Constipation-related Quality Of Life Research Articles

Risk Factors for Mucosal Redness in the Duodenal Bulb as Detected via Linked Color Imaging.

Linked color imaging (LCI) for image-enhanced endoscopy (IEE) highlights mucosal color differences. We investigated risk factors associated with mucosal redness of the duodenal bulb using LCI. Consecutive patients were retrospectively selected after their duodenal bulbs were observed via LCI. A symptom questionnaire (Izumo scale) was completed. The LCI of the duodenal bulb was subjectively evaluated on whether redness was present and objectively evaluated based on L* a* b* color values. The clinical characteristics of the 302 study participants were: male/female, 120/182; mean age, 70.9 years. Twenty-one cases (7.0%) were in the redness (+) group. After multiple regression analysis, independent predictors for the red component (a*) of the duodenal bulb using LCI were: age (β = -0.154, p < 0.01), female (β = -0.129, p < 0.05), body mass index (BMI; β = -0.136, p < 0.05), Helicobacter pylori eradication (β = 0.137, p < 0.05), endoscopic gastric mucosal atrophy score (EGAS; β = -0.149, p < 0.05), and constipation-related quality of life (QOL) (β = -0.122, p < 0.05) scores. Lower age, lower BMI, lower EGAS, a constipation-related QOL score, post-H. pylori eradication, and being male were associated with mucosal redness in the duodenal bulb with IEE using LCI.

Multiple thread ligations versus stapled hemorrhoidopexy on operative outcomes of grade III hemorrhoids: A retrospective cohort study.

Controversy remains regarding the safety and efficacy of hemorrhoid ligation and stapled hemorrhoidopexy (SH) in the treatment of hemorrhoids. The study was to explore the operative outcomes of patients underwent multiple thread ligations (MTL) with SH for the management of grade III hemorrhoids. This cohort study included patients who underwent MTL (MTL group, 128 cases) or SH (SH group, 141 cases) for grade III hemorrhoids between June 2019 and May 2021. A total of 115 patients in MTL group and 115 patients in SH group were finally included by propensity score matching with a ratio of 1:1. The primary outcome was the recurrence of prolapse within 6 months. Secondary outcomes were operative time, post-operative pain scores, hospital stay, the incidence of complications, Wexner incontinence score, and quality of life of patients with constipation at 6 months post procedure. Multiple thread ligations and SH resulted in comparable recurrence within 6 months of follow-up, with five and seven cases of recurrence, respectively, (P = 0.352). The two groups had comparable outcomes in terms of post-operative pain, hospital stay, Wexner incontinence scores, and constipation-related quality of life (all P > 0.05). The median operative time was 16 min (15-18 min) in the MTL group versus 25 min (16-33 min) in the SH group (P < 0.01). Univariate analysis showed that the MTL technique had a lower risk of postoperative bleeding than that with the SH technique (P < 0.05). The study indicated that the MTL technique might achieve comparable operative outcomes compared with the SH technique for the management of grade III hemorrhoids, nevertheless, MTL seemed to be associated with less risk of surgical bleeding than SH.

Involving patients in the process: Development of a constipation patient-reported outcome measure for symptoms and quality of life

ObjectivePatient-reported outcome measures (PROMs) are useful standardized tools to measure current patient health status and well-being. While there are existing constipation-related PROMs, the majority of PROMs were not developed with adequate patient involvement and few examined content validity. Accordingly, the current study aimed to develop a constipation PROM with multiple phases of patient and clinician involvement. MethodsTo generate PROM items, 15 patients with chronic constipation (age range =28–79 years, 10 females) underwent a qualitative interview exploring their experiences with chronic constipation. Following that, eight clinical experts completed the content validity index (CVI) ratings of all the items generated to assess content validity. Based on results of the content validity assessment, relevant items were maintained and 12 participants with chronic constipation were re-interviewed to obtain feedback about comprehensibility, comprehensiveness and relevance. ResultsSix themes and 25 sub-themes emerged from the qualitative interview, and an initial list of 33 symptom items and 18 quality of life (QoL) items were generated. Based on the CVIs calculated, 11 symptom items and nine QoL items were maintained with the scale-content validity index indicating excellent content validity. Overall, participants indicated the PROM to be relevant, comprehensive and easy to understand however, minor amendments were made to improve the three qualities of interest. ConclusionThe current study developed a constipation PROM that measures both symptom severity and constipation-related QoL, with supporting evidence for relevance, comprehensiveness and comprehensibility. Further prioritization should be given to validating and exploring new digital modalities of PROM administration.

The effects of synbiotics on indoxyl sulphate level, constipation, and quality of life associated with constipation in chronic haemodialysis patients: a randomized controlled trial

BackgroundGut microbiota dysbiosis in patients with chronic kidney disease on haemodialysis (CKD-HD) creates an increase in proteolytic bacteria activity, leading to an increase in the production of uraemic toxins, such as indoxyl sulphate, worsening of constipation symptoms and reducing patients’ quality of life. Improving gut microbiota dysbiosis is expected to improve this condition. This study aimed to evaluate the effect of synbiotics on indoxyl sulphate levels, constipation symptoms, and constipation-related quality of life in haemodialysis patients.MethodsThis was a double-blinded randomized controlled clinical trial with a parallel design involving haemodialysis patients. We included chronic haemodialysis patients with gastrointestinal complaints, difficulty defecating, faeces with hard consistency, or a bowel movement frequency of fewer than three times per week. Patients were randomly divided into two groups (synbiotics (Lactobacillus acidophilus and Bifidobacterium longum 5x109 CFU) and placebo) for 60 days of oral intervention. All participants, caregivers, and outcome assessors were blinded to group assignment. The primary outcome was a decrease in indoxyl sulphate toxin levels. Meanwhile, improvement in constipation symptoms (measured using the Patient Assessment of Constipation: Symptoms (PAC-SYM) questionnaire) and improvement in constipation-related quality of life (measured using the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire) were assessed as secondary outcomes.ResultsWe included 60 patients (30 intervention; median age of 51.23 (13.57) years, 33.3% male; 30 control; median age of 52.33 (11.29) years, 36.7% male). There was no significant difference in terms of pre- and postintervention indoxyl sulphate toxin levels in the synbiotics group compared to the placebo group (p=0.438). This study found an improvement in constipation symptoms (p = 0.006) and constipation-related quality of life (p=0.001) after synbiotic administration.ConclusionTwo months of synbiotic supplementation did not lower indoxyl sulphate toxin levels. Nevertheless, it had a major effect in improving constipation and quality of life affected by constipation in patients undergoing chronic haemodialysis.Trial registrationNCT04527640 (date of first registration: 26/08/2020)

A Systematic Review of the Development and Psychometric Properties of Constipation-Related Patient-Reported Outcome Measures: Opportunities for Digital Health.

Background/AimsConstipation can be a chronic condition that impacts daily functioning and quality of life (QoL). To aid healthcare providers in accurately assessing patient symptoms and treatment outcomes, patient-related outcome measures (PROMs) have been increasingly adopted in clinical settings. This review aims to (1) evaluate the methodological quality and measurement properties of constipation-related PROMs, using the COnsensus-based Standards for the selection of health Measurement INtruments (COSMIN) criteria; and (2) assess the modes of digital dissemination of constipation-related PROMs.MethodsPubMed, Embase, and PsycINFO databases were searched and 11 011 records ranging from 1989 to 2020 were screened by 2 independent reviewers. A total of 26 studies (23 PROMs; 18 measuring symptom-related items and 5 measuring constipation-related QoL items) were identified for the review and assessed.ResultsThere were multiple variations between PROMs, including subtypes of constipation, methods of administration, length of PROM and recall period. While no PROM met all the COSMIN quality standards for development and measurement properties, 5 constipation-related PROMs received at least 4 (out of 7) sufficient ratings. Only 2 PROMs were developed in Asia. Five PROMs were administered through digital methods during the validation process but methods of adapting the PROMs into digital formats were not reported.ConclusionsThe constipation-related PROMs identified in this review present varying quality of development and validation, with an overall need for improvement. Further considerations should be given towards more consistent methodology and reporting of PROM development, increase in culturally-specific PROMs, and better reporting of protocol for the digitization of PROMs.

Konstipasyon Yaşayan Gebelere Verilen Eğitimin Kabızlık Yaşam Kalitesi ve Kabızlık Ciddiyeti Üzerine Etkisi

Aim: The purpose of this study was to investigate the effects of education provided to pregnant women with complaints of constipation on their constipation-related quality of life and constipation severity.Methods: This randomized controlled experimental study consisted of an intervention group (n:32) and a control group (n:32). The data were collected by using a Personal Information Form, the Constipation Severity Instrument and the Patient Assessment of Constipation Quality of Life Questionnaire. In data analysis, frequency and percentage calculations, chi-squared, Student’s t-test or Mann-Whitney U test and Person’s correlation analysis were used.Results: After the education, the pregnant women in the intervention group had a lower mean total PAC-QOL score (49.42±4.19) and a lower mean total CSI score (19.40±2.62) than those in the control group (respectively, 74.00±5.47; 39.45±3.21) (p&amp;lt;0.001). Accordingly, the pregnant women who received constipation education had fewer constipation symptoms and higher levels of constipation-related quality of life. It was determined among all participants that, as the severity of constipation symptoms decreased, their quality of life increased (p&amp;lt;0.01).Conclusions: As a result of the education provided to the pregnant women experiencing complaints of constipation, the pregnant women’s constipation-related complaints significantly decreased, and their constipation-related quality of life increased. Nurses are recommended to provide pregnant women experiencing constipation with constipation-related evidence-based care and education.

Role of yoga therapy in improving digestive health and quality of sleep in an elderly population: A randomized controlled trial

IntroductionConstipation and sleep disturbances commonly affect elderly population results in compromised physical and mental health. Mind-body interventions like yoga not only address the mental and physical health but also promote healthy ageing. This study evaluates the effect of 3 months yoga intervention on the sleep and constipation related quality of life (QoL) among the elderly. Materials and methodsNinety six participants aged between 60 and 75 who did not had any history of yoga practice for past 1 year and having a zubrod score of 0–2 were randomized in to yoga (n = 48) or waitlisted control (n = 48). The yoga group received yoga interventions at a frequency of 3 sessions per week for 3 months. Pittsburg Sleep Quality Index (PSQI) and Patient Assessment of Constipation QoL (PAC-QOL) were used to assess the improvement. Intention to treat analysis method was used to include the drop-out participants. ResultsEighty one participants (Yoga = 48, waitlisted control = 33) completed the study. Wilcoxon's sign rank test has shown that the yoga group had statistically significant changes in most of the parameters in PSQI and PAC-QOL (P ≤ 0.05). Mann Whitney test revealed that yoga group has better improvement in the sleep quality and constipation related QOL (P ≤ 0.05) compared to the controls. DiscussionThe results signify yoga can ease old age related issues like constipation and insomnia. This is encouraging for inclusion of yoga as a daily practice regimen to improve the constipation and sleep related quality of life in elderly population.

Bulgarian yogurt relieved symptoms and distress and increased fecal short-chain fatty acids in healthy constipated women: A randomized, blinded crossover controlled trial

BackgroundProbiotic yogurt containing both starter culture and additional beneficial bacteria was shown to promote bowel movement and improve mood. The present study aimed to investigate the effect of Bulgarian yogurt containing only starter culture on defecation, constipation symptoms, mood, and fecal short-chain fatty acids in healthy constipated women. MethodA randomized, double-blinded, crossover-controlled trial was conducted in thirty-one healthy constipated women without irritable bowel diseases. After randomized into two groups, each group received an inverse order of Bulgarian yogurt (made by S. thermophilus and L. bulgaricus) and lactic-acidified milk curd for three weeks each with three-week washout period between interventions. Outcome included defecation frequency and fecal characteristics (Bristol stool scale), constipation symptoms (Constipation Assessment Scale and ROME IV criteria), mood (distress thermometer), and constipation-related quality of life (CRQoL questionnaire). Short-chain fatty acids were measured by GC–MS analysis of stool. ResultsConstipation symptoms (rectal pain, separate hard or lumps stool, and inability to pass stool) were relieved (p < 0.001); mood scores associated with emotional distress and constipation were reduced (p < 0.05); number of participants with fecal short-chain fatty acids (butyrate, propionate and acetate) were increased after taking Bulgarian yogurt but not the milk curd. Defecation frequency, CRQoL, and fecal characteristics were improved by both interventions. ConclusionsThe findings of this study suggested that continuous intake of Bulgarian yogurt with no additional probiotic bacteria for three weeks may relieve constipation symptoms and distress in healthy constipated women. The simultaneous increase in short-chain fatty acids suggests that the improved symptoms and mood may result from stimulation of gut-brain axis.

Association between the severity of constipation and sarcopenia in elderly adults: A single-center university hospital-based, cross-sectional study.

The aim of the present study was to investigate the association between the severity of constipation and sarcopenia in elderly adults. We conducted a single-center university hospital-based, retrospective cross-sectional study of consecutive outpatients aged ≥65 years from 2017 to 2020. Patients were included in the study if all of the following information were available from medical records: Patient's profile (age, sex, body mass index), laxative/prokinetics use, evaluation of sarcopenia, nutritional status, and questionnaires concerning the severity of constipation [Constipation Scoring System (CSS)], abdominal symptom-related quality of life (QOL) (Izumo scale) and stool shape [Bristol Stool Form Scale (BSFS)]. Multiple regression analysis of risk factors for high CSS score was performed. The results revealed that of the 310 eligible study subjects, [149 men (48.1%) and 161 women (51.9%); mean age, 75.7±6.1 years; mean body mass index, 23.0±3.6 kg/m2], sarcopenia was noted in 83 cases (26.8%). The CSS score was significantly higher in the sarcopenia group than that noted in the non-sarcopenia group (4.9±4.9 vs. 3.6±3.6, P=0.009). The CSS score was significantly associated with the albumin level (r=-0.148), lymphocyte count (r=-0.118), CONUT score (r=0.130), reflux-related QOL score (r=0.155), upper abdominal pain-related QOL score (r=0.171), fullness-related QOL score (r=0.299), constipation-related QOL score (r=0.615), diarrhea-related QOL score (r=0.235) and BSFS score (r=-0.114). In multiple regression analysis, independent predictors for CSS score were sarcopenia [standardized partial regression coefficient (β)=0.107, P=0.032], constipation-related QOL score (β=0.537, P<0.001), laxative/prokinetics use (β=0.211, P<0.001) and BSFS score (β=-0.098, P=0.031) (R2=0.436). In conclusion, sarcopenia, constipation-related QOL score, laxative/prokinetics use and BSFS score are associated with the severity of constipation in elderly adults.

Non-pharmacological interventions to improve constipation amongst older adults in long-term care settings: A systematic review of randomised controlled trials

Constipation is a highly prevalent condition amongst older adults in long-term care settings and laxatives are not always the solution. We aimed to examine the characteristics and the effects of non-pharmacological interventions to improve constipation amongst older adults in long-term care settings. Eligible studies were identified using PubMed, CINAHL, Scopus, Web of Science, Cochrane and EMBASE (up to April 2019). We included 7 studies with a total of 657 patients. Five interventions improved the number of bowel movements (i.e. laxative tea, fermented oat drink, patient education, probiotics and multi-component intervention). The administration of probiotic capsules and fermented oat drinks also improved stool form. Auricular acupressure improved constipation symptoms and constipation-related quality of life. After appraising the trials’ methodological quality and risk of bias, we cannot recommend any non-pharmacological interventions to improve constipation amongst older adults in long-term care settings until more robust studies have been conducted.

Systematic review on the treatment of functional constipation with electroacupuncture and gastro-kinetic drugs

To compare the therapeutic effect and safety in treatment of functional constipation between electroacupuncture (EA) and gastro-kinetic drugs. Using "functional constipation"， "prucalopride"， "mosapridecitrate"， "electro-acupuncture" and "randomized controlled trial"， both in Chinese and English, as search terms, the articles of randomized controlled trial (RCT) regarding to the comparison of therapeutic effect on functional constipation in the patients between EA and gastro-kinetic drugs were retrieved from CMB, Wanfang, VIP, CNKI, OpenGrey, CINAHL, Cochrane Library, JBI, PubMed, WOS and Ovid databases. The retrieval time was from the establishment date to June 2018. The two researchers screened articles, extracted data and assessed literature quality in reference to Cochrane Handbook. Using RevMan 5.3 software, the meta-analysis was conducted. A total of 11 articles were included finally, with 744 patients involved. It was found after meta-analysis that in EA group, the weekly spontaneous defecation frequency, constipation related quality of life in patients, depression relief and incidence of adverse reaction were all better than those in gastro-kinetic medication group. The therapeutic effect of the improvements in stool character and defecation difficulty in EA group were better or similar to that in gastro-kinetic medication group. Regarding the therapeutic effect and safety in treatment of functional constipation, the results of electroacupuncture are superior or similar to gastro-kinetic medication, presenting a satisfactory therapeutic prospect.

Evaluating the efficacy of biofeedback for chronic constipation using the constipation severity instrument and constipation-related quality of life measure

Background: Many studies have described using biofeedback to treat chronic constipation, but few reports have addressed its impact on quality of life (QOL). Objective: The aim was to evaluate the effect of biofeedback with a validated Constipation Severity Instrument (CSI) and Constipation-Related QOL (CRQOL) measure. Design: Prospectively collected data with retrospective analysis. Setting: Tertiary care academic center. Patients and Methods: Patients referred to the Center for Pelvic Physiology with chronic constipation and objective signs of pelvic floor dyssynergia, who received a complete course of biofeedback therapy and returned all of their questionnaires, were enrolled in the study. Questionnaires were given upon initial evaluation, immediately after the complete course of biofeedback, and 6 months later. Main Outcome Measures: Improvement of dyssynergia symptom and QOL by CSI and CRQOL. Sample Size: A total of 25 patients (20 females and 5 males) were included. Results: Overall, 75% of patients reported satisfactory symptom and QOL improvement. CSI total scores decreased after treatment (35.0 vs. 31.0, P = 0.06) and at 6-month follow-up (35.0 vs. 30.0, P = 0.05). Only the obstructive defecation (OD) subscale of CSI improved significantly after treatment (median 21.0 vs. 16.5, P

The Efficacy of Functional Electrical Stimulation of the Abdominal Muscles in the Treatment of Chronic Constipation in Patients with Multiple Sclerosis: A Pilot Study.

Chronic constipation in patients with multiple sclerosis (MS) is common and the current methods of treatment are ineffective in some patients. Anecdotal observations suggest that functional electrical stimulation (FES) of the abdominal muscles may be effective in the management of constipation in these patients. Patients and Methods. In this exploratory investigation we studied the effects of FES on the whole gut transit time (WGTT) and the colonic transit time (CTT). In addition, we evaluated the treatment effect on the patients' constipation-related quality of life and on the use of laxatives and the use of manual bowel evacuation. FES was given for 30 minutes twice a day for a period of six weeks. Four female patients were studied. Results. The WGTT and CTT and constipation-related quality of life improved in all patients. The patients' use of laxatives was reduced. No adverse effects of FES treatment were reported. Conclusion. The findings of this pilot study suggest that FES applied to the abdominal muscles may be an effective treatment modality for severe chronic constipation in patients with MS.

Cross Cultural Comparison of Constipation Profiles at Tertiary Care Centers Between India and USA

Introduction: Cultural and geographic differences in perception of constipation are not well studied. This study aims to determine if there are significant differences among clinical features, disease severity, and quality of life (QOL) of patients presenting with constipation at a tertiary care center in India and one in the US. Methods: Consecutive patients presenting with constipation of >6 months' duration were recruited. A detailed questionnaire about their demographics and constipation symptoms were administered. Severity of constipation and its impact on QOL were measured using patient assessment of constipation severity score (PAC-SYM) and constipation related QOL (CR-QOL) questionnaire, respectively. Anxiety and depression were assessed using hospital anxiety depression scale (HADS) and somatization was assessed using the patient health questionnaire (PHQ-15). Multivariate linear regression defined the independent effects of the measured parameters on CR-QOL. Results: 49 patients from US and 39 from India were enrolled. Mean frequency of bowel movements/week in Indian patients was significantly higher than US patients (6.6, 95% CI 5.2-8 vs. 3.4, 95% CI 2.7-4, P < 0.001). Stool form reported by patients were significantly different at two centers with Bristol stool form 1 being most common in the US (56.1%) and form 3 in India (28.1%, P=0.005). US patients considered their constipation to be more severe and their mean PACSYM scores (20.9, 95% CI 18.4-23.5) were significantly higher than Indian patients (15.6, 95% CI-13.3-18, P=0.004). Moderate to severe somatization symptoms were present in 57.1% of US patients compared to 28.2% of Indian patients (P=0.007). However, Indian patients were more depressed (46.2%) compared to US patients (14.3%, P=0.001). CR-QOL scores at two sites were similar (US 44.8, 95% CI 40.7-48.8 and India 44.8, 95% CI 40.6-48.9, P=0.99). Disease severity (P < 0.001), anxiety (P=0.01) and depression (P=0.04) were independent predictors of CR-QOL on multivariate analysis. Conclusion: Indian patients with constipation have significantly higher mean frequency of bowel movements than US patients indicating their perception of constipation is different. While disease severity was higher in US patients, depression was more prevalent among Indian patients. Disease severity, anxiety and depression appeared to be independent predictors of disease-specific QOL which was similarly affected at two centers.

Comorbid Depression, Not Symptom Severity or Disease-Specific Quality of Life, Predicts Work Absenteeism in Chronic Constipation

Introduction: Chronic constipation is common and has a considerable economic impact. Little is known about the effect of constipation on workplace productivity, specifically employee absenteeism. We sought to determine whether there is an association between clinical features, symptom severity, and comorbid conditions in constipation and employee absenteeism. Methods: We enrolled consecutive patients referred to our center for anorectal manometry (ARM) in the setting of chronic constipation. Patients completed validated constipation-specific questionnaires on symptom severity (PAC-SYM) and constipation-related quality of life (CR-QOL) as well as the Hospital Anxiety and Depression Score inventory (HADS) and the Patient Health Questionnaire 15 (PHQ-15), a measure of somatization. Additionally, patients completed a Rome III constipation questionnaire to determine Rome diagnosis and were asked about missed work days due to constipation symptoms occurring in the last year before enrollment. Multivariable ordinal logistic regression adjusting for confounders defined independent effect of measures of constipation severity and QOL, comorbidities, and demographics on work absenteeism. Results: Our study enrolled 114 patients referred for evaluation of chronic constipation, of whom 68 (59.6%) were employed, 18 (15.8%) were unemployed, 8 (7.0%) were students, and 20 (17.5%) were retired. Of the 75 patients who were employed or students with data on absenteeism (90.7% female, mean age 42.5, 13.3% functional constipation, 42.7% IBS, 44% no Rome diagnosis), 45 (60.0%) did not miss any work or school due to constipation symptoms, 16 (21.3%) missed 30 days (Figure 1). On univariate analysis, depression (P=0.0001), CR-QOL (P=0.0002), anxiety (P=0.003), and PAC-SYM (P=0.006) were all correlated with increased work or school absenteeism (Table 1). After multivariate adjustment, only depression remained an independent predictor of work/school absenteeism (OR=1.24, P=0.01).Figure 1Table 1: Correlations between patient parameters and work/school absenteeismConclusion: Among patients presenting for evaluation of chronic constipation, depression, rather than symptom severity or constipation-related quality of life, predicts work/school absenteeism. Providers should consider screening patients presenting with constipation for depression, which may affect treatment modalities offered.

PTU-181 An exploratory qualitative study investigating patients’ experiences of constipation and how their self-reported symptoms and quality of life compare with currently available validated measures

<h3>Introduction</h3> The most widely-used validated questionnaires for assessing constipation are the Patient Assessment of Constipation Symptoms (PAC-SYM) and the Cleveland Clinic Constipation Score (CCCS). We aimed to assess patients’ reported symptoms of constipation, preferred terminology, and quality of life (QoL) issues, and whether these are reflected in currently available validated questionnaires. <h3>Method</h3> Nineteen semi-structured interviews were conducted with patients presenting with constipation to assess their symptoms, the terminology they preferred, suitability of existing assessment tools, and to explore participants’ constipation-related QoL issues. An inductive thematic framework was adopted to identify subthemes. Eleven clinicians rated the clinical importance of the symptoms and QoL issues reported by patients. <h3>Results</h3> Three main themes were identified: a) language used to describe bowel issues, b) symptoms and toilet behaviours and c) issues regarding QoL. <i>“Stool”</i>and <i>“motions”</i>were the most acceptable words to describe stool, and <i>“going to the toilet”</i>for describing the act of defecation. The words <i>“digital assistance”, “evacuation”</i>and <i>“defecation”</i>were poorly understood. Of the 12 most troublesome symptoms patients reported, only four are included in the PAC-SYM and five in the CCCS. Six of the symptoms reported as most troublesome are not included in either the PAC-SYM or the CCCS. Although all clinicians reported uncontrolled leakage of stool as a clinically important symptom, this was not included in either assessment tool. Of the symptoms that clinicians thought to be the most clinically relevant, two were not reported to be bothersome by patients (use of laxatives, straining). Only a small number of clinicians perceived some of the most bothersome symptoms reported by patients as clinically relevant. <h3>Conclusion</h3> Patients presenting with constipation report a range of individual symptoms and QoL issues, most of which are not included in validated questionnaires. The terminology used in these questionnaires for describing bowel issues is poorly understood by patients. Furthermore, there is a discrepancy between patients and clinicians on what symptoms and QoL issues are perceived to be important. The development of a new assessment tool evaluating the wide range of constipation-related symptoms and QoL issues is needed. <h3>Disclosure of interest</h3> E. Dimidi: None Declared, L. Dibley: None Declared, N. Cotterill Consultant for: Astellas Pharma Europe B. V. and Procter and Gamble, C. Knowles: None Declared, S. Scott: None Declared, K. Whelan: None Declared, C. Norton: None Declared.

Perineal rectosigmoidectomy: quality of life

For any surgical treatment of full-thickness rectal prolapse, little attention has been given to quality of life (QoL). This study prospectively evaluated continence, constipation and QoL after perineal rectosigmoidectomy for full-thickness rectal prolapse in young and elderly patients in the long term. From May 2003 to May 2010, consecutive patients suffering from full-thickness rectal prolapse and treated with perineal rectosigmoidectomy were prospectively studied. A standardized questionnaire, including the Cleveland Clinic Constipation Score (CCCS), the Cleveland Clinic Incontinence Score (CCIS) and generic [EuroQol five-dimension (EQ-5D)] and constipation-specific [Patient Assessment of Constipation-Quality of Life (PAC-QOL)] QoL scores, was administered pre- and postoperatively. The Wilcoxon test (for EQ-5D data) and two-sample Student's t-test [for EuroQol visual analogue scale (EQ-VAS), CCCS, CCIS and PAC-QOL data) were used for statistical analyses. Fifty-three patients (47 women), 72.7 (range 30-89) years of age, underwent perineal rectosigmoidectomy. One patient died and one patient needed reoperation. Five full-thickness recurrences occurred. Thirty-seven patients completed the follow-up questionnaire at a median of 49 (range, 6-89) months. Postoperative incontinence and constipation improved significantly (CCIS from 13 ± 7.28 to 8.7 ± 6.96 and CCCS from 8.32 ± 6.96 to 3.49 ± 4.17). Furthermore, QoL, in terms of mobility, usual activity, pain/discomfort and anxiety/depression and subjective state of health, were significantly better at follow-up (P < 0.001). All dimensions of constipation-related QoL improved (P < 0.001). The results did not differ significantly between patients under or over 69 years of age. Patients' experience improved general and constipation-related QoL after perineal rectosigmoidectomy, and this was independent of age.

Quality of life after laparoscopic resection rectopexy

This study evaluated continence, constipation, and quality of life (QoL) after laparoscopic resection rectopexy (LRR) for full-thickness rectal prolapse. Results were compared with existing data after perineal rectosigmoidectomy (PRS). From May 2003 to February 2008, consecutive patients suffering from full-thickness rectal prolapse undergoing LRR were retrospectively studied. A standardized questionnaire including the Cleveland Clinic Constipation and Incontinence Scores (CCCS and CCIS) as well as general and constipation-related QoL scores (EQ-5D and PAC-QOL) was administered. Results were compared with those after PRS. For statistic analysis, the Wilcoxon test (EQ-5D and EQ-VAS) and two-sample Student's t test (CCCS, CCIS, and PAC-QOL) were used for LRR, for the comparison of both procedures Mann-Whitney test (EQ-5D) and two-sample Student's t test (EQ-VAS, CCCS, CCIS, and PAC-QOL). Eighteen patients, 15 female, aged 58.1 (±20.2) years underwent LRR. Eleven patients completed follow-up. Postoperatively, neither functional outcome nor QoL improved. Two recurrences occurred, morbidity was n = 2, and mortality n = 1. In comparison, patients after PRS benefit from improved constipation, general QoL measures, status of health, and all dimensions of constipation-related QoL. Patients after LRR do not benefit from improved general nor constipation-related QoL nor improved functional results compared to PRS.

Quality of life after transperineal rectosigmoidectomy

: This study evaluated continence, constipation and quality of life before and after perineal rectosigmoidectomy for full-thickness rectal prolapse. : Consecutive patients with full-thickness rectal prolapse undergoing perineal rectosigmoid- ectomy (Altemeier's procedure) between May 2004 and June 2008 were studied. A standardized questionnaire, including the Cleveland Clinic Constipation Score (CCCS), Cleveland Clinic Incontinence Score (CCIS) and quality of life scores (EuroQol-Five Dimensions, EuroQol-Visual Analogue Scale and Patient Assessment of Constipation-Quality of Life (PAC-QOL)), was administered before and after operation. : Thirty-eight patients (32 women) of mean(s.d.) age 75(13) years underwent rectosigmoid- ectomy. Seven patients developed postoperative complications and one died. There was one recurrence 5 months after surgery. Twenty-nine patients completed the follow-up questionnaire and were reviewed after a median of 24 (range 6-48) months. Constipation and incontinence were significantly improved after surgery (mean CCCS from 10.21 to 3.58 and CCIS from 14.17 to 11.42; P < 0.001). Quality of life, in terms of mobility, usual activities, pain/discomfort and anxiety/depression, were significantly better at follow-up (P < 0.001), as was subjective health status (P < 0.001). The PAC-QOL score improved significantly in all dimensions (P < 0.001). : Transperineal rectosigmoidectomy improves general and constipation-related quality of life with good functional results.

Increased Frequency of Gastrointestinal Symptoms in Patients with Fibromyalgia and Associated Factors: A Comparative Study

To determine the frequency and severity of gastrointestinal (GI) symptoms in patients with fibromyalgia (FM). We included 152 women with FM (mean age 45.4 +/- 12.2 yrs), 98 women with rheumatoid arthritis (RA; mean age 45.5 +/- 12.3 yrs), and 60 healthy female controls (mean age 44 +/- 11.3 yrs). All patients were questioned about the severity of their chronic widespread pain, symptoms of FM, symptoms of dyspepsia, using a visual analog scale (VAS), and anxiety-depression scale. Patients were asked self-reported (yes/no), symptom-based (>/= 2 criteria) constipation and severity of constipation questions, and about the severity of quality of life (QOL) disturbance secondary to dyspepsia and constipation. Patients with FM had higher symptom severities for belching, reflux, bloating, sour taste, and vomiting than patients with RA and controls (all p values < 0.01). Patients with FM had significantly more dyspepsia-related QOL disturbances than the other 2 groups (p < 0.01). FM and RA patients had more frequent self-reported constipation than controls (respectively, 42.1%, 48%, 21.7%; p < 0.01). The frequency of symptom-based constipation was significantly higher in the RA group (49%) than in FM (29.6%) and control groups (23.3%) (p < 0.01). Constipation-related QOL disturbance was significantly higher in patients with FM than in controls (p < 0.01). In patients with FM, the severity scores of dyspepsia symptoms, constipation, and dyspepsia-related QOL disturbance were higher than in patients with RA and controls. The higher GI symptom severity in patients with FM might have negative effects on their QOL.