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Functional bowel disorders / Other functional bowel disorders: Functional abdominal bloating and functional constipation
Other functional bowel disorders: Functional abdominal bloating and functional constipation
Rome III diagnostic criteria* for Functional Constipation(1)
| 1 - | Must include two or more of the following criteria: |
| - | Straining in at least 1/4 defecations. |
| - | Lumpy or hard stools in at least 1/4 defecations. |
| - | Sensation of incomplete evacuation in at least 1/4 defecations. |
| - | Sensation of anorectal obstruction/blockade in at least 1/4 defecations. |
| - | Manual manoeuvres to facilitate >1/4 defecations (e.g., digital evacuation, support of the pelvic floor). |
| - | Fewer than 3 defections/week. |
| 2 - | Loose stools are rarely present without the use of laxatives |
| 3 - | Insufficient criteria for irritable bowel syndrome |
"The physician should clarify what the patient means by constipation"(1), as patients describe it in various ways . "Most patients complaining of constipation have normal colonic transit and anorectal function."(1) Evaluation of the patient's general health, psychological status, use of constipating medications, dietary fiber intake, and medical illnesses (e.g., hypothyroidism) is important.
In patients who do not respond to fiber supplementation, measurements of whole gut transit time and anorectal function may be indicated to place them in a physiological subgroup.
Dietary fiber increases fecal bulk by providing indigestible matter and promoting fecal water holding and bacterial proliferation . Other useful bulking agents include psyllium, methylcellulose, and calcium polycarbophil. Severely constipated patients may respond to polyethelene glycol solution. Otherwise, stimulant laxatives such as bisacodyl, sodium picosulphate, or sennosides may be tried.
Moreover, prokinetics agents such serotonin, 5-HT4 receptor agonists or tegaserod may improve functional constipation.
Functional abdominal bloating is a recurrent sensation of abdominal distension that may or not be associated with measurable distension but is not part of an other functional bowel or gastroduodenal disorder.
Functional constipation comprises a group of functional disorders which have in common persistent difficult, infrequent or seemingly incomplete defecation(1).
· Functional abdominal bloating
Few studies adequately separate bloating from IBS and other functional disorders(1), most of the IBS patients report this symptom(1) but it occurs in about 10-30% of individuals in community-based surveys, usually with a female predominance(1).
Rome III diagnostic criteria* for Functional Bloating(1)
| Must include all of the following: | |
| 1. | recurrent feeling of bloating or visible distension at least 3 days/month in last 3 months |
| 2. | insufficient criteria for a diagnosis of functional dyspepsia, irritable bowel syndrome, or other functional gastrointestinal disorder |
*criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.
Functional bloating is usually absent on awakening and worsens throughout the day. It may be intermittent and related to ingestion of specific foods. Excessive burping or farting may be present, but these are not necessarily related to the bloating. Diarrhea, weight loss, or nutritional deficiency should alert the physician to investigate for another disorder.
There is no proved effective therapy for functional bloating, and its cause is unknown, so only education and reassurance are recommended. The common practice of restricting certain "gas-forming" foods may be beneficial.
· Functional constipation
Constipation occurs in up to 27% of the population(1) , varying in different groups depending on demographic factors, sampling and the definition used. It is more common in women and is usually found to increase with age.
The criteria for functional constipation were expanded in Rome III due to the overlap between this disorder and the functional anorectal disorders.