Constipation

Constipation is a symptom or condition characterized by difficult and infrequent bowel movements, typically 3 or fewer times a week. It is one of the most common gastrointestinal complaints in the United States and a common reason for referral to colorectal surgeons and gastroenterologists. Constipation is a prevalent condition that often remains unrecognized until the patient starts having sequelae, such as anorectal disorders.

Constipation encompasses several subtypes, each with its unique characteristics and underlying factors. Functional constipation, a common subtype, often affects children and adults and is marked by infrequent and difficult bowel movements without any evident structural or organic cause. Functional constipation is common in childhood, with about 29.6% prevalence worldwide. It comprises 3% to 5% of pediatric visits in the United States and represents a high annual healthcare cost. Most patients do not have an etiological factor, and one-third continue to have issues beyond adolescence. Up to 84% of functionally constipated children suffer from fecal incontinence, while more than one-third of children present with behavioral problems due to constipation. The pathophysiology underlying functional constipation is multifactorial and not well understood. Factors contributing to functional constipation include pain, fever, dehydration, dietary and fluid intake, psychological issues, toilet training, medicines, and a family history of constipation.

Chronic idiopathic constipation is another common subtype characterized by irregularity in defecation and difficulty in passing stool. Unlike functional constipation, where underlying factors may be apparent, chronic idiopathic constipation lacks a clear physiological or anatomical explanation for the persistent discomfort and irregularity in defecation. An underlying cause is identified in <5% of cases. This subtype is defined by its chronic nature, often lasting for an extended period and its primary symptom of infrequent and challenging bowel movements. Management typically involves a combination of lifestyle modifications, dietary changes, and, in some cases, pharmacological interventions to alleviate symptoms and improve the patient's quality of life.

Secondary constipation, a third subtype of constipation, can be linked to specific causes such as medications, certain medical disorders, dietary issues, or structural abnormalities in the gastrointestinal tract. The treatment approach for secondary constipation often involves addressing the root cause, including adjusting medications, managing underlying health conditions, or making dietary modifications. Proper identification and management of these underlying factors are essential in effectively alleviating constipation symptoms.

Understanding these subtypes is pivotal for healthcare professionals as it guides tailored approaches to diagnosis and treatment, optimizing patient care and outcomes.