Constipation can be a persistent condition with multiple, bothersome symptoms, which can impact negatively on a patient’s quality of life.1

Definition

Doctors often define constipation based on stool frequency, whereas patients regard the disorder as having a number of symptoms. The symptoms which patients find bothersome vary but can include not only infrequent bowel movements, but also hard or lumpy stools, straining, bloating, a feeling of incomplete evacuation after a bowel movement and abdominal discomfort.1

According to the Rome III Criteria2 constipation becomes a chronic condition when symptoms have persisted for more than 6 months. These criteria were developed to

standardise the definition of chronic constipation, based on a constellation of symptoms, for enrolment in clinical trials. To be diagnosed with chronic constipation using these criteria, patients must experience two or more of the following symptoms for at least 3 months, with symptom onset at least 6 months prior to diagnosis:

• Straining during at least 25% of defaecations

• Lumpy or hard stools in at least 25% of defaecations

• Sensation of incomplete evacuation for at least 25% of defaecations

• Sensation of anorectal obstruction/blockage for at least 25% of defaecations

• Manual manoeuvres to facilitate at least 25% of defaecations (eg, digital evacuation,

supporting pelvic floor)

• Fewer than three defaecations per week.

Additional diagnostic criteria2 for chronic constipation stipulate that:

• Loose stools are rarely present without the use of laxatives

• Not all the criteria for irritable bowel syndrome are fulfilled.

Prevalence

Chronic constipation is a widespread disorder. Global data suggest a higher rate of chronic constipation among women, older individuals and those with lower socioeconomic status.3 A review of seven studies has estimated the prevalence of constipation in Europe to be between 5% (in a prospective study using the diagnostic criterion of <3 defaecations per week) and 35% (in an interview questionnaire survey of self-reported constipation).4

Impact of chronic constipation

Chronic constipation may inflict a heavy burden on the patient in terms of an impaired psychological well-being and overall quality of life.1

In very severe cases, chronic constipation can lead to very bothersome and potentially lifethreatening complications such as faecal impaction, volvulus, ulcers or bowel perforation.5,6

Additionally, the multi-symptom nature of the disorder and its complications mean that some people with chronic constipation report loss of work productivity and activity impairment, including absenteeism, which has an effect on society.1,7,8

Chronic constipation may also impact the health system, due to the substantial use of health resources by patients who remain dissatisfied and seek an alternative treatment to relieve their symptoms.9

References

1. Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment

Pharmacol Ther 2007;25:599–608.

2. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology

2006;130:1480–91.

3. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the

community: systematic review and meta-analysis. Am J Gastroenterol 2011;106:1582–91.

4. Peppas G, Alexiou VG, Mourtzoukou E, Falagas ME. Epidemiology of constipation in Europe

and Oceania: a systematic review. BMC Gastroenterol 2008;8:5.

5. Dennison C, Prasad M, Lloyd A, et al. The health-related quality of life and economic burden

of constipation. Pharmacoeconomics 2005;23:461–76.

6. Eoff JC. Optimal treatment of chronic constipation in managed care: review and roundtable

discussion. J Manag Care Pharm 2008;14:1–15.

7. Sun SX, DiBonaventura M , Purayidathil FW, Wagner JS et al. Impact of chronic constipation

on health-related quality of life, work productivity, and healthcare resource use: an analysis of the

National Health and Wellness Survey. Dig Dis Sci 2011;56:2688–95

8. Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal

disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993;38:1569–80.

9. Irvine EJ, Ferrazzi S, Pare P, Thompson WG, Rance L. Health-related quality of life in functional GI disorders: focus on constipation and resource utilization. Am J Gastroenterol 2002;97:1986–93.