Understanding Constipation: A Cross-Sectional Multicenter Study From A Developing Country Setting

Abstract

Introduction: Constipation is a major public health issue worldwide and is associated with significant health care financial burden and reduced quality of life. About half of the patients are dissatisfied with the treatment prescribed. There is a lack of data on patients understanding of constipation; we therefore aimed to understand the nature of patient's defecatory disorders by using ROME III criteria. Methods: A cross-sectional study was carried out in outpatient gastroenterology clinics of two major hospitals of Karachi-Pakistan; one public and other was private tertiary care hospital. Purposive sampling was done and all patients complaining of constipation and consenting to participate in the study were included. Patients with alarm features (GI bleeding and weight loss) were excluded. Face to face interviews were conducted by trained doctors using a structured Rome III based pre-tested questionnaire and Bristol Stool Scale scoring system. Results: A total of 396 study participants were enrolled with mean (SD) age 38.8(14.7) years. Out of these 210(53%) participants were men. Irritable bowel syndrome-constipation (IBS-C) was present in 209(52.7%) and remaining 186(46.9%) had fulfilled the criteria of functional constipation (FC). Of all the participants, 214(54.0%) reported to have slow transit constipation based upon Bristol Stool Scale (Figure 1). Some accompanying symptoms reported by patients include sensation of incomplete evacuation (69.2%), feeling of abdominal distension (63.9%) and bloating (74.2%). Frequency of other symptoms reported by study participants and gender differences are given in Table 1. In our study FC was found to be more common amongst men (66.1% vs. 33.9%) whereas IBS-C was more common amongst women (57.9% vs. 42.1%, P < 0.001). A higher proportion of women reported more severe form of constipation as compared to men (83.3%, n=150 vs. 66%, n=138 P < 0.001). However, a higher percentage of men reported using medications to treat their symptoms (71.2%, n=151 vs. 57.1%, n=105, P=0.003). Various treatment modalities used by study participants are shown in Figure 2.FigureFigureTable: Table. Frequency of symptoms reported by study participants (n=396)Conclusion: Almost half of the patients were not suffering from slow transit constipation. A large number of patients had diverse accompanying defecatory symptoms. Proper understanding of patient's symptoms is essential for optimizing individual patient management.