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Clinician’s Corner: Constipation

Your Thompson Pharmacist has a real opportunity to bring comfort to our patients that need a recommendation for constipation.  We’ve been all trained to ask about how frequent your bowels move, consistency, what makes it better or worse, diet, and exercise but we also need to inquire about the presence of pain.  Pain in the belly seems to be the determining factor between Chronic Idiopathic (unknown cause) Constipation (CIC) and Irritable Bowel Syndrome Constipation Predominant (IBS-C).

But as always before we act on any such symptom we need to check the medication list for DRUGS frequently causing constipation:

Opioids-Pain medications Calcium channel blockers (verapamil)
Anticholinergics- antidiarrheals Calcium carbonate (OS-Cal)
Aluminum antacids Iron supplements
Antidepressants Clonidine (Catapres®)
Antipsychotics Sucralfate (Carafate®)
Diuretics Cholestyramine (Questran)

CHRONIC IDIOPATHIC CONSTIPATION (CIC)

Chronic idiopathic constipation is frequently referred to as “functional constipation”It is estimated that 14% (as many as 35 million) patients may suffer from this condition.  The cause is unknown.

  • Chronic constipation is more common in females, in older subjects, and those of lower socioeconomic status. 58% of patients suffering from CIC are female
  • Chronic constipation has also been linked to impaired quality of life, especially among the elderly.
  • 72% of CIC patients self-treat with over the counter medications, while 13% receive prescription therapy.

IRRITABLE BOWEL SYNDROME-Constipation predominant (IBS-C)

Irritable bowel syndrome is defined as belly pain or discomfort associated with constipation. This condition is long-lasting and keeps recurring.  Patients will have hard or lumpy stools at least 25% of the time, and loose or watery stools less than 25% of the time.

It is estimated that 5% (as many as 13 million) patients may suffer from IBS-C.

64% of IBS-C patients are female, and 66% are under the age of 50, therefore this seems to be a “younger woman” problem.

  • Pain is what separates IBS-C from CIC, patients will complain “it feels like a knot in my guts”. 62% will experience abdominal pain.
  • 72% of the patients are constipated, and 59% will have incomplete evacuation on bowel movements
  • 57% of IBS- C patients will self-treat with over-the-counter medications, while 15% will receive prescription medications.
  • Over-the-counte meds most often recommended by physicians
    • 52% fiber supplements: psyllium, methylcellulose, wheat dextrin etc.
    • 32% OTC laxatives: senna, docusate, bisacodyl etc.

Next week we will begin discussions of the pharmacological treatment of constipation.