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Chronic Idiopathic Constipation (CIC) Symptoms, Diagnosis and Treatment

News January 31, 2020 | CanadaOnlineHealth

Chronic idiopathic constipation (CIC) is a health condition in which a person experiences chronic symptoms of constipation, yet no visible cause can be identified through standard diagnostic testing. 

The term idiopathic is used because it means there is no known cause. 

While estimates vary, as many as 35 million adults in the U.S. may suffer from CIC.

People who are at higher risk include women, older individuals of all ages and genders, and those who have a lower socioeconomic status.

Symptoms

Photo source: globalsourcemedical.com

Signs and symptoms of chronic constipation include:

  • Passing fewer than three stools a week
  • Having lumpy or hard stools
  • Straining to have bowel movements
  • Feeling as though there's a blockage in your rectum that prevents bowel movements
  • Feeling as though you can't completely empty the stool from your rectum
  • Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum

Many people who have CIC also report experiencing the following symptoms alongside the constipation:

  • Abdominal pain or discomfort
  • Bloating
  • Gas pain

Constipation may be considered chronic if you've experienced two or more of these symptoms for the last three months.

 

What factors may contribute to CIC?

There are several factors that may contribute to the development of CIC.

Fluid absorption

The colon may be absorbing too much fluid from the stool, or the muscles in the colon may be moving too slowly. This can cause the stool to become dry, hard, and difficult to pass.

Muscle contractions

The muscles of the colon may be contracting too slowly, which can reduce the movement of stool through the colon and cause infrequent stools.

Decreased urge

Some patients may have less sensitivity, which may reduce the urge to have a bowel movement. Other patients may have extra-sensitive nerves, which can cause discomfort.

Problems with the nerves around the colon and rectum

Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:

  • Damage to the nerves that control bodily functions (autonomic neuropathy)
  • Multiple sclerosis
  • Parkinson's disease
  • Spinal cord injury
  • Stroke

Difficulty with the muscles involved in elimination

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

  • The inability to relax the pelvic muscles to allow for a bowel movement (anismus)
  • Pelvic muscles that don't coordinate relaxation and contraction correctly (dyssynergia)
  • Weakened pelvic muscles

Conditions that affect hormones in the body

Hormones help balance fluids in your body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:

  • Diabetes
  • Overactive parathyroid gland (hyperparathyroidism)
  • Pregnancy
  • Underactive thyroid (hypothyroidism)

Diagnosis

If you suspect that you have CIC, your doctor will most likely do a physical exam and run some bloodwork in order to rule out other illnesses.

Other diagnostic tests may be recommended depending on your symptoms and medical history.

  • Blood tests

Your doctor will look for a systemic condition such as low thyroid (hypothyroidism) or high calcium levels.

  • An X-ray

An X-ray can help your doctor determine whether our intestines are blocked and whether there is stool present throughout the colon.

  • Examination of the rectum and lower, or sigmoid, colon (sigmoidoscopy)

In this procedure, your doctor inserts a lighted, flexible tube into your anus to examine your rectum and the lower portion of your colon.

  • Examination of the rectum and entire colon (colonoscopy)

This diagnostic procedure allows your doctor to examine the entire colon with a flexible, camera-equipped tube.

  • Evaluation of anal sphincter muscle function (anorectal manometry)

In this procedure, your doctor inserts a narrow, flexible tube into your anus and rectum and then inflates a small balloon at the tip of the tube. The device is then pulled back through the sphincter muscle. This procedure allows your doctor to measure the coordination of the muscles you use to move your bowels.

  • Evaluation of anal sphincter muscle speed (balloon expulsion test)

Often used along with anorectal manometry, this test measures the amount of time it takes for you to push out a balloon that has been filled with water and placed in your rectum.

  • Evaluation of how well food moves through the colon (colonic transit study)

In this procedure, you may swallow a capsule that contains either a radiopaque marker or a wireless recording device. The progress of the capsule through your colon will be recorded over 24 to 48 hours and will be visible on X-rays.

In some cases, you may eat radiocarbon-activated food and a special camera will record its progress (scintigraphy). Your doctor will look for signs of intestinal muscle dysfunction and how well food moves through your colon.

  • An X-ray of the rectum during defecation (defecography)

During this procedure, your doctor inserts a soft paste made of barium into your rectum. You then pass the barium paste as you would stool. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination.

  • MRI defecography

During this procedure, as in barium defecography, a doctor will insert contrast gel into your rectum. You then pass the gel. The MRI scanner can visualize and assess the function of the defecation muscles. This test also can diagnose problems that can cause constipation, such as rectocele or rectal prolapse.

CIC vs. Irritable Bowel Syndrome

Photo source: verywellhealth.com

Constipation-predominant irritable bowel syndrome (IBS-C) shares many of the same symptoms as CIC. And in fact, by definition, CIC is only diagnosed if the criteria for IBS has not been met.

The main difference between the two disorders is that the diagnostic criteria for IBS-C require that there be the experience of chronic pain associated with bowel movements.

In the real world, many doctors will tell their patients that they have IBS if they are experiencing chronic constipation without an identifiable cause, regardless of whether or not pain accompanies bowel movements.

Some researchers believe that the two disorders are not so distinct. Many people who have a diagnosis of CIC do experience abdominal pain and discomfort and there are many people who find themselves switching from one diagnosis to the other over time.

It is possible that the two disorders actually fall upon the same continuum. One important distinction between the two may be related to treatment, as people with IBS-C appear to be more likely than those with CIC to respond to treatment options that are effective for pain relief, while those with CIC appear to be more likely to respond to certain medications or treatments that target the functioning of the muscles of the large intestine.

Treatment

Treatment for chronic constipation usually begins with diet and lifestyle changes meant to increase the speed at which stool moves through your intestines.

If those changes don't help, your doctor may recommend medications or surgery.

Photo source: verywellhealth.com

Diet and lifestyle changes

Your doctor may recommend the following changes to relieve your constipation:

  • Increase your fiber intake

Adding fiber to your diet increases the weight of your stool and speeds its passage through your intestines. Slowly begin to eat more fresh fruits and vegetables each day. Choose whole-grain breads and cereals.

Your doctor may recommend a specific number of grams of fiber to consume each day. In general, aim for 14 grams of fiber for every 1,000 calories in your daily diet.

A sudden increase in the amount of fiber you eat can cause bloating and gas, so start slowly and work your way up to your goal over a few weeks.

  • Exercise most days of the week

Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week. If you do not already exercise, talk to your doctor about whether you are healthy enough to start an exercise program.

  • Don't ignore the urge to have a bowel movement

Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions and without feeling rushed.

Photo source: stylecraze.com

Laxatives

Several types of laxatives exist. Each works somewhat differently to make it easier to have a bowel movement. The following are available over the counter:

  • Fiber supplements. 

Fiber supplements add bulk to your stool. Bulky stools are softer and easier to pass.

Fiber supplements include:

    • Psyllium: Metamucil, Konsyl, others
    • Calcium polycarbophil: FiberCon, Equalactin, others
    • Methylcellulose: Citrucel
  • Stimulants.

Stimulants cause your intestines to contract, including:

    • Bisacodyl: Correctol, Dulcolax, others
    • Sennosides: Senokot, Ex-Lax, Perdiem

Photo source: pharmacychecker.com

  • Osmotics

Osmotic laxatives help stool move through the colon by increasing secretion of fluid from the intestines and helping to stimulate bowel movements.

Examples include:

    • Oral magnesium hydroxide: Phillips' Milk of Magnesia, Dulcolax Milk of Magnesia, others
    • Magnesium citrate
    • Lactulose: Cholac, Constilac, others
    • Polyethylene glycol: Miralax, Glycolax
  • Lubricants

Lubricants such as mineral oil enable stool to move through your colon more easily.

  • Stool softeners

Stool softeners moisten the stool by drawing water from the intestinessuch as:

    • Docusate sodium: Colace
    • Docusate calcium: Surfak 
  • Enemas and suppositories

Tap water enemas with or without soapsuds can be useful to soften stool and produce a bowel movement.

Glycerin or bisacodyl suppositories also aid in moving stool out of the body by providing lubrication and stimulation.

Other medications

Photo source: singlecare.com

If over-the-counter medications don't help your chronic constipation, your doctor may recommend a prescription medication, especially if you have irritable bowel syndrome.

  • Medications that draw water into your intestines

A number of prescription medications are available to treat chronic constipation. They work by drawing water into your intestines and speeding up the movement of stool.

  • Serotonin 5-hydroxytryptamine 4 receptors

Prucalopride helps move stool through the colon. Such as:

Photo source: motegrityhcp.com

  • Peripherally acting mu-opioid receptor antagonists (PAMORAs)

If constipation is caused by opioid pain medications, PAMORAs reverse the effect of opioids on the intestine to keep the bowel moving. Such as:

Training your pelvic muscles

Biofeedback training involves working with a therapist who uses devices to help you learn to relax and tighten the muscles in your pelvis.

Relaxing your pelvic floor muscles at the right time during defecation can help you pass stool more easily.

Photo source: singlecare.com

During a biofeedback session, a special tube (catheter) to measure muscle tension is inserted into your rectum. The therapist guides you through exercises to alternately relax and tighten your pelvic muscles.

A machine will gauge your muscle tension and use sounds or lights to help you understand when you've relaxed your muscles.

Surgery

Surgery may be an option if you have tried other treatments and your chronic constipation is caused by a blockage, rectocele or stricture.

For people who have tried other treatments without success and who have abnormally slow movement of stool through the colon, surgical removal of part of the colon may be an option.

Surgery to remove the entire colon is rarely necessary.

Reference:

https://www.mayoclinic.org/diseases-conditions/constipation/

https://www.mayoclinicproceedings.org/article/S0025-6196(19)30123-5/fulltext

https://www.singlecare.com/blog/trulance-vs-linzess/

https://www.verywellhealth.com/chronic-idiopathic-constipation-1944861

https://www.ajmc.com/journals/supplement/2019/reviewing-treatment-data-and-the-role-of-serotonin-in-cic/update-on-the-management-of-chronic-idiopathic-constipati?p=2

https://www.linzess.com/types-of-constipation/cic-symptoms

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You have 90 days to return your medications from the date your order ships for a full refund. We accept returns if any mistake has been made on our part during dispensing, or if any damage or issues occurred during shipping that affected your order.

To authorize a return, please call us at our toll-free number for instructions on where to mail the product back and receive authorization for a refund of your shipping cost (up to $12.95 USD).

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How does your Referral Program work?

Refer any of your friends, family, or anyone! Once they are signed-up, they will be linked to your account as your referral. For every order they place, your account will automatically be credited 5% of the amount of their order.

If your referrals start signing up their friends and family, you will then get 2.5% cashback from the orders of their referrals.

Want to know more? Talk to us! Call us and we’ll be happy to explain our Referral Program!

Can I use my pet as a referral?

Although pets are considered part of our families, they are not eligible to participate in the Referral Rewards Program.

Can I use my referral rewards to purchase medications or products from Canada Online Health?

Yes, you can usually use your referral credits to purchase items from our company. We want to make it easy for you to access the products you need.

Can I withdraw my referral credits?

Referral credits may only be used to pay for your order with us and cannot be withdrawn but with your authorization, referral credits can be transferred to your family member who has an account with us.

Are there any restrictions on who I can refer?

You can refer friends. Family, or anyone interested in purchasing from our Canadian Drugstore. There are typically no restrictions on who you can refer.

How do I know if my referral was successful?

You can call us at our toll-free number 1-800-226-3784 (1-800-CAN-DRUG) and our patient service representative will check if you were credited when your referral successfully completes a purchase.

Are there any limits on the number of referrals I can make?

There is no limit on the number of referrals you can make. You can refer as much as you want to get more referral credits!

How do I sign up my friends and family?

After you complete your first order, you can have your friends and family place their first order by: creating one online on our website or calling us at 1-800-CAN-DRUG (226-3784). They simply need to give us the Name, and one of the following (Phone Number, Mailing Address, or Email Address) of the person referring them to us; that person being “YOU”! Your referral savings will start with their very first order.

Can I be sent a check for earnings?

Yes! Once your rewards grow to be $50 or more you can choose to have us send you a check in the mail. Individuals who choose to cash out their Canada Online Health Referral Rewards are subject to a $10 Cash Out Fee that will be deducted from their account balance. This covers all administrative, printing, and the mailing costs associated to sending out a check to you. Also, the maximum cash payout is capped at a $500 USD per month.

How much can I earn?

Quite simply the more people you refer, the more you earn in referral rewards! And when your family and friends sign up you will earn more with every person who joins Canada Online Health as a Customer. The maximum cash payout is capped at a $500 USD per month.

Am I charged anything to cash out my referral earnings?

There is a $10 service fee to have your referral money paid out. This fee is to cover the administrative costs associated in preparing and mailing the check to you. However, there is no cost to use your rewards dollars as credit towards purchases.

Can I transfer my referral earnings to my spouse or someone else?

Yes! You can ask for your earnings balance to be transferred to another person’s account with us.

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How does Canada Online Health prioritize patient security and privacy

At Canada Online Health, patient security and privacy are our top priorities. We employ advanced security measures and adhere to strict privacy policies to protect your information and ensure a safe online shopping experience. We are committed to the strict standards of Canada’s Personal Information Protection and Electronic Document’s Act. Further details are available on our Privacy Policy page.

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Yes. We have a secure platform that protects your credit card information. Additionally, credit cards use online security features like encryption and fraud monitoring to keep your accounts and personal information safe.

What measures do you take to secure online transactions at Canada Online Health?

We employ industry-standard security measures to protect your payment information during online transactions. This includes encryption and secure payment gateways.

Are Canada Online Health customers’ medical records kept confidential?

Yes, we maintain strict confidentiality of all medical records and personal information is never shared without your consent.

How do you handle prescription orders to protect patient privacy?

Prescription orders are processed with the utmost care to protect patient privacy. We use discreet packaging to maintain confidentiality.

Shipping and Tracking

What is the tariff compliance fee?

This tariff compliance fee covers the cost of the tariff compliance software that manages tariffs and helps determine duties based on the contents of your shipment. The fee supports tariff management, duties and tax calculations, and ensuring compliance for shipments from anywhere in the world, including Canada, the UK, Australia, and New Zealand. The tariff itself may be 0% or more, but this fee still applies. It is not a tax or a tariff. If you have any questions about this fee, please contact our customer service representatives.

How long will my order take to arrive?

Once the order is processed and shipped via regular mail, your package will normally take 14 to 28 days to be delivered right to your door. Express shipping normally takes 8-10 days from Canada.

Please note: Due to some factors beyond our control, on rare occasions, delivery times may take longer. We advise all our customers to place their orders 8 weeks prior to running out of their medication(s).

Are there any additional charges?

Tracked shipping fee will be applied to all orders. For international or expedited shipping services, there will be varying charges. Rest assured; we will communicate all charges with you before confirming your order.

Do you ship to the United States from Canada?

Yes, we provide shipping to the United States. Our pharmacy in Canada ships to the US, ensuring you get the medications you need conveniently.

Where else do you ship aside from the United States?

We can ship products globally with some restrictions. Please call us to verify if we can ship to your country of residence.

What guarantee do you offer to ensure I receive my order?

If you did not receive your order within our current reshipment guarantee time frame, we will reship your order to you. Please contact us right away to set-up a reshipment. We don’t charge for reshipments, but if you receive both products and decided to keep both, you will have to pay for both orders.

What is the cost of shipping?

All orders are shipped using tracked shipping services. The cost of this service is as posted when you order is being priced. We’ve chosen tracked for all orders to ensure our customers can follow their orders during the shipping phase. For expedited and international shipping options please contact one of our Patient Service Representatives.

How can I track my order?

All orders will be shipped using tracked services. Once order is shipped, you will receive an email with the tracking number and the link for tracking. Alternatively, feel free to contact us, and we can provide you with the latest tracking updates.

Do you offer overnight or 2-day delivery?

Not at this time. Our orders pass through customs which can take a few days. We have no control over US customs processes and cannot provide this level of service guaranteed. Our current quickest delivery option is from Canada using Expedited delivery service through Canada Post.

How do you ship your orders?

Our orders are shipped using the dispensary’s local postal service. Upon entry into the USA, the United States Postal Service takes over the final portion of delivery to your door. This includes orders with tracked shipping or expedited shipping services added.

What is your shipping time frame?

Our regular shipping time frame averages between 14-28 days. Order shipped with expedited shipping from Canada usually take 8-10 business days to arrive. We work with all our shipping and logistic services and strive to get orders to you in 28 days or less.

Can I change my shipping address after placing an order?

To ensure accurate and secure delivery, we recommend contacting our patient service representative as soon as possible if you need to change your shipping address. Our Toll-free number is 1-800-226-3784 (1-800-CAN-DRUG).

What should I do if there are shipping delays or issues with my order?

If you encounter any shipping delays or issues with your order, please contact our patient service representatives at 1-800-226-3784 (1-800-CAN-DRUG). We will assist you in resolving any concerns.

US Tariffs

What determines the tariff on my medications?

The tariff is determined by the country of manufacture (the country where the medication is produced), not by where it is shipped from or to. Tariffs follow current US policy for each country of manufacture. For details, see https://www.canadaonlinehealth.com/faq.

Are there offsets or discounts on tariffs?

No. Our policy does not include offsetting or discounting tariffs. The tariff amount is added based on the country of manufacture.

What are the current country-of-manufacture tariff rates?

Illustrative current rates by country of manufacture (these can change with policy updates):

  • India (IN): 50% (includes current penalty imposed by the US for India’s purchase of Russian oil.
  • Switzerland (CH): 39%
  • Canada (CA): 35%
  • European Union (EU): 15%
  • Israel (IL): 15%
  • New Zealand (NZ): 15%
  • Turkey (TR): 15%
  • United Kingdom (GB): 10%
  • United States (US): 0%

Tariffs are shown as an amount on the checkout line item that represents a percentage of the product value.

How are these charges shown at checkout?

You will see a clear, itemized breakdown that includes:

  • Medication price
  • Tariff by country of manufacture (shown as an amount that represents a percentage of the product value)
  • Other standard charges (e.g., shipping)

The total payable is displayed before you place your order.

Can you give me examples of how this works?

Example 1: Medication shipping from Canada and manufactured in Canada

  • Tariff amount: shown as an amount representing 35% of the product value
  • Shipping: included in the standard shipping fee
  • Total charges at checkout: product price + tariff amount + shipping

Example 2: Medication shipping from UK and manufactured in India

  • Product manufacture: India
  • Tariff amount: shown as an amount representing 50% of the product value
  • Shipping: included in the standard shipping fee
  • Total charges at checkout: product price + tariff amount + shipping

How do you determine country of manufacture?

The country of manufacture is the country where the medication is produced. If a medication is manufactured in one country but sourced from another, the tariff rate is determined by the country of manufacture as defined by our policy and regulatory rules.

Are tariffs the same for all medications within a country of manufacture?

Tariff rates are fixed by the country of manufacture and are the same for medications produced in that country, subject to regulatory updates. Some medications may be classified differently under applicable law, so rates can vary by medication category as defined by policy.

How will I know if rates change?

We publish updates on our tariff information and reflect any material changes in checkout notices. You’ll also see the updated rates reflected in medication pages and the tariff explanation here: https://www.canadaonlinehealth.com/faq.

Do these charges apply to all shipments?

Tariffs apply to medications that are imported and are determined by country of manufacture, for orders shipping to the United States only. The standard shipping fee applies to all shipments as part of the checkout charges.

Are there any exemptions or waivers?

At this time, tariffs are fixed by country of manufacture and offsets are not offered. If any exemptions or policy changes occur, we will clearly communicate them at checkout and on the FAQ page.

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