What is functional constipation? How is it different from IBS?

Struggle with constipation? Dr. Rafatjah discusses functional constipation in children and adults, including causes, treatment plans, and long-term outlook.

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According to the American College of Gastroenterology, there are at least 2.5 million visits to the doctor every year that have to do with constipation. Constipation is nothing to be embarrassed about, but it may be something to see a doctor about.

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What is functional constipation?

Like all functional gastrointestinal disorders, functional constipation is when you have chronic constipation that has no physical (or hormonal) cause.

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 harder.

There are three types of functional constipation:

  1. Normal transit constipation — most common, muscles squeeze and relax incorrectly
  2. Slow transit constipation — when your colonic transit time is slow to remove waste
  3. Defecation disorders — when a specific colon muscle is dysfunctional

Knowing more about functional constipation can mean the difference between a comfortable and an unbearable everyday life.

Functional Constipation Symptoms

Here are the most common symptoms associated with functional constipation:

  • No urge to go to the bathroom
  • A lot of time on the toilet
  • Defecating once per week or less (stool frequency)
  • Bloating in your stomach
  • Dry or hard stool
  • Headaches, especially in children
  • Undesired weight loss
  • Low blood count
  • Blood in stool

Functional constipation does not typically exhibit intense abdominal pain, like irritable bowel syndrome does.

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

When you visit the doctor, what should you expect?

First off, do not be embarrassed. Constipation is a very common issue. And if it is your child who has it, pediatricians well-trained in “normalizing” the situation will treat and encourage your child.

As always, a healthcare professional will ask about your medical history, including bowel habits.

Some doctors may even ask about your family’s medical history. Even though a systematic review showed that family history has no significant relation to recovery in children, it can illuminate both environmental and genetic factors that could have triggered the chronic constipation in the first place.

The easiest of the diagnostic criteria is whether you have bowel movements less than twice a week. Although every human has a different natural pattern of bowel movements based on many different factors, two or less bowel movement every week is 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:

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.

Diagnostic tests can seem embarrassing, but the medical staff perform them all the time. And the tests are over quickly. 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

Functional constipation is similar to IBS in many ways and different in a few important ways.

Chronic constipation is a symptom of IBS-C, which means constipation-predominant irritable bowel syndrome. It stands to reason that functional constipation and IBS-C bear a resemblance to one another since they both involve trouble defecating.

Both bowel disorders result in loss of work productivity. Patients of both report similar social quality of life issues.

But non-IBS patients dealing with functional constipation tend to be younger. They also tend to have more incomplete evacuations.

IBS results in abdominal pain that is very uncommon in functional constipation. This is the primary difference.

At PrimeHealth, we treat IBS patients all the time. Our years of experience have healed bowel conditions in many patients. If you believe you may have IBS, set up a free consultation with us.

Manage Functional Constipation: Eight Proven Strategies

How do you treat functional constipation? The use of laxatives does not always work, and they can sometimes do more harm than good.

Fortunately, there are several proven strategies to treat your functional constipation:

Probiotics restore good bacteria in your gut. An imbalance of bacteria can lead to all sorts of autoimmune disorders and hard-to-trace medical conditions.

Probiotics can be found in supplement form or in your diet (yogurt, miso, sauerkraut, etc.). A 2014 meta-analysis confirmed probiotics’ ability to treat functional constipation.

Stress relief is a great way to ameliorate functional constipation — since chronic stress is a common cause of functional constipation. Meditation, a full night’s sleep, yoga, and spending time outside are all great ways to relieve stress.

Dietary changes may include:

  • More dietary fiber (if low on fiber)
  • More liquids (if dehydrated)
  • More sorbitol-containing juices, like apple and pear juice
  • Less cow’s milk
  • Less gluten
  • Less FODMAPs (fermentable carbs)

Enemas are a more controversial treatment option. Not only are they very invasive, their efficacy is questionable. One study found soap water enemas can help with constipation, but more robust studies are required.

Glycerin suppositories are a well-established treatment option, though they are as invasive as enemas.

Polyethylene glycol (PEG) is an osmotic laxative — meaning it 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.

Biofeedback therapy teaches patients how to relax pelvic floor muscles when defecating. It is a well-established treatment of functional constipation. Biofeedback works by providing you with visual-audio feedback on a monitor which translates your involuntary bodily functions into easy-to-read visuals.

Here are some pharmaceuticals your healthcare provider may prescribe:

  • Lubiprostone
  • Prucalopride
  • Plecanatide
  • Lubiprostone
  • Linaclotide
  • Tegaserod
  • Velusetrag
  • Elobixibat
  • Sodium picosulphate

After disimpaction (the successful removal of feces), you should be prescribed with maintenance therapy. This prevents you from relapsing back 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, and toilet training in children.

During maintenance treatment, pay attention to soiling, also called encopresis. If you or a child is unable to 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.

As we have discussed, functional constipation has no physical cause. However, there are several widely accepted causes of functional constipation:

  • Poor diet
  • Dysbiosis (imbalanced gut bacteria)
  • SIBO (small intestinal bacterial overgrowth)
  • Low fluid intake, dehydration
  • High fiber intake or low fiber intake
  • Some laxatives
  • Nervousness
  • Chronic stress or anxiety
  • Anismus (which is a failure to relax pelvic floor muscles)
  • Descending perineum syndrome (where your perineum “balloons”)
  • Unwillingness to defecate

Up to a quarter of kids in the US have some sort of chronic constipation. A common cause for childhood constipation is an aversion to the pain their first bowel movements triggered. Many children want to avoid that pain again, so they will not relax their external anal sphincter — typically early in their toilet training.

Looking to the Future

Millions of people across the world deal with constipation every year. Even though functional constipation is common, it doesn’t have to be your “normal.”

Although it can often be resolved with self-care, 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 the underlying cause of your constipation and treat it. At PrimeHealth, we empower patients to overcome constipation. And our patients prove recovery is possible.

Stop Googling and finally get to the root of your gut issues.
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