Chronic constipation, including functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C), is common and significantly affects quality of life. Both conditions share symptoms like infrequent bowel movements, straining, and a sensation of incomplete evacuation, but IBS-C is further characterized by abdominal pain. This pain, a major contributor to disease burden, involves complex mechanisms such as abnormal gut distension, sensory nerve activation, and disrupted motility. Factors like diet, gut microbiota, serotonin metabolism, and genetic predisposition all influence pain perception. The overlap in symptoms suggests that FC and IBS-C may be part of a spectrum, rather than entirely distinct disorders.

Managing abdominal pain in constipation requires a multimodal approach targeting motility, hypersensitivity, and neuroimmune regulation. Treatments like laxatives, 5-HT4 agonists, and guanylate cyclase-C agonists can relieve symptoms but may have side effects. Psychological therapies, including cognitive-behavioral therapy and antidepressants, help address central pain mechanisms but show variable responses. Probiotics and acupuncture show potential but lack consistent evidence. Future research should focus on understanding the mechanisms, identifying biomarkers, and exploring innovative diagnostic and treatment strategies, like multi-omics studies and machine learning, to improve outcomes for patients with IBS-C and FC.

Reference: Luo J, Xu Q, Xu S, et al. Decoding Abdominal Pain in Constipation-predominant Irritable Bowel Syndrome and Functional Constipation: Mechanisms and Managements. Curr Gastroenterol Rep. 2025 Mar 17;27(1):22. doi: 10.1007/s11894-025-00967-7. PMID: 40095229; PMCID: PMC11914341.