Prevalence of constipation: agreement among several criteria and evaluation of the diagnostic accuracy of qualifying symptoms and self-reported definition in a population-based survey in Spain

Characterization of irritable bowel syndrome and constipation in children with allergic diseases

Allergy is believed to play a role in the pathogenesis of irritable bowel syndrome (IBS) and constipation. We investigated whether allergic patients are more prone to constipation or IBS. In a multicenter study, two groups of outpatient children aged 3-13 years were included. In group 1, children with allergic symptoms were enrolled. Group 2 consisted of nonallergic children. In both groups, the assessment of IBS and constipation was carried out using a questionnaire based on the Rome criteria for functional gastrointestinal disorders. All children were examined and underwent skin prick tests (SPT) to foods and aeroallergens. The allergic group (n=196) and controls (n=127) were comparable with respect to sex, age, and anthropometric parameters. IBS was found in 6.6% of the allergic children and in 6.3% of the controls (p=0.581). The frequency of constipation was similar in the two groups. In allergic children, positive SPTs to food and self-reported reactions to food were associated with IBS. Our results show that evaluation of constipation comorbidity is not required in allergic children. In allergic children with positive SPT to foods attention may be paid to IBS symptoms.

Dietary patterns associated with functional constipation among Japanese women aged 18 to 20 years: a cross-sectional study

Although several nutrients and foods have been suggested to be preventive for constipation, all previous studies have examined a single nutrient or food in each analysis. In contrast, analysis of dietary patterns may provide new insights into the influence of diet on functional constipation. We conducted a cross-sectional examination of the association between dietary pattern and functional constipation in 3,770 Japanese female dietetic course students aged 18-20 y from 53 institutions in Japan. Diet was assessed with a validated self-administered diet history questionnaire with 148 food items, from which 30 food groups were created and entered into a factor analysis. Functional constipation was defined using the Rome I criteria, which has previously been used in several epidemiologic studies on constipation. The prevalence of functional constipation was 26.0% (n=979). Four dietary patterns were identified: (1) "Healthy", (2) "Japanese traditional", (3) "Western," and 4) "Coffee and dairy products." After adjustment for several confounding factors, the "Japanese traditional" pattern, characterized by a high intake of rice, miso soup, and soy products and a low intake of bread and confectionaries, was associated with a significantly lower prevalence of functional constipation. In comparison with the lowest quintile, the multivariate adjusted odds ratio (95% confidence interval) was 0.52 (0.41-0.66) in the highest quintile (p for trend < 0.0001). Other dietary patterns were not associated with functional constipation. The Japanese traditional dietary pattern, characterized by a high intake of rice and a low intake of bread and confectionaries, may be beneficial in preventing functional constipation in young Japanese women.

Factors associated with childhood constipation

AIM

To evaluate factors associated with constipation, determine its risk factors and identify common methods of managing constipation among schoolchildren from ages 7-12 in Edirne, Turkey.

METHODS

This was a cross-sectional and descriptive study and 1900 children were stratified by the school population, age and gender. The questionnaire collected information from parents about the prevalence of constipation and associated factors as well. It asked about bowel movements, socio-demographic data, personal and family stressors, parental concern about constipation, and treatment methods.

RESULTS

The overall prevalence of constipation was 7.2%. It was 7.3% in boys and 7.2% in girls (P > 0.05). The parameters of siblings with health problems, constipation history in family members, abnormal oral habits, and little regular sporting activity were more common in constipated children than in non-constipated ones (P < 0.05). In the logistic regression analysis, never having used school toilets (OR: 5.9) and having problem to control their bowel after 2 years of age (OR: 3.1) were found to be major risk factors for constipation in schoolchildren ages 7-12 years. Constipated children had a lower consumption rate of fruits and vegetables and a higher consumption rate of milk-group foods, biscuits and macaroni than non-constipated children. Parental concern was at 90% and the rate of medical consultation was 23.2% for constipated children.

CONCLUSIONS

The risk factors for childhood constipation may be genetic, psychological or organic. Bowel functions may be affected by dietary habits. Parents, health and education professionals should give special attention to childhood constipation.

A cost analysis of functional bowel disorders in Iran

BACKGROUND AND AIMS

The objective of this work is to evaluate the health care utilization and cost of different types of functional bowel disorder (FBD) in a population of Iranian patients and compare the costs in consulters and non-consulters.

MATERIALS AND METHODS

A consecutive sample of 1,023 patients in an outpatient gastroenterology clinic in central Tehran were interviewed, using two questionnaires based on the Rome II criteria, from December 2004 to May 2005 to detect FBD patients and to determine the frequency of health resource utilization (physician visit, hospitalization, laboratory tests, imaging studies, and drugs) and productivity loss (days off work or with low functionality) due to FBD symptoms in the past 12 months. Societal perspective was used and cost per person per year was estimated in purchasing power parity dollars (PPP$).

RESULTS

The direct costs (for consulters, non-consulters; data presented in this order) were: irritable bowel syndrome (IBS; $92.04, $1.04), unspecified functional bowel disorder (FBD; $100.94, $0.39), functional constipation ($57.23, $1.04), and functional abdominal bloating ($71.35, $0.63). Indirect costs (for consulters, non-consulters) were: IBS ($811.85, $669.09), unspecified FBD ($705.85, $263.47), functional constipation ($587.48, $97.49), and functional abdominal bloating ($147.88, $38.60). Total yearly costs of IBS and functional constipation for urban adult population of Iran were roughly estimated at 2.94 billion PPP$ and 89.2 million PPP$, respectively.

CONCLUSIONS

As proven in developed countries, FBD and especially IBS seem to put a heavy burden on the economy of a developing country like Iran. Further population-based studies are needed for more precise estimations.

A randomized, double-blind, placebo-controlled trial assessing the efficacy and safety of tegaserod in patients from China with chronic constipation

AIM

To evaluate the efficacy and safety of tegaserod, 6 mg twice daily (b.i.d.), in men and women with chronic constipation (CC) from China.

METHODS

This was a multicenter, double-blind, placebo-controlled study. Following a 2-wk treatment-free baseline period, patients were randomized to receive either tegaserod (6 mg b.i.d.) or placebo (b.i.d.) for 4 wk. An analysis of covariance with repeated measures was used to determine the overall effect of treatment for the primary efficacy variable; the change from baseline in the number of complete spontaneous bowel movements (CSBMs) during the 4-wk treatment period. Secondary efficacy endpoints included other measures of response in terms of CSBMs, and patients' daily and weekly assessment of bowel habits. Safety was also assessed, based on the incidence and severity of adverse events (AEs).

RESULTS

A total of 607 patients were randomized to receive either tegaserod (n = 304) or placebo (n = 303). Tegaserod treatment resulted in a rapid and significant increase from baseline in the adjusted mean number of CSBMs per week over wk 1-4 compared with placebo (1.39 vs 0.91, P = 0.0002). A statistically significant difference in favor of tegaserod was also observed for a mean increase > or = 1 CSBM/wk over wk 1-4 (47.7% vs 35.0%, tegaserod vs placebo, respectively, P = 0.0018) and for the absolute number of > or = 3 CSBMs/wk over wk 1-4 (25.0% vs 14.5%, tegaserod vs placebo, respectively, P = 0.0021). Improvements in other symptoms of CC were also seen in the tegaserod group, including improved stool form and reduced straining. In addition, more patients in the tegaserod group reported satisfactory relief from their constipation symptoms. The frequency and severity of AEs was comparable between tegaserod and placebo groups, with the exception of a greater incidence of diarrhea in patients receiving tegaserod (3.6%) compared with placebo (1.7%).

CONCLUSION

Tegaserod treatment improved multiple symptoms of CC and was associated with a favorable safety profile.

Efficacy of tegaserod in chronic constipation in men

OBJECTIVES

Chronic constipation/idiopathic constipation is highly prevalent in western countries and traditional treatments are suboptimal. This multicenter study evaluated the efficacy and safety of tegaserod, a selective 5-HT(4) agonist and promotility agent, in men with chronic constipation.

METHODS

After screening and baseline phases, men with chronic constipation were randomized to receive either tegaserod 6 mg twice daily or placebo in a double-blind manner for 12 wk. Patients recorded symptoms using a diary. Primary efficacy variable was the response rate for an increase in complete spontaneous bowel movements (CSBMs) during the first 4 wk of double-blind treatment. Other efficacy measures included patient assessment of symptoms and satisfaction with symptom relief. Safety and tolerability were also evaluated.

RESULTS

In total, 322 patients were randomized to tegaserod (N = 158) or placebo (N = 164). Increases of at least one CSBM per wk during the first 4 wk of treatment observed for tegaserod compared with placebo (40.5%vs 29.3%, P= 0.03) were sustained throughout the 12-wk treatment period. Response rate for CSBM was also superior for tegaserod (P= 0.04 vs placebo) over the treatment period. Benefits for tegaserod over placebo were also observed for some secondary efficacy variables, however, statistical significance was not achieved at all weeks. Frequency of adverse events was similar with tegaserod and placebo.

CONCLUSIONS

Tegaserod 6 mg twice daily was effective and well tolerated in the treatment of chronic constipation in men. Tegaserod provided rapid relief of constipation within 1 wk and the effects were sustained for up to 12 wk.

Association between dietary fiber, water and magnesium intake and functional constipation among young Japanese women

OBJECTIVE

Most research on constipation has focused on dietary fiber intake. Here, we examined the intake of water and magnesium, nutrients possibly associated with constipation, as well as that of dietary fiber in relation to constipation.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 3835 female Japanese dietetic students aged 18-20 years from 53 institutions in Japan.

METHODS

Dietary intake was estimated with a validated, self-administered diet history questionnaire. Functional constipation was defined using the Rome I criteria.

RESULTS

The prevalence of functional constipation was 26.2%. Neither dietary fiber intake (mean=6.4 g/4186 kJ) nor intakes of total water and water from fluids were associated with constipation. Conversely, low intake of water from foods was associated with an increasing prevalence of constipation. In comparison with women in the first (lowest) quintile, the multivariate adjusted odds ratio (OR) (95% confidence interval (CI)) for women in the second, third, fourth, and fifth quintiles were 0.72 (0.57, 0.90), 0.78 (0.62, 0.98), 0.71 (0.56, 0.89), and 0.77 (0.61, 0.97), respectively (P for trend=0.04). Additionally, low magnesium intake was associated with increasing prevalence of constipation. Compared with women in the first quintile, the multivariate adjusted OR (95% CI) for women in the second, third, fourth and fifth quintiles were 0.70 (0.56, 0.88), 0.75 (0.60, 0.95), 0.73 (0.58, 0.92) and 0.79 (0.63, 0.996), respectively (P for trend=0.09).

CONCLUSIONS

Low intakes of water from foods and magnesium are independently associated with an increasing prevalence of functional constipation among a population whose dietary fiber intake is relatively low.

Symptom patterns and relative distribution of functional bowel disorders in 1,023 gastroenterology patients in Iran

BACKGROUND AND AIMS

There are scanty data on functional bowel disorder (FBD) patterns in Iran. This first-time study tried to provide preliminary data on relative distribution of different types of FBD and their symptom patterns in Iranian patients.

METHODS

A consecutive sample of 1,023 patients in an outpatient gastroenterology clinic in central Tehran was interviewed using two questionnaires based on Rome II criteria from December 2004 to May 2005 to detect FBD patients.

RESULTS

Of 1,023 gastroenterology patients, 410 met Rome II criteria for FBD; functional constipation, 115 (28%); irritable bowel syndrome (IBS), 110 (27%) [IBS-C, 29%; IBS-D, 11%; IBS-A, 60%]; functional bloating, 102 (25%); unspecified FBD, 76 (18%); and functional diarrhea, 7 (2%). FBD had no association with age or level of education, while it was more frequent in women (P=0.001). FBD was also more frequent among those with a history of abdominal/pelvic surgery (P=0.021). IBS patients had a lower mean of age compared with non-FBD group, while patients with constipation were older (Mann-Whitney U test, P=0.006). Constipation-related symptoms were the most frequent symptoms among IBS patients. Constipation (<3 defecations/week) was also the most frequent change in bowel habit in bloating and unspecified FBD patients. Fourteen percent of IBS consulters and 8.7% of functional constipation consulters met Rome II criteria for dyspepsia (disregarding the ruling out of upper gastrointestinal organic disease). Only 20% of patients with functional constipation were consulters.

CONCLUSIONS

Population-based studies at provincial levels are essential to clarify FBD patterns in each provincial district in the country.

Constipation and Diarrhea in Patients with Cancer

Constipation and diarrhea are both common problems in patients with advanced cancer. They are source of major morbidity and distress. Constipation is, overall, more common that diarrhea. Diarrhea may be severe and, in some cases, associated with life-threatening dehydration and electrolyte abnormalities. Indeed, with some of the newer chemotherapy agents, this is a problem seen with increasing frequency. Oncologists must be familiar with the common causes of constipation and diarrhea in cancer patients and the strategies to evaluate and manage these common and distressing symptoms. Both with constipation and diarrhea, there is a differential diagnosis. In many cases, management can be complex and challenging. Approaches to diagnosis, evaluation, and management are reviewed.

A combination of fibre-rich rye bread and yoghurt containing Lactobacillus GG improves bowel function in women with self-reported constipation

OBJECTIVE

The aim of the study was to investigate the effects of fibre-rich rye bread and yoghurt containing Lactobacillus GG (LGG) on intestinal transit time and bowel function, and to test whether they have an interaction in cases of self-reported constipation.

DESIGN

The study was carried out as a two-by-two factorial design.

SETTING

Free-living subjects.

SUBJECTS

A total of 59 healthy women with self-reported constipation, recruited by advertisement.

INTERVENTIONS

After a baseline period, the subjects were randomized into four diet groups: (1) rye bread+LGG yoghurt, (2) rye bread, (3) LGG yoghurt, and (4) control. The 3-week dietary intervention was followed by a 3-week follow-up period. During each period, total intestinal transit time was measured and the subjects recorded faecal frequency and consistency, difficulty in defecation and gastrointestinal symptoms.

RESULTS

The rye bread shortened total intestinal transit time (mean difference, -0.7; CI(95), -1.1 to -0.2; P=0.007), increased faecal frequency (0.3; CI(95), 0.1 to 0.5; P=0.001), softened faeces (-0.3; CI(95), -0.4 to -0.2; P<0.001) and made defecation easier (-0.4; CI(95), -0.5 to -0.2; P<0.001), but also increased gastrointestinal symptoms (1.6; CI(95), 0.7 to 2.4; P<0.001) compared to the low-fibre toast consumed in the LGG and control groups. There were fewer symptoms in the rye bread+LGG group compared to the rye bread group (-1.3; CI(95), -2.4 to -0.2; P=0.027).

CONCLUSIONS

Fibre-rich rye bread can be recommended in the treatment of constipation, and the simultaneous consumption of LGG yoghurt relieves the adverse gastrointestinal effects associated with increased intake of fibre.

SPONSORSHIP

Valio Ltd, R&D, and Fazer Bakeries Ltd.

Healthcare seeking for constipation: a population-based survey in the Mediterranean area of Spain

BACKGROUND

The use of healthcare resources for the management of constipation is not well-known.

AIM

To analyse healthcare seeking for constipation, defined by three different criteria, and its related factors and to assess the frequency of use of laxatives, suppositories and enemas for the treatment of constipation.

METHODS

A cross-sectional study in the general community. A questionnaire comprising 21-items was developed and delivered by mail to a random sample of 506 subjects aged 18-65 years, and belonging to a Spanish population.

RESULTS

Seeking of health care was high in the sample (16%) and was similar for all definitions of constipation (over 40% of constipated subjects). It was associated with female gender, a higher educational level and two symptoms, such as prolonged defecation and abdominal pain. A 14% of the sample used laxatives, and about a 25% of constipated subjects used laxatives at least once a week. Utilization was more frequent in women, with no differences by age group.

CONCLUSIONS

Chronic constipation is a problem that causes an important consumption of resources in our setting, derived from laxative use and the seeking of medical help to combat the problem. The use of these resources is higher in women.

Patterns of constipation in urogynecology: clinical importance and pathophysiologic insights

OBJECTIVE

We have analyzed the prevalence and patterns of constipation in women with urinary symptoms and/or genital prolapse.

STUDY DESIGN

Seven hundred and eighty-six consecutive urogynecologic patients underwent a questionnaire and structured clinical assessment. Comparison between constipated and nonconstipated women was made. Fisher exact test, Wilcoxon rank sum test, and logistic regression were used for statistical analysis (P < .05 for significance).

RESULTS

Thirty-two percent of women were constipated (172 difficult stool passage, 13 reduced stool frequency, 64 both). A genital prolapse > or = 2 degree Half Way System (HWS) was present in 44% of women. A posterior colpocele was more frequent in constipated women (35% vs 19%; P < .0001), resulting in a risk factor for constipation (OR 2.31; 95% CI 1.63-3.27). By contrast, higher degrees of anterior colpocele appeared to protect against constipation (OR 0.80; 95% CI 0.66-0.96). No differences in prevalence of constipation were observed for urinary symptoms or urodynamic diagnosis.

CONCLUSION

Bowel dysfunction correlates exclusively with posterior aspects of the pelvic floor support.

Dietary intake in relation to self-reported constipation among Japanese women aged 18-20 years

OBJECTIVE

Information on modifiable lifestyle factors associated with constipation is limited, especially among non-Western populations. We examined associations between dietary intake and self-reported constipation in young Japanese women.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 1,705 female Japanese dietetic students aged 18-20 years and free of current disease and current dietary counseling.

METHODS

Dietary intake was estimated over a 1-month period with a validated, self-administered, diet history questionnaire, and lifestyle variables including self-reported constipation were assessed by a second questionnaire designed for this survey.

RESULTS

A total of 436 women (26%) reported themselves to be 'constipated'. A multivariate odds ratio (OR) for women in the highest quartile of rice intake was 0.47 (95% confidence interval (CI): 0.33, 0.68) compared with the lowest. Additionally, women in the highest category of coffee intake had a multivariate OR of 0.67 (0.47, 0.94) compared with women in the lowest. Conversely, women in the highest quartile of confectionery intake had a multivariate OR of 1.54 (1.12, 2.13) compared with women in the lowest. Moreover, a multivariate OR for constipation for women in the highest quartile of Japanese and Chinese tea intake was 1.49 (1.09, 2.05) compared with women in the lowest. Neither total dietary fiber intake nor other lifestyle factors examined were associated with constipation.

CONCLUSIONS

The consumption of rice and coffee was inversely associated with and that of confectioneries and Japanese and Chinese tea was positively associated with a prevalence of self-reported constipation.

Posterior pelvic floor compartment disorders

Posterior pelvic floor compartment disorders generally refer to functional anorectal disturbances that by definition are symptom-based rather than anatomical defect-based and have a significant impact on quality of life. Symptoms attributed to the posterior compartment are often non-specific and associated with structural, neuromuscular and functional defects giving rise to symptoms of prolapse, pelvic pressure, faecal incontinence, stool trapping and constipation. They may range from mild to incapacitating and occur in varying combinations. While symptoms of constipation and incontinence may conceptually represent the opposing extremes of normal anorectal function, the dynamic interrelationships between the different pathophysiological mechanisms involved in the development of these disorders suggest a more complex explanation. Faecal continence and defecation are dependent on several neurological and anatomical factors that involve coordinated physiological processes, including intestinal transit and absorption, colonic transit, rectal compliance, anorectal sensation and continence mechanism. However, it is well recognized that pelvic floor symptoms originating from one compartment do not imply absent pathology in another compartment. Furthermore, symptoms associated with one disorder (such as constipation related to functional obstructed defecation) can be causative in the sequential development of other pelvic floor disorders, such as a urogenital prolapse syndrome, that may further exacerbate symptoms. In addition, it has been found that treatment that corrects one problem may improve, worsen or even predispose to other symptoms from another compartment. Consequently, while the concept of global pelvic floor dysfunction has emerged, the traditional single speciality referral and evaluation of pelvic floor problems continues to foster potentially segregated management strategies that can overlook the relevance of concomitant symptomatology. The evaluation and treatment of posterior pelvic compartment disorders needs to assume an individualized but multidisciplinary therapeutic approach. Given the variation in surgical approaches described to correct anatomical integrity of posterior pelvic compartment deficits, the consensus on optimal management has yet to be achieved. Therefore, it is critical that outcome measures following surgery are clearly defined. Treatment is to a great extent dictated to by functional severity and the impact that symptoms have on quality of life. Long-term follow-up should ensure that the potential for complications is minimized and satisfactory bowel, bladder and sexual function is maintained.