relieving symptoms. Just taking a walk from time to time may prove helpful.

If you are looking for a prescription to help with CIC, there are a handful that have been approved by the FDA. Lubiprostone is the newest drug to receive FDA approval for the treatment of adult patients with chronic idiopathic constipation. However most patients can solve CIC without the use of drugs.

Here are some more aggressive treatments

• Psychological Therapy
  
  
• Biofeedback
  
  
• Surgery might be indicated to give relief in a few patients with intractable constipation
  
  

Role of magnesium

Osmotic agents such as Milk of Magnesia or Epson Salt are an approved medical treatment option for CIC.

However, because of high doses of magnesium, these should only be used occasionally.
Another option is to take a daily magnesium supplement that simply meets the daily need for magnesium.

Magnesium helps in bowel movements:

• By allowing relaxation of the smooth muscle tissue in the intestines
  
  
• By pulling water into the colon to hydrate the stool, making it soft, slick and bulkier. A larger stool triggers the colon muscles to contract and push the stool through the colon.
  
  

Conclusion

Although Chronic Idiopathic Constipation doesn’t have a definite cure, it can be managed by altering one’s lifestyle, diet and by introducing various other agents, including magnesium.

Note: As with any over-the-counter remedy, talk with your doctor before starting on a magnesium supplement. Supplemental magnesium may interfere with certain prescription medications.

Those with kidney disease should not take a magnesium supplement unless instructed to do so by their doctor.

(Return from Chronic Idiopathic Constipation to Causes of Constipation)