Editorial: Constipation and colorectal cancer risk: a continuing conundrum

Abstract

There are conflicting data regarding the association between bowel movement frequency, constipation, and colorectal cancer (CRC). In this issue, Citronberg et al. present data from a large prospective study that was designed to examine this issue. In addition to examining bowel habits, these authors included information about the participants' laxative use, distinguishing between fiber and non-fiber-based laxatives. The investigators also collected data with respect to CRC risk factors including demographics, family history, lower endoscopy exposure, smoking, medication use, and detailed dietary information. The results demonstrated no relationship between bowel movement frequency or constipation and CRC. The authors also observed an increased CRC risk in patients who were in either the low or high non-fiber laxative use groups as compared with individuals who never used these agents (low risk: hazard ratio (HR)=1.49; and high risk: HR=1.43; Ptrend=0.05). Conversely, there was a statistically significant lower risk for those patients who reported a high use of fiber laxatives (HR=0.44, 95% confidence interval: 0.21-0.95) as compared with the nonuse group. These data have implications for physicians who treat patients with constipation.