An Epidemiological Survey of Constipation in Canada
Abstract & Commentary
Synopsis: Constipation is extremely common, especially in women. Women, older subjects, and all antidepressant users were most likely to seek help from a doctor.
Source: Pare P, et al. Am J Gastroenterol. 2001;96:3130-3137.
Forty percent of Canadian adults reported constipation within the past year, with 27% constipated in the past 3 months. Thirty-four percent had seen physicians, and one third had used laxatives. Primary care physicians need to understand this disorder and its management.
This study involved 1149 participants selected in a random Canadian survey of 10,613 households. Constipation was reported by 27.2% of all participants, and the rate for women was twice that of men. It is interesting that the more restrictive Rome II criteria for functional constipation would only have defined constipation in 14.9% of the population vs. the higher number for self-reporting. In either case, the number is far higher than those seen in some previous North American surveys. However, the study from Talley and colleagues described a somewhat similar number of functionally constipated individuals at 30.9%.1 Unlike the self-report of constipation in the past 3 months, Rome criteria for constipation did not predict physician-seeking behavior.
Comment by Malcolm Robinson MD, FACP, FACG
This study confirms the ubiquity of constipation as a complaint among presumably otherwise healthy people in North America. Since one third of constipated individuals seek medical help for this problem (especially if laxatives have been tried or if the patients are women, elderly, or antidepressant users), physicians need to have a ready armamentarium to relieve these individuals. The pathophysiology of constipation is variable, and many physicians do not adequately understand therapeutic options and their appropriate application. Although bulk agents such as bran or psyllium can be helpful, they also can severely exacerbate functional constipation if the colon is not thoroughly emptied prior to their use. Many more severely constipated patients respond to polyethylene glycol preparations (now available in various tablet and liquid formulations). Except for brief use, stimulant laxatives (such as those containing senna alkaloids or phenolphthalein) should be assiduously avoided. Their chronic use can lead to irrevocable colonic neural damage. Obviously, the sudden onset of changed bowel habits or the presence of bleeding or weight loss should prompt immediate evaluation including colonoscopy.
Reference
1. Talley NJ, et al. Gastroenterology. 1993;105:781-790.
Dr. Robinson, Medical Director, Oklahoma Foundation for Digestive Research; Clinical Professor of Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, is Associate Editor of Internal Medicine Alert.
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