ChronicConstipation
Definition of Idiopathic
The word idiopathic is an important term in the medicine of constipation. Very often, the cause of chronic constipation cannot be identified. This is referred to as primary or idiopathic chronic constipation - possibly the largest categorization for patients reporting to suffer from constipation.
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Because the cause is unknown, often idiopathic constipation must be characterized functionally or descriptively, in terms of its manifestation and effects. Occasionally, people will try to categorize the idiopathic condition into three groups.
Functional Constipation
The first is chronic constipation that is purely functional. People afflicted with irritable bowel syndrome often fall into this category. The patient experiences difficulty in passage of stool, accompanied by a feeling of bloat or discomfort in the abdomen. There may even be some pain but it is not the primary symptom.
Slow Transit or Prolonged Constipation
The second is prolonged or slow transit chronic constipation. In this, patients will complain about excessive time between bowel movements, in excess of three days. Measurements by the physician will also show an unsually long time between bowel movements. Although this may be alarming, no evidence suggests that prolonged delays on the order of days has a negative impact on patient health. The symptoms accompanying slow transit constipation also include a diminished urge to have a bowel movement, perhaps some distension of the abdomen, a feeling of bloat and discomfort.
Mechanical Causes
The third idiopathic chronic constipation type may be localized to mechanical causes arising near the exit point of the stool. A defecography or rectal x-ray can confirm that the stool has difficulty passing through the outlet. Underlying causes may be prolapses. What is a prolapse? A prolapse is simply the unusual displacement of an organ, possibly due to weakened muscles. The muscles controlling the anorectal area can be impaired due to prolapses. Once the cause is identified, of course, the constipation is no longer termed idiopathic.
Non-idiopathic Constipation
Non-idiopathic chronic constipation are disorders which are definitively found to have a cause. A concrete example is the class of secondary constipation, which are constipations that arise from a more fundamental underlying cause such as a disease of the organ or medications for treating a disease. Diseases of the colon such as colorectal cancer, or endocrine disorders like hypothyroidism, can lead to constipation. In such cases, treatment of the underlying cause is more important. For colorectal cancer, the prognosis can be good or grim depending on staging. For hypothyroidism, thyroid replacement therapy can alleviate the symptoms of constipation. It has also been discovered that certain medications like anti-hypertensives for treating high blood pressure can increase the risk of constipation. The physician should switch the patient to a drug with a different mode of action to alleviate the symptoms of constipation due to these secondary causes.
Sources:
Fox-Orenstein et al, Update on constipation: One treatment does not fit all, Cleveland Clinic Journal of Medicine, 2008; 75(11):813-824