Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management

Abstract

Chronic idiopathic constipation (CIC) is one of the most common gastrointestinal disorders, with a global prevalence of 14%. It is commoner in women and its prevalence increases with age. There are three subtypes of CIC: dyssynergic defaecation, slow transit constipation and normal transit constipation, which is the most common subtype. Clinical assessment of the patient with constipation requires careful history taking, in order to identify any red flag symptoms that would necessitate further investigation with colonoscopy to exclude colorectal malignancy. Screening for hypercalcaemia, hypothyroidism and coeliac disease with appropriate blood tests should be considered. A digital rectal examination should be performed to assess for evidence of dyssynergic defaecation. If this is suspected, further investigation with high resolution anorectal manometry should be undertaken. Anorectal biofeedback can be offered to patients with dyssynergic defaecation as a means of correcting the associated impairment of pelvic floor, abdominal wall and rectal functioning. Lifestyle modifications, such as increasing dietary fibre, are the first step in managing other causes of CIC. If patients do not respond to these simple changes, then treatment with osmotic and stimulant laxatives should be trialled. Patients not responding to traditional laxatives should be offered treatment with prosecretory agents such as lubiprostone, linaclotide and plecanatide, or the 5-HT4 receptor agonist prucalopride, where available. If there is no response to pharmacological treatment, surgical intervention can be considered, but it is only suitable for a carefully selected subset of patients with proven slow transit constipation.

Potentially Inappropriate Prescriptions for Anticholinergic Medications for Patients with Constipation

“…The differences in the prescription patterns of laxatives are possibly due to the inclusion or absence of these medications in the health systems of different countries. For example, bisacodyl is only found in the health benefits plan in Colombia [11], which would explain the increased use of stimulant laxatives in the country; stimulant laxatives are indicated for patients who do not respond to osmotic laxatives [2,5,21,22]. Constipation is a pathology caused by multiple factors, including physiological changes in the intestine associated with age, comorbidities, consumption of certain medications, loss of mobility, and inadequate diet [14].…”

Chronic constipation among community-dwelling older people in the East Coast region of Peninsular Malaysia

“…Furthermore, we did not measure other factors, such as existing diseases, medication consumption, fluid and dietary fiber intakes, and physical activity, which are important factors that contribute to chronic constipation in older people. 1,2,17,20…”

“…Chronic constipation is common, but studies among older people are limited, especially in Southeast Asian countries. 1,2 Several studies have reported a wide variation in the prevalence of chronic constipation among community-dwelling older people, ranging from 16.5% to 75% of the population in question. 1,[3][4][5] Nevertheless, a lack of knowledge and understanding among older people of the symptoms may result in under-or overreporting of its occurrence.…”

Evaluation of Plecanatide for the Treatment of Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation in Patients 65 Years or Older

“…3 In the past, CIC and IBS-C were considered separate and distinct disorders; however, these disorders often coexist in patients and, because symptoms wax and wane over time, can be difficult to differentiate in routine clinical practice. 4 Furthermore, Rome IV criteria support the emerging concept of CIC and IBS-C as a continuous spectrum of disorders with overlapping symptoms. 3 Prosecretory agents are efficacious in the treatment of CIC and IBS-C; however, data are limited regarding the safety and efficacy of these agents for the treatment of constipation in elderly populations.…”