The influence of demographic characteristics on constipation symptoms: a detailed overview

Abstract

Background: Diagnosing constipation remains difficult and its treatment continues to be ineffective. The reason may be that the symptom patterns of constipation differ in different demographic groups. We aimed to determine the pattern of constipation symptoms in different demographic groups and to define the symptoms that best indicate constipation.

Methods: In this cross-sectional study the Groningen Defecation and Fecal Continence questionnaire was completed by a representative sample of the adult Dutch population (N = 892). We diagnosed constipation according to the Rome IV criteria for constipation.

Results: The Rome criteria were fulfilled by 15.6% of the study group and we found the highest prevalence of constipation in women and young adults (19.7 and 23.5%, respectively). Symptom patterns differed significantly between constipated respondents of various ages, while we did not observe sex-based differences. Finally, we found a range of constipation symptoms, not included in the Rome IV criteria, that showed marked differences in prevalence between constipated and non-constipated individuals, especially failure to defecate (∆ = 41.2%).

Conclusions: Primarily, we found that certain symptoms of constipation are age-dependent. Moreover, we emphasize that symptoms of constipation not included in the Rome IV criteria, such as daily failure to defecate and an average duration of straining of more than five minutes, are also reliable indicators of constipation. Therefore, we encourage clinicians to adopt a more comprehensive approach to diagnosing constipation.

Keywords: Constipation; Demographic factors; Diagnostic procedure; Digestive symptoms.

Fig. 1

The probability of constipation in males and females plotted against the age of the respondents. The probability of constipation in males gradually decreased from 0.24 to a minimum value of approximately 0.08 at 56 years, after which the probability increased as respondents’ ages increased (a). The probability of constipation in females showed a similar pattern, albeit with a higher starting value of 0.45 and with a more fluent decrease of probability down to a value of 0.17 at the age of 57 years, followed by a milder increase in probability as the age increased (b)

Fig. 2

Constipation symptoms in the constipated respondents. No significant difference exists between men and women in the prevalence of any of the constipation symptoms (a). Bonferroni correction of the comparison of constipation symptoms in three age groups shows significantly different prevalences of incomplete defecation between the middle and oldest age group (p = 0.038), of daily failure to defecate between the youngest and the oldest and the middle and the oldest age group (p = 0.046 and p = 0.073, respectively), and of anal pain between the youngest and middle age group (p = 0.012) (b)

Fig. 3

Constipation symptoms in constipated versus non-constipated respondents. The prevalences of all constipation symptoms were significantly different between the constipated and the non-constipated group (p < 0.001 for all symptoms). The highest differences in prevalence were found for the symptoms straining, incomplete defecation, and anal blockage