Clinical features of constipation in general practice in Italy

Abstract

Background: Definition and diagnosis of constipation remain challenging, partly due to different perceptions of the disease by doctors and patients.

Aim: To evaluate prevalence and features of constipation among individuals seen in general practice, by comparing different diagnostic instruments.

Methods: Standardized questionnaires and the Bristol stool form scale were distributed to all subjects attending 10 general practitioners for any reason in a 2-week period. The questionnaires investigated constipation defined according to: (1) self-perception (yes/no); (2) a visual analogue scale; (3) Rome III Criteria.

Results: The prevalence of constipation in 1306 subjects (790 female, 516 male) resulted: (1) 34% self-reported; (2) 28% by visual analogue scale; (3) 24% by Rome Criteria. Constipation was more frequent in females. A high frequency of symptoms of obstructed defecations was observed with differences among patients with self-reported constipation with or without Bristol stool type 1-2.

Conclusions: Prevalence of constipation among individuals attending their GP ranges between 24 and 34%, according to the different definitions adopted. Symptoms of obstructed defecations are frequent. The combination of self-evaluation and the Bristol stool type scale is potentially useful to identify subgroups of patients with different clinical features in general practice.

Keywords: Constipation; Rome criteria; epidemiology; general practice; questionnaire.

Figure 1.

Frequency of constipation and missing data in 1306 patients answering questionnaires on constipation during a GP visit. Self-C: self-reported constipation (positive answer at the direct question: ‘Do you consider yourself suffering of constipation?’); VAS-C: constipation measured by a visual analogue scale (score >2 out of 10 cm); Rome-C: constipation defined according to the Rome III Criteria *p = .0.01 vs. Rome-C by chi-squared test. **p = 0.01 vs. VAS-C and Rome-C by chi-squared test.

Figure 2.

Age group prevalence of constipation in 1306 patients answering questionnaires on constipation during a GP visit. Self-C: self-reported constipation (positive answer at the direct question: ‘Do you consider yourself suffering of constipation?’); VAS-C: constipation measured by a visual analogue scale (score >2 out of 10 cm); Rome-C: constipation defined according to the Rome III Criteria. *p = 0.04 vs. 56–65 years by multivariate analysis.