Editing Functional constipation (section)

{{Infobox medical condition (new)
| name            = Functional constipation
| synonyms        = Chronic idiopathic constipation
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| field           = [[Gastroenterology]]
| symptoms        = Hard or lumpy stools, decreased frequency of [[Bowel movement|bowel movements]], a feeling of incomplete evacuation or obstruction, straining, [[Abdominal pain|stomach pain]] and [[bloating]].
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| diagnosis       = [[Rome process|Rome criteria]], history and physical examination.
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| treatment       = Education, lifestyle modification, faecal disimpaction, and maintenance therapy.
| medication      = [[Polyethylene glycol|polyethylene glycol (PEG)]], [[milk of magnesia]], [[Senna glycoside|senna]], [[bisacodyl]], [[plecanatide]], [[linaclotide]], and [[lubiprostone]].
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'''Functional constipation''', also known as '''chronic idiopathic constipation''' ('''CIC'''), is defined by less than three [[bowel movements]] per week, hard stools, severe straining, the sensation of anorectal blockage, the feeling of incomplete evacuation, and the need for manual maneuvers during [[feces]], without organic abnormalities. Many illnesses, including [[Endocrine disease|endocrine]], [[Metabolic syndrome|metabolic]], [[Neurological disorder|neurological]], [[Mental disorder|mental]], and gastrointestinal obstructions, can cause [[constipation]] as a secondary symptom. When there is no such cause, functional constipation is diagnosed.<ref name="Sex/Gender-Specific">{{cite book | last=Shin | first=Jeong Eun | title=Sex/Gender-Specific Medicine in the Gastrointestinal Diseases | chapter=Functional Constipation | publisher=Springer Nature Singapore | publication-place=Singapore | date=2022 | isbn=978-981-19-0119-5 | doi=10.1007/978-981-19-0120-1_17 | pages=259–272}}</ref>

Functional constipation requires symptoms to be present at least a fourth of the time. Causes include [[anismus]], [[descending perineum syndrome]], inability to control the external anal sphincter, poor diet, unwillingness to defecate, nervous reactions, and deep [[Somatic symptom disorder|psychosomatic disorders]]. Comorbid symptoms such as [[headache]] may also be present, especially in children.

Functional constipation is diagnosed using the [[Rome process|Rome criteria]], a consensus of experts. The criteria include over 25% of defecations involving straining, 25% resulting in lumpy or hard stools, 25% requiring partial evacuation, 25% experiencing anorectal blockage or obstruction, and 25% using manual techniques. Less than three weekly spontaneous bowel movements are also considered. A thorough history and physical examination, including a [[Rectal examination|digital rectal exam]], is crucial for diagnosing constipation. Additional laboratory testing is typically used in cases of uncertainty or to rule out underlying medical conditions.

Functional constipation is a condition that requires nonpharmacological management, including education and lifestyle modifications. It begins with dietary guidelines, focusing on regular [[fiber]] and fluid intake. Children with functional constipation should consume a normal intake of fiber, as per ESPGHAN/NASPGHAN criteria. Parents and children should receive counseling about [[overflow incontinence]] and withholding behavior. An organized toilet-training program with a reward system can help reduce faecal impaction.

Pharmacological treatment for children with functional constipation consists of maintenance therapy and faecal disimpaction. High-dose oral [[polyethylene glycol]] (PEG) or [[Enema|enemas]] containing active substances can induce fecal disimpaction, while maintenance therapy is recommended after successful disimpaction to avoid reoccurring stool buildup. [[Glycerine]] or [[bisacodyl]] suppositories are also used for both adults and children. Maintenance treatment for functional constipation includes osmotic laxatives, [[milk of magnesia]], and mineral oil. Stimulant laxatives such as senna or bisacodyl are recommended for those with persistent symptoms.