Constipation is defined as difficulty in passing stools, infrequent defecation or both. There is usually a reduced stool frequency or less than 3 defecations per week.

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.

Symptoms of difficulty passing stools

Difficulty in passing stools includes features like:-

• Straining when defecating
• Incomplete bowel movements
• Feeling of incomplete evacuation after defecation
• Passing hard and/or lumpy stools
• Prolonged time interval between two bowel motions
• There may be abdominal pain
• There is abdominal bloating and discomfort
• There may be excessive flatulence as well
• In severe cases there may be a need for manual removal of hardened and impacted stool
• Severely hardened stools may also cause injury and bleeding of the tissues around the anus
• There may be poorer physical functioning
• There may poor social functioning
• There is a decreased quality of life and perception of health by the patient

Meaning of the term Chronic Idiopathic Constipation

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.

Chronic constipation is further defined as the presence of these symptoms for at least 6 months. Idiopathic constipation accounts for 75% of cases of chronic constipation cases.

Types of idiopathic constipation

Two types of idiopathic constipation have been distinguished:-

Slow transit constipation - This condition results when there is failure of the fecal matter to move through the colon at a normal rate. The exact cause of this condition is unclear.

Functional outlet obstruction or evacuation disorders - This is also referred to in the literature as spastic pelvic floor syndrome, paradoxical puborectalis contraction or anismus. An obstruction in the anus may be due to abnormality in the pelvic floor muscles. During straining of defecation in these disorders the puborectalis muscle contracts instead of relaxing and the anal canal remains closed. This prevents defecation.