Constipation, Diarrhea, and Irritable Bowel Syndrome
Veronica F. Wilbur
Functional bowel disorders of the lower gastrointestinal (GI) tract can include symptoms of hypogastric cramping, abdominal pain, diarrhea, or constipation. Constipation and diarrhea can be self-limiting or considered symptoms of possibly serious medical problems. Temporary dysfunctions of the bowel can include common GI upsets that can cause short-lived episodes of diarrhea or episodes of constipation. Irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) are two of the most common GI complaints globally (Ford et al., 2014). Additionally, the increased prescribing of opiates and opioid narcotics has led to an increase in opioid-induced constipation (OIC) (Camerilli, 2011). IBS typically presents with vague, crampy hypogastric pain and can be accompanied by constipation, diarrhea, and/or alternating patterns, while CIC presents with issues of stool consistency and problems with defecation but without the presence of abdominal pain. Similar pharmacologic agents are used to treat the symptoms of IBS, CIC, OIC, or diarrhea, whether self-limited or chronic.
Constipation is a common GI symptom that is defined as infrequent or difficult evacuation of stool. Every individual affected by constipation defines it differently, but normal defecation can vary from daily to three times a day or to every 3 days. Constipation can be a consequence of multiple factors, including diet, lifestyle, medications, and many disease states. In a systematic review of the epidemiology of constipation globally by Suares and Ford (2011), the mean prevalence of constipation in the general population was found to be 14%. Constipation affects 2.2 females to 1 male, and the incidence increases with age, especially in those over age 65. Sommers et al. (2011) report a 41.5% increase of emergency room visits and ambulatory care visits for constipation between 2006 and 2011. The incidence of constipation in children is reported between 0.7% and 29% worldwide with prevalence equal between boys and girls (Rajindrajith & Devanarayana, 2011). Dietary and lifestyle modifications are the preferred therapy for constipation, but many patients use over-the-counter (OTC) laxatives for relief. Americans spend over $290 million billion for OTC and prescription laxatives and over $7.5 billion dollars annually for treatment (Pomeranz et al., 2013). Most of these laxatives are considered safe and effective, but overuse or abuse may have serious consequences.