Irritable Bowel Syndrome
A common disorder
For some patients, the causes of constipation may be due to a disorder known as irritable bowel syndrome (IBS). For such patients, treatment of irritable bowel syndrome should be the focus of therapy rather than the symptoms of constipation itself. However, it has been found that the symptoms of IBS and constipation overlap significantly, due largely to the fact that both disorders are characterized by decreased motility of the lower gastrointestinal tract.
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Likely it is good to consider the constipation medications and constipation treatments that are generally therapeutic.
Complex disorder with no clear cause
Irritable bowel syndrome should not be confused with the inflammatory diseases inflammatory bowel disease or Crohn's disease, both of which are diseases in which the lining of the colon becomes inflamed. Like chronic constipation, irritable bowel syndrome is a complex disorder, characterized more by its symptoms than by its underlying causes. That is to say, the root causes are often mysterious. Patients may complain of bloating, fullness, or gas. In particular, pain is felt in the abdomen, but is relieved by bowel movement. People who suffer from IBS also, significantly, experience chronic constipation. These symptoms worse in those who experience emotional distress.
There are some clues that IBS may be do to physical problems with the muscles of the intestine, such as reduced tolerance for stretching that leads to irritation. Structurally, the organ shows no defects. In others, IBS develops post-infection. This type is called post-infectious IBS. The demographics of people with IBS is also slightly different from those with constipation. IBS seems to strike those in adolescence or early adulthood, whereas constipation is common the elderly. Both affect women more than men. IBS is also the most common complaint which results in a referral to your local gastroenterologist.
Abdominal pain distinguishes between the two
The key feature that distinguishes IBS from chronic constipation is the presence of abdominal pain in patients with IBS. Therefore, chronic constipation and IBS are distinct disorders. Constipation medication by itself may not reduce teh pain. The Rome criteria for defining chronic constipation specifically state that the definition of chronic constipation means a preclusion of symptoms of IBS. In other words, IBS must be ruled out clearly before a diagnosis of chronic constipation is made.
Overlapping treatments
Frequently patients with chronic constipation will nevertheless experience abdominal pain. It becomes difficult to distinguish between the two disorders. However, it turns out that many of the constipation treatments for IBS are the same as those for chronic constipation, with the exception of abdominal pain. Patients with IBS are usually first treated for constipation. Once it is brought under control, various forms of painkillers may be used to ease discomfort.
Switching antidepressants
It may be interesting as a sidenote that antidepressants used as constipation treatments have been found to relieve pain in patients with IBS. However, use of the same antidepressants, known as tricyclics, can lead to constipation. The irony is relieved with the use of an antidepressant with another mode of action, the selective serotonin reuptake inhibitors (SSRIs) that also have been found to relieve pain in IBS. SSRIs were originally developed to combat depression by preventing the clearance of serotonin in the neural synaptic spaces. Serotonin has been found to modulate mood and anxiety common in many psychiatric disorders.
Sources:
Muller-Lissner et al, Myths and Misconceptions about Constipation, American Journal of Gastroenterology, 2005, 100:232-242