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This site is intended for U.S. Healthcare Professionals.
To report an adverse event or product quality complaint, call 1-877-TAKEDA-7 (1-877-825-3327)
Chronic Idiopathic Constipation
Not an actual patient.
Although traditionally regarded as less than 3 bowel movements a week, constipation is much more than a number.1 It is a bowel condition characterized by infrequent bowel movements, and/or lumpy or hard stools, and/or difficulty with defecation.
Epidemiology
Constipation is seen in 6.9% of adults in the general U.S. population,3 and becomes more common with age.2,4 Constipation is more than twice as prevalent in women,4 who are more likely than men to use laxatives and seek health care.2 The prevalence is higher in older individuals, and is even more common in elderly patients receiving long-term care in hospitals or nursing homes.5
Diagnosis
For a diagnosis of chronic idiopathic constipation (CIC), symptoms should be “chronic” (persisting at least six months), and “idiopathic”, lacking another known cause.2,6 Patients should experience two or more of the following symptoms:2,6,7
- less than 3 bowel movements per week
- ≥25% of bowel movements affected by lumpy or hard stools
- ≥25% of bowel movements affected by straining
- ≥25% of bowel movements affected by sensation of incomplete evacuation
- ≥25% of bowel movements affected by sensation of anorectal blockage
- ≥25% of bowel movements affected by use of manual maneuvers to facilitate defecation
Additionally, patients with CIC rarely have loose stools without use of a laxative, and have insufficient criteria for irritable bowel syndrome.2,6,7
CIC can be further divided into 3 subtypes largely based on further physiologic testing: dyssynergic defecation (outlet obstruction), slow transit constipation (STC) and normal transit constipation (NTC).7,8,9
Pathophysiology
The pathology is multi-faceted and the 3 constipation subtypes may not be mutually exclusive, with some patients experiencing two or even three of these overlapping constipation subtypes.2,7 The symptoms of dyssynergic defecation — poor coordination between rectal and abdominal wall muscles, pelvic floor muscles and anal sphincter muscles — may co-exist with the increased rectal compliance experienced with NTC.7,10 Fewer postprandial high-amplitude propagating contractions (HAPCs) are observed in both STC, characterized primarily by reduced phasic colonic motor activity, and NTC.10
Navigating CIC
A survey of patients with chronic constipation found that the most frequent symptoms were straining (79%), hard stools (71%), abdominal discomfort (62%), bloating (57%), infrequent bowel movements (57%), and feelings of incomplete evacuation after a bowel movement (54%).6 CIC patients with abdominal symptoms also report substantial missed work, and significant financial burdens.11,12 A careful history and examination of the patient experiencing constipation is essential for taking appropriate steps to manage the condition and alleviate symptoms.2
- Bharucha AE, Dorn SD, Lembo A, et al. Gastroenterology. 2013;144(1):211-217.
- Brenner DM and Shah M. Gastroenterol Clin N Amer. 2016;45(2):205-216.
- Palsson OS, Whitehead W, Törnblom H, et al. Gastroenterology. 2020;1-49.
- Higgins PD and Johanson JF. Am J Gastroenterol. 2004;99(4):750-759.
- De Giorgio R, Ruggeri E, Stanghellini V, et al. BMC Gastroenterology. 2015;15:130.
- Lacy BE, Mearin F, Chang L, et al. Gastroenterology. 2016;150:1393-1407.
- Tack J, Müller-Lissner S, Stanghellini V, et al. Neurogastroenterol Motil. 2011;23:697-710.
- Locke GR, Pemberton JH, Philipps SF. Gastroenterology. 2000;119(6):1766-1778.
- Rao SSC and Patcharatrakul T. J Neurogastroenterol Motil. 2016;22(3):423-436.
- Ravi K, Bharucha AE, Camilleri M, et al. Gastroenterology. 2010;138(1):1-21.
- Heidelbaugh JJ, Stelwagon M, Miller SA, et al. Am J Gastroenterol. 2015;110:580-587.
- Herrick LM, Spalding WM, Saito YA, et al. J Med Econ. 2017; 20(3): 273-279.
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This site is intended only for healthcare professionals registered to practice in the U.S. and is intended to provide balanced, scientific, and evidence-based answers to unsolicited medical questions. The information is not intended as medical advice and may be incomplete. This resource may include information that has not been approved by the U.S. Food and Drug Administration (FDA). Takeda does not recommend the use of any Takeda product beyond the approved labeling. Any decisions regarding the usage of a Takeda product beyond the approved labeling is left to the discretion of the healthcare professional.
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