Constipation with bloating: a clinical approach to evaluation and management

INTRODUCTION: Constipation and bloating are common bothersome gastrointestinal (GI) symptoms that frequently occur concurrently. It is important to recognize the underlying condition(s) and tailor therapeutic interventions appropriately. This review discusses the evaluation and management of patients with constipation who also have bloating as a predominant symptom. DISCUSSION: Key areas reviewed are potential etiologies for constipation with bloating and clinical evaluation, including differentiation between common underlying causes such as chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). Management approaches discussed include dietary modification, biofeedback, and pharmacologic therapy, including over-the-counter treatments, plecanatide, linaclotide, lubiprostone, tenapanor, neuromodulators, and antibiotics. CONCLUSIONS: Constipation and bloating are common GI symptoms; however, bloating is a relatively nonspecific symptom with a complex pathophysiology. While specifically treating constipation may also improve bloating, this strategy does not improve bloating in all patients. There is a need for additional research to further understand the physiology of bloating. In an era when personalized medicine is becoming increasingly emphasized, understanding the pathophysiology of bloating for an individual patient, be it alongside constipation or other GI and non-GI symptoms, will be paramount to improve treatment outcomes.