What Is Chronic Idiopathic Constipation?

Chronic idiopathic constipation (CIC) is a health condition in which you experience chronic symptoms of constipation, but doctors can't identify a cause through standard diagnostic tests. Chronic idiopathic constipation is also referred to as functional constipation and is classified as one of the functional gastrointestinal disorders (FGDs), meaning that although testing does not show any visible physical abnormality, there is a problem in the way that the digestive system—or in this case, the large intestine—is functioning.

An estimated 14% of people experiences chronic constipation. Women, older people, and those with lower socioeconomic status are at higher risk.

Midsection Of Woman Sitting On Toilet Seat At Home
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Chronic Idiopathic Constipation Symptoms

The primary symptoms of CIC include:

  • Infrequent bowel movements
  • Straining
  • Hard or lumpy stools
  • Feeling of incomplete evacuation
  • Feeling that something is blocking the stool from coming out
  • Need to use fingers to get stool to pass (digital evacuation and vaginal splinting)

Many people who have chronic idiopathic constipation also report experiencing the following symptoms in addition to the above:

Diagnosis

If you have chronic constipation, your doctor will work to rule out identifiable causes before deeming your case idiopathic.

They'll most likely do a physical exam and run some bloodwork. They may also order other diagnostic tests depending on your symptoms and medical history.

FGDs are diagnosed according to the Rome IV criteria, which refer to the disorder as functional constipation. For a diagnosis of functional constipation, your diagnostic workup must not show any sign of abnormality.

These criteria attempt to quantify chronic idiopathic constipation symptoms, stating that there needs to be:

  • Fewer than three bowel movements per week
  • Other symptoms occurring at least 25% of the time
  • Rare loose stools (unless you've used a laxative)

To be diagnosed with chronic idiopathic constipation, symptoms must not meet the criteria for irritable bowel syndrome (IBS) and be present for at least three months, with onset at least six months prior to diagnosis.

CIC vs. Irritable Bowel Syndrome

Constipation-predominant irritable bowel syndrome (IBS-C) shares many of the same symptoms as chronic idiopathic constipation. By definition, though, CIC is only diagnosed if the criteria for IBS has not been met.

The main difference between the two disorders is that the diagnostic criteria for IBS-C require that there be the experience of chronic pain associated with bowel movements. With that said, many doctors will tell their patients that they have IBS if they are experiencing chronic constipation without an identifiable cause, regardless of whether pain accompanies bowel movements.

Some researchers believe the two disorders are not very distinct from each other and may just be different points on a spectrum. Many people diagnosed with chronic idiopathic constipation do have abdominal pain and discomfort, and many people switch from one diagnosis to the other over time.

One important distinction may be related to treatment, as people with IBS-C appear more likely to respond to treatments that are effective for pain relief, while those with CIC appear to respond better to treatments that target muscle function in the large intestine.

CIC
  • No pain linked to bowel movements

  • Better response to drugs targeting muscle function

IBS-C
  • Pain is linked to bowel movements

  • Better response to drugs targeting pain

Treatment

There's no one specific treatment for CIC, but you and your doctor have a variety of treatment options to choose from, including:

  • Dietary fiber
  • Medications, including laxatives
  • Biofeedback

Dietary Fiber

Your doctor may recommend that you increase your intake of dietary fiber, as fiber can help to soften stools and make them easier to pass.

You can increase your intake of dietary fiber through the foods you eat or with a fiber supplement.

Too much fiber too soon could lead to symptoms of gas and bloating, but you can avoid this by increasing intake slowly so your body has time to adjust. You may find soluble fiber easier to tolerate.

Medications

Laxative medications can provide short-term relief of constipation. There are two types:

Many laxatives are available over the counter. However, there's little evidence that long-term laxative use is beneficial for CIC.

Prescription medications may provide more relief. Some common ones are:

Biofeedback

If your doctor has determined that dyssynergic defecation (pelvic floor dysfunction) is playing a role in your chronic idiopathic constipation, they may recommend that you try biofeedback. This method helps train you to tune into your body's processes in an effort to exert some control over them.

This treatment has been shown to be helpful in improving the coordination of the muscles of the pelvic floor that are involved in the process of having a bowel movement.

A Word From Verywell

Chronic idiopathic constipation may be a diagnosis that, in a way, is a letdown to get. Knowing the exact cause of any symptoms generally gives you a more concrete path toward managing them. Nevertheless, those with CIC can find relief. Speak openly with your doctor about what you are experiencing and seek additional consults if your treatment plan is not as effective as it should be.

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Article Sources
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