Let’s talk constipation…

DID YOU KNOW?

·       Constipation affects 14% of adults worldwide. 

·       More than 75% of patients with constipation experience abdominal pain.

·       800 million people suffer from Irritable Bowel Syndrome (IBS) worldwide, a chronic condition which is notoriously difficult to diagnose and treat.

A recent medical review article by Australian researchers explores the complex relationship between constipation and abdominal pain. The article aims to assess the differences between IBS-C (IBS with constipation predominance) and functional constipation (FC) and identify the potential treatment options to reduce abdominal pain. You can read the original article here.

KEY TAKEAWAYS

·       Constipation is both a symptom and a disorder. 

·       Patients with chronic constipation typically fall into three diagnostic categories: FC, IBS-C and dyssynergic defecation. 

·       Patients diagnosed with FC do not describe abdominal pain as the dominant symptom; patients with IBS-C do.

·       Most therapeutic agents that are effective for IBS-C have also shown to be effective for FC, however, not the other way around. 

TREATMENT OPTIONS

Constipation in both IBS-C and FC patients is currently treated by laxation. Studies have shown that increasing bowel movements improves abdominal pain. Sadly, most of the gains are in patients with FC, not IBS-C. Laxatives can be broadly divided into 5 groups. 

BULKING AGENTS

·       Includes dietary fibre and bulk-forming laxatives. 

·       Studies of pysillium husk, a common dietary fibre, showed that patients noted fewer hard stools and reduced abdominal pain.

·       Well established treatment for constipation. 

STIMULANT LAXATIVES

·       Increases bowel movement and secretion.

·       But… while stimulants can improve straining and obstructive symptoms, they can also lead to increased abdominal pain.

OSMOTIC LAXATIVES

·       Increases stool frequency and symptoms and reduces hardened stools, but increases abdominal pain

·       The article finds that up to 20% of patients taking lactulose experience bloating, abdominal cramps and pain.

·       Polyethylene glycol has shown to have little effect on pain in IBS-C patients.

STOOL SOFTENERS

·       Softens stools by allowing water and fats to penetrate the stool.

·       No evidence to support the effectiveness of stool softeners on the treatment of constipation and pain.

New trials are being conducted to find alternative treatments for chronic constipation. These are mainly receptor-specific drugs that target active sites in the gastrointestinal system. Although these newer agents have been shown to reduce pain, it is still unclear whether it is more effective than laxation. These include lubiprostone, prucalopride and linaclotide.

 SO WHAT HAVE WE LEARNED?

There are many factors that contribute to abdominal pain in individuals with chronic constipation. IBS-C is characterised by the complexity of an individual’s heightened sensitivity to pain, altered processing of gut events and environmental stressors. The article concludes that although laxation improves the symptoms of constipation, it may not necessarily relieve abdominal pain. And there isn’t enough research yet to determine which treatment options work best for which patients. And this is even more complicated because of the difficulties in differentiating between IBS-C and FC.

THINGS YOU SHOULD KNOW ABOUT THIS ARTICLE BEFORE YOU QUOTE IT AT A BBQ

·       Australian research 

·       It’s a review article (something that summarises other people’s research)

·       The paper was funded by Zespri International Ltd, the world’s largest marketer of kiwi fruit

·       The article was published in June 2020 in a well-respected, peer-reviewed international journal - Journal of Gastroenterology and Hepatology