Constipation may need to be redefined to meet public perception

Many patients with constipation might not even recognize their condition, leaving researchers from King’s College London to call for new diagnostic criteria and new efforts to improve public education.

In a study published in the American Journal of Gastroenterology, Eirini Dimidi, BSc, MSc, PhD, from the department of nutritional sciences at King’s College, and colleagues wanted to determine how the public and physicians — both general practitioners and GI specialists — perceive constipation and its symptoms.

“Previous studies have tried to estimate how many people suffer from constipation, but their results vary between 3% and 35%,” Dimidi said in a press release. “One potential reason for this range is the lack of a consistent way to diagnose it. Accurately identifying a condition is at the root of good care. Currently prescription medication for constipation fails in nearly 60% of patients and almost half report not being satisfied with their treatment.”

Researchers recruited more than 2,500 individuals from the general public and more than 700 physicians to complete a questionnaire that asked them to report the symptoms that they thought would be most important for a diagnosis of constipation. They also judged 10 case studies where constipation was present or absent based on the Rome IV criteria.

From the public cohort, 934 had self-reported constipation and 1,623 did not. The group of doctors comprised 411 general practitioners and 365 gastroenterologists.

Based on answers from the questionnaires, 94% of patients with self-reported constipation met Rome IV criteria for functional constipation. Researchers found that nearly a third of patients who did not self-report constipation met the Rome IV criteria (29%) but did not know it.

Just 26% of responders from the general population perceived infrequent bowel movements as important for a constipation diagnosis compared with 41% of general practitioners and 65% of gastroenterologists.

Investigators identified six symptom clusters that were most commonly agreed upon by the study group; abdominal discomfort, pain and bloating, rectal discomfort, infrequent movements and hard stools, sensory dysfunction, flatulence and bloating, and fecal incontinence.

Researchers said there might be a need to redefine the diagnostic criteria for constipation and believe the six symptom clusters could provide a solid base to start on.

“Our study has revealed that numerous symptoms are considered important for a diagnosis of constipation by the general population that are not part of any current diagnostic criteria or assessment tools, with significant differences between patients and doctors,” author Kevin Whelan, BSc, MSc, MA, PhD, from King’s College, said in the release. “This is important as patients who seek medical care for their constipation-related symptoms may not have their symptoms recognized as constipation by the doctor and, therefore, may not be managed as such. This could significantly impact patients' access to care and treatment.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.