According to the American College of Gastroenterology, at least 2.5 million visits to the doctor every year have to do with constipation. Constipation is nothing to be embarrassed about, but it may warrant a discussion with your doctor.
What is functional constipation? Functional constipation is chronic constipation with no known cause, including physical abnormalities or underlying medical conditions. Signs of functional constipation include passing hard stools, infrequent or difficult bowel movements, and the sense of incomplete emptying (evacuation) of your bowels.
Also known as chronic idiopathic constipation, functional constipation is similar to constipation-predominant IBS (irritable bowel syndrome). Their symptoms are similar but not identical, making diagnosis a little more complicated.
Knowing more about functional constipation can mean the difference between a comfortable and unbearable everyday life. Let’s take a look at why this might happen and what you can do about it.
Functional Constipation Symptoms
The most common symptoms associated with functional constipation are:
- No urge to go to the bathroom
- A lot of time on the toilet
- Defecating once per week or less (poor stool frequency)
- Bloating in your stomach
- Dry or hard stool
- Headaches, especially in children
- Undesired weight loss
- Feeling of incomplete evacuation (it feels like your bowels aren’t ever completely empty)
- Low blood count
- Blood in stool
- Anal fissures
Unlike irritable bowel syndrome, functional constipation does not typically cause intense abdominal pain.
How long can functional constipation last? Your functional constipation will likely last as long as the underlying cause remains. For example, if you experience functional constipation because of chronic anxiety, you may only find relief once you resolve that everyday worry.
How to Diagnose Functional Constipation
To diagnose functional constipation, your healthcare provider must identify that you have bowel movements fewer than 2 times per week and that your constipation has no identifiable cause.
Although every human has a different natural pattern of bowel movements based on many other factors, 2 or fewer bowel movements every week are considered chronic constipation.
A physical examination may be required to rule out physical triggers of constipation, as well as test for alarm signs and symptoms. This may include:
- Rectal examination
- Blood tests
- Endoscopy
- Defecography
- Balloon expulsion testing
- Anorectal manometry
To diagnose functional constipation, your doctor or gastroenterologist will need to rule out organic causes of constipation, such as IBS. The main difference between functional constipation and IBS is that IBS brings about intense abdominal pain.
What To Expect At the Doctor
When you visit the doctor about your constipation, what should you expect?
First off, do not be embarrassed. Constipation is a widespread issue. And if it is your child who has it, pediatricians well-trained in “normalizing” the situation will treat and encourage your child.
A healthcare professional will always ask about your medical history, including bowel habits. It’s helpful to have a note on hand detailing the last several weeks of your bowel movement history.
Some doctors may even ask about your family’s medical history.
A systematic review showed that family history has no significant relation to recovery in children. However, this history it can illuminate both environmental and genetic factors that might have triggered the chronic constipation in the first place.
Finally, your doctor may perform a physical examination and/or run a variety of tests to rule underlying causes.
Diagnostic tests can seem embarrassing, but the medical staff always perform them. Feel free to build trust with your doctor and nurses by letting them know anything that can help them treat you.
Functional Constipation vs. IBS-C
Chronic constipation is a symptom of IBS-C, which stands for “constipation-predominant irritable bowel syndrome.” Functional constipation and IBS-C resemble one another, as they both involve trouble pooping.
The primary difference between IBS-C and functional constipation is that IBS results in abdominal pain, which is very uncommon in functional constipation. Non-IBS patients dealing with functional constipation also tend to be younger and have more incomplete evacuations.
Both bowel disorders result in loss of work productivity. Patients with both conditions report similar social quality of life issues.
At PrimeHealth, we treat IBS patients all the time. Our years of experience have healed bowel conditions in many patients. If you live in Colorado and believe you may have IBS, set up a free consultation with us.
Manage Functional Constipation: 8 Proven Strategies
Laxatives do not always relieve constipation permanently and may sometimes do more harm than good.
Fortunately, several proven strategies may treat your functional constipation. So, how do you treat functional constipation?
1. Probiotics
Probiotics restore good bacteria in your gut. An imbalance of bacteria can lead to autoimmune disorders and hard-to-trace medical conditions.
Probiotics can be found in supplement form or your diet (yogurt, miso, sauerkraut, etc.). A 2014 meta-analysis confirmed probiotics’ ability to treat functional constipation.
2. Stress relief
Relieving stress is a great way to alleviate functional constipation — since chronic stress is a common cause of functional constipation. Meditation, a full night’s sleep, yoga, and spending time outside are great ways to relieve stress.
3. Dietary changes
Changes to your diet that may help with functional constipation include:
| Eating more: | Eating less: |
| dietary fiber or fiber supplements (if low on fiber) | gluten |
| liquids (if dehydrated) | cow’s milk |
| sorbitol-containing juices, like pear and apple juice; unripe bananas | FODMAPs (fermentable carbs) |
4. Enemas
Enemas are a more controversial treatment option for constipation. Not only are they very invasive, their efficacy is questionable. One study found soap and water enemas can help with constipation, but more robust studies are required.
5. Glycerin suppositories
These suppositories are a well-established treatment option, though they are as invasive as enemas.
6. Polyethylene glycol
PEG is an osmotic laxative that draws water into the bowels. Although PEG is not always more effective than enemas, PEG can be taken orally, so it is generally more preferred by patients.
Side effects of PEG (AKA PEG 3350) may include nausea and abdominal pain.
Examiners found PEG to be more effective than other better-known treatments, such as milk of magnesia (magnesium hydroxide), lactulose, and mineral oils, such as paraffin.
7. Biofeedback therapy
This therapy teaches patients how to relax pelvic floor muscles when defecating. It is a well-established treatment for functional constipation.
Biofeedback provides visual-audio feedback on a monitor, which translates your involuntary bodily functions into easy-to-read visuals.
8. Medications
Pharmaceutical interventions your healthcare provider may prescribe:
- Lubiprostone
- Prucalopride
- Plecanatide
- Lubiprostone
- Linaclotide
- Tegaserod
- Velusetrag
- Elobixibat
- Sodium picosulphate
After Constipation Is Relieved…
After disimpaction (the successful removal of feces), you should be prescribed maintenance therapy. This prevents you from relapsing into constipation and may include:
- PEG
- Osmotic or stimulant laxatives (such as senna or bisacodyl)
- Magnesium
- Ayurvedic herbs like triphala
- Pharmaceuticals
- Dietary changes
- Lifestyle changes
- Regular physical activity
- Toilet training in children
During maintenance treatment, pay attention to soiling, also called encopresis. If you or a child cannot prevent leakage on underpants, the treatment is likely too much and should be scaled back upon follow-up with a specialist.
Causes of Functional Constipation in Children & Adults
What causes functional constipation? Certain risk factors can increase your risk of constipation. Functional constipation has no physical cause, but there are several widely accepted triggers of functional constipation:
- Poor diet
- Dysbiosis (imbalanced gut bacteria)
- SIBO (small intestinal bacterial overgrowth)
- Low fluid intake, leading to dehydration
- High fiber intake or low fiber intake
- Some laxatives
- Nervousness
- Chronic stress or anxiety
- Unwillingness to defecate
Up to 25% of kids and adolescents in the US have some chronic constipation. A common cause of childhood constipation is functional fecal retention — an aversion to bowel movements. Many young children want to avoid painful BMs, so they will not relax their external anal sphincter. This typically occurs early in toilet training, ending around 5 years of age.
Attempting to avoid defecation often leads to fecal incontinence when young children can’t hold it anymore. This can frustrate parents, especially when their child exhibits no similar urinary problems.
Addressing the pathophysiology behind fecal retention often involves regular sitting schedules and medication or supplementation. Dietary restrictions may also make BMs easier.
In infants, doctors will want to rule out Hirschsprung’s disease, the most common congenital colonic motility disorder. This occurs when there are nerve cells missing in the large intestine, preventing BMs altogether.
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Other Kinds of Constipation
There are 3 main types of non-functional constipation:
- Normal transit constipation — most common; muscles squeeze and relax incorrectly
- Slow transit constipation — when your colonic transit time is slow to remove waste
- Defecation disorders — when a specific colon muscle is dysfunctional
Each of these types of constipation have to do with abnormalities that lead to some form of colonic motility dysfunction. Physical causes of constipation may include:
- IBS
- IBD
- Diabetes
- Hypothyroidism (underactive thyroid)
- Spinal or sacral injury
- Anal fissures
- Hemorrhoids in the rectum
- Anismus (which is a failure to relax pelvic floor muscles)
- Tumors in the lower intestine or anus
- Descending perineum syndrome (where your perineum “balloons”)
If you struggle with chronic constipation, it is important to discuss it with your doctor. They can work to determine the etiology and help you form a treatment plan.
Looking to the Future
Millions of people around the world deal with constipation every year. Even though functional constipation is common, it doesn’t have to be your “normal.”
Although self-care can often resolve it, it may occasionally require emergency treatment.
If you exhibit any of the following symptoms along with constipation, see a doctor right away:
- Vomiting
- Blood in your stool
- Intense and constant stomach pain
Many people live with chronic constipation without daily life complications.
However, you can identify and treat the underlying cause of your constipation. At PrimeHealth, we empower patients to overcome constipation. And our patients prove recovery is possible.
Denver residents: Set up a free consultation today.
Sources
- Inaloo, S., Dehghani, S. M., Hashemi, S. M., Heydari, M., & Heydari, S. T. (2014). Comorbidity of headache and functional constipation in children: a cross-sectional survey. Turk J Gastroenterol, 25(5), 508-11.
- Pijpers, M. A., Bongers, M. E., Benninga, M. A., & Berger, M. Y. (2010). Functional constipation in children: a systematic review on prognosis and predictive factors. Journal of pediatric gastroenterology and nutrition, 50(3), 256-268.
- Baum, C. F., John, A., Srinivasan, K., Harrison, P., Kolomensky, A., Monagas, J., … & Hyman, P. E. (2013). Colon manometry proves that perception of the urge to defecate is present in children with functional constipation who deny sensation. Journal of pediatric gastroenterology and nutrition, 56(1), 19-22.
