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What is Chronic Idiopathic Constipation (CIC)?

By Dr Ananya Mandal, MD

Constipation is one of the most frequent gastrointestinal complaints worldwide. In the United States it is one of the common reasons for a visit to the physician.

Definition of chronic idiopathic constipation

Constipation is defined as reduced stool frequency or less than 3 times per week or difficulty passing stools, or both. The frequency of 3 times per week is different from different individuals. For some this may be a normal habit and any change or reduction in frequency is considered to be constipation in these individuals.

Difficulty in passing stools include straining, incomplete bowel movements or a feeling of incomplete evacuation after defecation, passing hard/lumpy stools and a prolonged time interval between two bowel motions.

In severe cases there may be a need for manual removal of hardened and impacted stool and there may be injury and bleeding of the tissues around the anus due to passage of the hard stools.

Chronic Idiopathic Constipation (CIC) is defined as the chronic presence of these symptoms. It is called idiopathic because the cause of this type of constipation is unknown and it is not caused by underlying illness or medication.

Symptoms of chronic idiopathic constipation

Symptoms of chronic idiopathic constipation include:-

  • Constipation or difficulty in passing stools
  • Hard and lumpy stools
  • Straining when defecating
  • Feeling of incomplete evacuation after completion
  • Abdominal pain
  • Abdominal discomfort and bloating
  • Excessive flatulence
  • Poorer physical functioning
  • Poor social functioning
  • Decreased quality of life and perception of health

Causes of Chronic Idiopathic Constipation

This is a condition that has no well defined underlying cause. However, there are several factors that are associated with chronic idiopathic constipation. This includes reduction in fluid and fibre intake in diet, changes in water balance, changes in motility in the colon etc.

Changes in motility means changes in the contractility and the rate at which the muscles in the colon contract to move the fecal matter pass through the colon to the rectum. As the movement slows down, more water is absorbed from the fecal mass. This makes it hard and dry and more difficult to pass. Furthermore these hard, dry stools may be small and lack the bulk to stimulate the urge to defecate and this result in infrequent bowel movements.

The symptoms of chronic idiopathic constipation are also aggravated when there are visceral sensory abnormalities or changes in the enteric nervous system. This pathology may also cause abdominal discomfort. Visceral hypersensitivity may result in diminished rectal sensation and this decreases the urge to defecate.

Epidemiology

In the United Sates as many as 35 million adults may suffer from chronic idiopathic constipation. The numbers may be higher as all patients do not seek medical help. Studies have shown that only about 12% with the condition seek medical help. Now, however, over 40% of patients with chronic idiopathic constipation are under medication.

It is slightly more common in women (56%) and adults over the age of 35 years (84%). Caucasians are worst affected (82%) than other races and ethnicities.

Diagnosis of chronic idiopathic constipation

Diagnosis is made mainly on the basis of history and physical examination of the patient. Individuals with symptoms such as bloating, hard, infrequent stools, and straining are commonly seen initially.

Some of the warning signs or red flags are enquired and watched out for to rule out other more serious conditions that may mimic chronic idiopathic constipation like bowel cancers.

Warning signs for more serious conditions

These red flags include:-

  • Blood in the stool
  • Onset of symptoms after age 50
  • Family history of bowel cancer and inflammatory bowel disease like ulcerative colitis and Crohn's disease
  • Presence of fever and low blood count
  • Severe constipation not responsive to treatment
  • Unexplained weight loss

Confirming the diagnosis

Colonoscopy, imaging studies like MRI scans and anal manometry may be performed to confirm diagnosis.

Treatment of chronic idiopathic constipation

Treatment strategies are based on the severity of symptoms of the condition. Diet and life style changes including regular physical exercise are advised. The patient is asked to increase fibre and water intake in diet and take healthy and balanced diets.

A symptom diary may help identify triggers that exacerbate symptoms and possible diet and other triggers may be avoided.

Medications that may be used include over-the-counter laxatives and stool softeners.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Mar 26, 2013

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Comments
  1. Lynne Krop Lynne Krop United States says:

    I have had CIC all my life, but was able to control it with food and exercise. Now that I'm 50, my entire colon became impacted and I had a 3-day stay at the hospital to clear it out. MOVIPrep and GoLytely are NOT fun. Three GALLONS later, I was cleared only to go home and become impacted two days later. I'm taking Linzess daily. Does anyone have information on this medication?

    • PC Jarrett PC Jarrett Canada says:

      Hi Lynn...I am a 45 yr old female who has suffered from chronic consitpation for most of my life.  I had actually never heard of CIC until tonight when I came across this surfing the internet...but I believe that this is what I have.  I am now currently just over 3 weeks with only having had 2 small movements.  This also after having taken the typical concoctions that are given to someone just prior to a colonoscopy.  I spoke with my Dr. as well as the pharmacist and had high hopes that this would help...but barely helped at all.  Do you know what they do at the hospital if the MOVIPrep and GoLytely do not work??  I'm pretty nervous and scared at this point to just go to the hospital but I know I may have to :-(.  Do you have any advice??  Also, how has Linzess been working for you??

  2. Gerald Marks Gerald Marks United States says:

    I am 71 year old male and have suffered from progressive constipation for 15 years.  My doctor asked me to try Linzess 145, once a day.  At first, I believed some relief resulted.  After a couple months, whatever relief there was diminished.  This is an expensive drug and is not on my Rx Plan Formulary.  I no longer take Linzess.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
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