SEARCH · PubMed Health

Results for “CONSTIPATION”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources

PubMed2001

The prevalence of constipation in institutionalized people with intellectual disability.

Constipation is a common problem in people with intellectual disability (ID). Laxatives are frequently prescribed with disappointing results. The prevalence of constipation was investigated in a random population of 215 people with ID (IQ < 50) and constipation was correlated with clinical symptoms. All subjects were scored for bowel habits. Constipation was defined as having a bowel movement less than three times a week or the necessity of using laxatives more than three times a week. Further possible accompanying factors were evaluated. The control subjects were defined as individuals who did not use laxatives. Subjects with constipation were defined as patients and were compared to subjects without constipation (controls). One hundred and forty-nine out of 215 cases (69.3%) showed constipation. Constipation was significantly correlated with non-ambulancy, cerebral palsy, the use of anticonvulsive medication or benzodiazepines, H2-receptor antagonists or proton pump inhibitors, food refusal, and an IQ < 35. Fifty-eight per cent of the patients used bisacodyl or magnesium oxide, 39% lactulose, 13% sodiumlaurylsulphoacetate/sodium citrate/sorbitol and only 10% were given sodium phosphate enemas. Faecal soiling was found in 15% of subjects, while manual evacuation of faeces was performed in nearly 7% of cases. Constipation was randomly demonstrated in almost 70% of the population with ID. Subjects with the above-mentioned accompanying factors are especially at risk for constipation. Contrary to the general population, constipation in people with ID is associated with little use of phosphate enemas, microlax, a low incidence of faecal soiling and manual evacuation of faeces, suggesting an aetiology without distal faecal impaction. The regimen and effect of therapy has to be studied to define adequate treatment schedules.

Adolescent↗

PubMed1989

Clinical epidemiology of chronic constipation.

Using health statistics from the United States and England and Wales, we review the epidemiology of constipation and possible etiologies of this disorder as suggested by its epidemiologic distribution. The analysis revealed that constipation is one of the most common chronic digestive disorders in the United States, affecting one of every 50 people. The occurrence of constipation increased with advancing age, showing an exponential increase in prevalence after the age of 65. The age distribution of constipation was similar in both sexes, but overall constipation was three times more common in women than in men. Constipation more frequently affected nonwhites than whites, and people from families with low income or less formal education. The characteristic epidemiologic pattern of constipation suggests the influence of environmental factors. Insufficient dietary fiber is widely believed to be a major cause of constipation, yet it is difficult to devise a mechanism by which dietary fiber alone could produce the marked differences observed between gender, race, and socioeconomic status. Recent evidence suggests that disruption of neural regulation of colonic motility plays an important role in the development of chronic constipation. This loss of neural regulation may result from mechanical damage to the pelvic nerves due to childbirth or pelvic surgery, exposure to environmental toxins (e.g., organochlorine insecticides or heavy metals), or possibly exposure to an infectious agent. Other environmental factors that may play a role in the pathogenesis of chronic constipation have not yet been elucidated. Consequently, studies examining the epidemiology of chronic constipation are important for providing insight into potential environmental risk factors relevant to the etiology of this disorder.

Age Factors↗

PubMed2003

Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women.

Because the risk factors for constipation in the general population are poorly defined, we examined the association between age, body mass index, and selected lifestyle and dietary factors with the prevalence of constipation in the Nurses' Health Study.A total of 62,036 women, aged 36-61 yr and free of cancer, responded to mailed questionnaires in 1980 and 1982, which assessed bowel movement frequency, dietary, and lifestyle factors. Constipation was defined as two or fewer bowel movements weekly.A total of 3327 women (5.4%) were classified as having constipation. Age and body mass index were inversely associated with constipation (p for trend < 0.0001). In multivariate analysis, women who reported daily physical activity had a lower prevalence of constipation (prevalence ratio [PR] = 0.56, 95% CI = 0.44-0.70). Women in the highest quintile of dietary fiber intake (median intake 20 g/day) were less likely to experience constipation (PR = 0.64, 95% CI = 0.57-0.73) than women in the lowest quintile (median intake 7 g/day). The PR for constipation for women who both reported daily physical activity and were in the highest quintile of fiber intake was 0.32 (95% CI = 0.20-0.54) compared with those with physical activity less than once weekly and those who were in the lowest quintile of fiber intake. Higher frequency of aspirin intake was associated with an increasing prevalence of constipation (PR = 1.38, 95% CI = 1.17-1.62). Current smoking and alcohol use were inversely associated with constipation. Our data suggest that moderate physical activity and increasing fiber intake are associated with substantial reduction in the prevalence of constipation in women.

Adult↗

PubMed1997

Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood.

OBJECTIVES: To evaluate the frequency of urinary incontinence and urinary tract infection in children with chronic constipation and report on the resolution of these with treatment of the underlying constipation. METHODS: We evaluated the frequency of urinary incontinence and urinary tract infection in 234 chronic constipated and encopretic children before, and at least 12 months after, the start of treatment for constipation. RESULTS: Twenty-nine percent complained of daytime urinary incontinence and 34% of nighttime urinary incontinence. Urinary tract infection was present in 11% and was more commonly present in girls than in boys (33% vs 3%). Vesicoureteral reflux was present in four and megacystis in four of the 25 children who had a voiding cystourethrogram because of urinary tract infection. One girl who came in had constipation and acute urinary retention. The treatment for constipation consisted of disimpaction and maintenance treatment, which included the prevention of reaccumulation of stools and reconditioning to normal bowel habits through timed toilet sitting. Follow-up, at least 12 months after start of treatment for constipation, revealed that the constipation was relieved successfully in 52%. Relief of constipation resulted in disappearance of daytime urinary incontinence in 89% and nighttime urinary incontinence in 63% of patients, and disappearance of recurrent urinary tract infections in all patients who had no anatomic abnormality of the urinary tract. CONCLUSION: Urinary symptoms were found in a significant number of children who had functional constipation and encopresis. With treatment of the constipation, most patients became clean and dry and further recurrence of urinary tract infections was prevented.

Adolescent↗

PubMed2002

When fiber is not enough: current thinking on constipation management.

Constipation is a common disorder and many patients fail to respond to the simple constipation remedies of increased fiber and fluid intake. When secondary to other conditions, medications, or disease processes, the focus of constipation management is correction of causative factors. However, primary constipation - ie, constipation with no identifiable causative factor - is very common. Patients generally present with one of three patterns: constipation-predominant irritable bowel syndrome, slow transit constipation, or pelvic floor dysfunction resulting in dyssynergic defecation. Baseline evaluation for patients with chronic constipation includes a careful history, focused physical examination, and limited laboratory studies. Patients with dyssynergic defecation usually respond best to biofeedback therapy and pelvic muscle re-education. Constipation-predominant irritable bowel syndrome is best managed with dietary monitoring and modifications, fiber therapy, and education regarding self-monitoring and self-care. Patients with slow transit constipation may benefit from fiber therapy and increased activity, but most also will require laxative therapy. Current guidelines for prescribing laxatives suggest bulk agents as first line and osmotic agents as second line therapy. Stimulant laxatives should generally be reserved for PRN use. Current understanding about the etiology, pathology, and classification of different types of constipation are summarized and a stepwise approach to evaluation and management is presented.

Cathartics↗

PubMed1994

Long-term follow-up of children with chronic idiopathic constipation.

To determine the outcome of chronic idiopathic constipation, we followed 62 children with chronic idiopathic constipation (mean age: 5.2 +/- 2.8 years) for a period of five years. Each child received the same initial treatment over a 12-week period and was then followed every three months. After five years from diagnosis, chronic idiopathic constipation persisted in 52% of the children; 47% who remained symptomatic were > 10 years old at the time of the five-year evaluation. Of the 27 who were constipated in the first year of life, 63% remained constipated after five years. Children who recovered within the five-year interval were significantly different from those that remained symptomatic in age of onset of constipation (P < 0.05) and family history of constipation (P < 0.05). After five years, both severity of abdominal pain and degree of soiling significantly decreased in both the recovered and unrecovered groups (P < 0.05). This study suggests that chronic idiopathic constipation persists for > or = 5 years in at least half of children. Early age of onset and family history of constipation are predictive of persistence. Abdominal pain and soiling improve in long-term follow-up irrespective of constipation outcome.

Child↗

PubMed2001

Constipation in very-low-birth-weight children at 10 to 14 years of age.

BACKGROUND: The authors documented that very-low-birth-weight children (less than 750-g) when compared with 750-to 1,499-g birth-weight and normal-birth-weight-matched controls have higher than normal rates of neurosensory and cognitive impairments at school age. In this population, the authors found a higher rate of constipation than expected among 19 of 59 (32%) less-than-750-g-birth-weight children. The authors therefore wanted to evaluate in greater detail the problem of constipation and associated toileting problems in this population. METHODS: Nineteen less-than-750-g-birth-weight children with constipation were matched to the next less than 750-g-birth-weight child of comparable age, sex, and race who did not have constipation. A telephone questionnaire was administered to 15 of 19 parents of the less-than-750-g-birth-weight children who had constipation. RESULTS: The 15 children with constipation had significantly higher rates of neurosensory impairment (7 [47%] vs. 1 [7%]) and lower mean WISC III IQ scores (72 +/- 22 vs. 89 +/- 13) when compared with birth-weight-matched controls without constipation (P < 0.05). The constipated children also had significantly higher rates of associated toileting problems, including encopresis (8[53%] vs. 1 [7%])and stool withholding (9 [60%] vs. 2 [13%]; P < 0.05). CONCLUSION: The higher incidence of constipation among less-than-750-g-birth-weight children is associated with neurodevelopment impairment. Awareness of this problem and preventive intervention to ensure regular stools could possibly decrease the high rate of constipation and associated toileting problems.

Adolescent↗

PubMed1989

Constipation in the elderly living at home. Definition, prevalence, and relationship to lifestyle and health status.

The prevalence of self-reported constipation and the factors which contribute to it were investigated in a door-to-door survey of 209 people aged 65 to 93. Thirty percent of men and 29% of women described themselves as constipated at least once a month. However, elderly people define constipation differently than do their physicians: only 3% of men and 2% of women in the community sample reported that their average stool frequency was less than three per week, the customary medical criterion for constipation. The primary symptom which elderly people used to define constipation was having to strain in order to defecate. Multiple factors were found to influence self-reports of constipation. The amount of liquids consumed was significantly related to longest period without a bowel movement in men, but fiber and liquids were not related to self-reported constipation in either sex. The number of chronic illnesses and the number of nonlaxative medications were significantly related to constipation in women but not men, and the number of psychological symptoms correlated significantly with self-reports of constipation in both men and women. Age was not significantly related to self-reported constipation in men or women over the age of 65.

Aged↗

PubMed1999

Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features.

OBJECTIVE: Constipation is a common heterogeneous condition, possibly encompassing different clinical subtypes. Little is known about the comparative epidemiology of constipation subtypes. This study was conducted to estimate the prevalence of constipation subtypes and determine whether subtypes differ by sociodemographic factors. METHODS: Between June and September 1997, a telephone interview was conducted with individuals about their bowel habits in the preceding 3 months. Survey data on 15 constipation-related symptoms were used to identify individuals who met prespecified symptom criteria for the following mutually exclusive subgroups: functional constipation, irritable bowel syndrome (IBS), outlet obstruction or delay (outlet), both IBS and outlet (IBS-outlet), and frequent laxative users (i.e., at least every other day). A total of 10,018 eligible individuals in the United States 18 yr of age or older completed the interview. Test-retest reliability of reporting symptoms was assessed in a separate national survey. The Spearman's correlation coefficient for reporting symptoms ranged from 0.54 to 0.83; all but three symptoms had correlations above 0.68. RESULTS: The overall prevalence of constipation was 14.7%. By subtype, prevalence was 4.6% for functional, 2.1% for IBS, 4.6% for outlet, and 3.4% for IBS-outlet. An additional 1.8% of respondents reported laxative use at least every other day. Outlet was the most common subtype among women, whereas functional constipation was the most common subtype among men. The gender ratio varied by subtype, with elevated ratios for outlet (F/M = 1.65) and IBS-outlet (F/M = 2.27) subtypes. The age pattern differed among each of the four subtypes. Prevalence of functional subtype decreased with increasing age. In contrast, outlet subtype did not seem to vary by age, and IBS (both men and women) and IBS-outlet (women only) subtypes increased to age 35 yr and declined thereafter. Prevalence of functional constipation increased with increasing education. Outlet type was more common in nonwhites compared to whites. Finally, 45% of individuals with constipation reported having the condition for 5 yr or more. CONCLUSIONS: Constipation is a heterogeneous condition. Differences in epidemiological profile by age, sex ratio, and relation to other sociodemographical factors support the distinction of two and possibly more symptom-based subtypes.

Adolescent↗

PubMed2002

Health-related quality of life in functional GI disorders: focus on constipation and resource utilization.

OBJECTIVE: Functional GI disorders are common in the general population. However, their impact on health status and health resource use in Canada has not been well examined. We describe 1) health-related quality of life in Canadians with functional constipation or other functional GI disorders versus Canadian normative data or those without a functional GI disorder and 2) health resource utilization in subject's self-reporting of constipation. METHODS: An independent research firm was employed to conduct a randomly selected national survey examining GI symptoms and personal health. Household members 18 yr or older were recruited by a random-digit dial technique. Participants were then mailed a questionnaire and data were retrieved by a follow-up phone call. All functional GI disorders were defined using Rome II criteria, and constipation was further defined using self-report. Health-related quality of life was assessed using the Short Form 36. RESULTS: One thousand one hundred forty-nine subjects (49.3% male) with a mean age of 42.2 yr completed the survey. The prevalence of any Rome II functional GI disorder was 61.7%. The rate of functional constipation was 14.9%, whereas that of self-reported constipation was 27.2%. The mean physical and mental component summary and eight subscores of the Short Form 36 were significantly lower (p < 0.05) than Canadian norms for both self-reported constipation and Rome II functional constipation. Subjects with no GI disorder had significantly better Short Form 36 scores than the Canadian norms. The rate of physician visits for constipation was strongly predicted by the physical component of the Short Form 36. Most subjects (66.2%) were satisfied with their current constipation treatment. CONCLUSIONS: Constipation is common in the Canadian population and significantly impairs health-related quality of life. Poor quality of life is an important predictor of health care utilization in these subjects.

Adult↗

PubMed1994

Is encopresis always the result of constipation?

Encopresis is often the result of chronic constipation in the majority of paediatric patients. In clinical practice, however, encopresis is also seen without constipation and it is unknown whether these two clinical variants are based on similar or different pathophysiological mechanisms, requiring different therapeutic approaches. We analysed clinical symptoms, colonic transit time (CTT), orocaecal transit time (OCTT), anorectal manometric profiles, and behavioural scores. Patients were divided into two groups, one consisted of 111 children with paediatric constipation, and another group of 50 children with encopresis and/or soiling without constipation. Significant clinical differences in children with encopresis/soiling existed compared with children with paediatric constipation regarding: bowel movements per week, the number of daytime soiling episodes, the presence of night time soiling, the presence and number of encopresis episodes, normal stools, pain during defecation, abdominal pain, and good appetite. Total and segmental CTT were significantly prolonged in paediatric constipation compared with encopresis/soiling, 62.4 (3.6-384) and 40.2 (10.8-104.4) hours, respectively. No significant differences were found in OCTT. Among the two groups, all manometric parameters were comparable, except for a significantly higher threshold of sensation in children with paediatric constipation. The defecation dynamics were abnormal in 59% and 46% in paediatric constipation and encopresis/soiling, respectively, and were significantly different from controls. Using the child behaviour checklist no significant differences were found when comparing children with paediatric constipation and encopresis/soiling, while both patient groups differed significantly from controls. In conclusion, our findings support the concept of the existence of encopresis as a distinct entity in children with defecation disorders. Identification of such children is based on clinical symptoms, that is, normal defecation frequency, absence of abdominal or rectal palpable mass, in combination with normal marker studies and normal anal manometric threshold of sensation, Thus, encopresis is not always the result of constipation and can be the only clinical presentation of a defecation disorder.

Adolescent↗

PubMed1996

Long-term results of subtotal colectomy and evidence of noncolonic involvement in patients with idiopathic slow-transit constipation.

BACKGROUND: Patients with chronic idiopathic constipation can be difficult to manage either medically or surgically. We report our experience of long-term follow-up of 21 patients who had undergone colectomy with ileorectal anastomosis for difficult chronic idiopathic constipation. METHODS: The patients (19 female, 2 male) were aged 26-68 (median = 46) years and had undergone subtotal colectomy 5-12 (median = 8) years before their assessment. They answered a questionnaire about severity of abdominal pain, bloating, urgency, and straining. They also completed the hospital anxiety and depression questionnaire. Fifteen ulcerative colitis patients with panproctocolectomy and 13 colon cancer patients with colonic resection who had a similar follow-up period served as control groups. The following assessments were performed in chronic idiopathic constipation patients with subtotal colectomy: a) oesophageal manometry; b) scintigraphic gastric emptying test; c) review of barium follow-through; d) glucose H2 breath test; e) urodynamic studies; and f) autonomic function tests. RESULTS: Twenty-four per cent of patients with chronic idiopathic constipation had a family history of difficult constipation requiring hospital investigations and treatment. At the time of assessment abdominal pain, bloating, urgency, and straining at defecation were all significantly more frequent in patients with chronic idiopathic constipation with colectomy than in the control groups with colectomy. Seventy-one per cent of chronic idiopathic constipation patients had at least one episode of intestinal obstruction after subtotal colectomy, which is significantly higher (P < 0.01) than in the control groups (ulcerative colitis, 13%; colonic carcinoma, 8%). In patients with chronic idiopathic constipation, among those studied, 68% had some oesophageal motor dysfunction: 19% delayed gastric emptying; 10%, prolonged small-bowel transit on barium follow-through; 54%, abnormal urodynamic variables; and 14%, abnormal autonomic function tests. CONCLUSIONS: This study shows considerable morbidity in a selected cohort of patients with chronic idiopathic constipation who were sufficiently disabled by their symptoms to undergo subtotal colectomy. They had more abdominal and rectal symptoms and more frequent intestinal obstructive episodes than control groups with colonic resection. Evidence of generalized smooth-muscle dysfunction and familial occurrence of constipation suggests a primary chronic intestinal pseudo-obstruction-like disorder in some of these patients.

Case-Control Studies↗

PubMedDate not supplied

Hostility in patients with chronic constipation.

Personality changes have been reported in chronic constipation. Hostility is an important personality factor involved in psychosomatic disorders. The aim of this study was to investigate hostility in patients with chronic constipation. Sixty subjects with chronic constipation (24 males, 36 females, mean age 44.5 years) were investigated with the hostility scale of the Minnesota Multiphasic Inventory. The patients were divided in four groups according to their symptoms: functional chronic constipation (Group I, n = 18), irritable bowel syndrome expressed as chronic constipation and abdominal pain (Group II, n = 21), irritable bowel syndrome expressed as chronic constipation, abdominal pain and bloating (Group III, n = 13) and irritable bowel syndrome expressed as chronic constipation alternating with episodes of diarrhoea (Group IV, n = 8). Twenty-five clinically healthy subjects were investigated as controls. Hostility was as follows (mean +/- SD): 68 +/- 9 in group I, 62 +/- 12 in group II, 70 +/- 14 in group III, 56 +/- 12 in group IV and 40 +/- 12 in controls. The scores were significantly higher in all groups of patients with constipation versus controls (p < 0.01; < 0.001; < 0.001; < 0.02, respectively). These data suggest that hostility is increased in patients with chronic constipation. It is rather a feature of the functional bowel disorders than of constipation, as symptom, only.

Abdominal Pain↗

PubMed1990

[Constipation symptoms studied by a standard questionnaire and anorectal manometry before and after promontory rectopexy (Orr-Loygue technic) in 25 female patients].

Intractable constipation is frequently observed after rectopexy. The aim of our study was to look for clinical and manometric data, which could help to predict postoperative constipation. Twenty-five consecutive female patients treated by Orr-Loygue rectopexy were asked to answer a standard questionnaire and underwent anorectal manometry pre- and postoperatively. Nineteen patients complained of constipation after surgery. Preoperative constipation was significantly more frequent in patients who complained of postoperative constipation, than in patients who did not. Preoperative colonic transit time study in 8 patients was not useful in predicting postoperative constipation. Moreover, symptoms of constipation were quite similar pre- and postoperatively in the 19 patients complaining of postoperative constipation. Anorectal manometric data were not different between patients who complained of postoperative constipation and patients who did not. Therefore preoperative complaints of constipation are most important to consider before rectopexy.

Adult↗

PubMed1996

Constipation in an elderly community: a study of prevalence and potential risk factors.

OBJECTIVE: The epidemiology of chronic constipation in the elderly remains poorly defined. We aimed to study the prevalence of, and potential risk factors for, constipation in a representative elderly community, using symptom-based diagnostic criteria. METHODS: An age and gender-stratified random sample of 1833 eligible residents of Olmsted County, Minnesota, aged 65 yr and over, was mailed a valid self-report questionnaire; 1375 responded (75%). RESULTS: The overall age- and gender-adjusted prevalence (per 100) of any constipation was 40.1 (95% CI 38.9, 44.4); for functional constipation and outlet difficulty or delay, the prevalence rates were 24.4 (95% CI 22.0-26.9) and 20.5 (95% CI 18.2-22.8), respectively. Self-reported constipation did not reliably identify functional constipation or outlet delay. Outlet delay, but not functional constipation, was more frequent in women; functional constipation, but not outlet delay, was associated with advancing age. Nonsteroidal anti-inflammatory drugs and other medications were significant risk factors in subjects with functional constipation and outlet delay combined. CONCLUSIONS: In independently living, elderly persons, constipation is a common complaint; among these subjects, there appear to be symptom subgroups that can be identified.

Age Distribution↗

PubMedDate not supplied

Time and economic cost of constipation care in nursing homes.

OBJECTIVE: Chronic constipation is a common disorder among residents in long-term care; yet the cost to the nursing home of constipation-related care is not known. The objective of this study was to quantify the nursing staff and supply-related cost of constipation care to nursing homes from the perspective of the nursing home. DESIGN: Prospective, observational time-and-motion design. SETTING: Two United States nursing homes. PARTICIPANTS: A total of 59 nursing home residents with chronic constipation and nursing staff providing constipation care to them. MEASUREMENTS: Actual time to complete constipation care-related tasks was measured via stopwatch by trained observers, and the number and professional level (eg, staff nurse, CNA) of staff performing each task was recorded. Frequency of constipation care task data was obtained through 60-day retrospective medical chart review for each subject. Nurse wage rate data was obtained from the Nursing Home Salary and Benefits Report, a US-based national source. Resident and nursing home descriptive information was also collected. RESULTS: The average cost per task occurrence ranged from 0.72 US dollars for enema administration to 1.74 US dollars for oral medication administration. Average nursing staff costs per subject per year were 1577 US dollars for oral medication administration, 215 US dollars for dietary supplement administration, 39 US dollars for constipation assessment, 17 US dollars for suppository administration, and 6 US dollars for enema administration. Based on estimates of frequency of occurrence, the total annual labor and supply cost per long-term care resident with constipation was 2253 US dollars. CONCLUSION: Nursing staff performance of constipation care-related tasks is time consuming and costly in the long-term care setting.

Journal Article↗

PubMed1992

Association of constipation with neurologic diseases.

To investigate possible etiologic influences on the development of constipation, the present study examines the concordant occurrence of constipation with other diseases. Using 8.8 million Medicare patients hospitalized in the United States during 1987, the frequency distribution of all three-digit International Classification of Diseases (ICD) codes was compared in constipated patients and patients without constipation. Most associations and the closest associations were observed between constipation and neurologic diseases, the majority of which resulted from damage to the central nervous system. Associations between constipation and disorders of the spine also involved neuronal damage. The influence of potential confounding factors such as immobility or pain on the development of constipation was assessed and found to be minimal. The frequent association of constipation with disorders involving neuronal malfunction suggests that disruption of the neural modulation of colonic motility may play an important role in the development of constipation.

Aged↗

PubMed2000

Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS).

PURPOSE: The aim of this study was to devise a symptom scoring system to assist in diagnosing constipation and in discriminating among pathophysiologic subgroups. METHOD: A structured symptom scoring questionnaire (11 questions) was completed by 71 chronically constipated patients and by 20 asymptomatic controls. The symptom score was correlated with a previously validated constipation score (Cleveland Clinic Score). All patients underwent colonic transit studies, standard anorectal physiology testing, and evacuation proctography. On the basis of these investigations alone, an observer blinded to the questionnaire results allocated patients to one of three pathophysiologic subgroups: slow-transit constipation, rectal evacuatory disorder, or mixed (slow-transit constipation and rectal evacuatory disorder). Linear discriminant analysis was used to assess the ability of different questionnaire symptoms to discriminate among these subgroups. RESULTS: Total symptom score was strongly correlated with the Cleveland Clinic Score (r = 0.9). The median total score in constipated patients was 20 (range, 11-35) compared with a median of 2 in controls (range, 0-6). Discriminant analysis using cross validation estimated that pathophysiology could be predicted correctly for 55 percent (95 percent confidence interval = 43-67 percent) of patients using just five symptoms. The discriminant function rarely misclassified patients with rectal evacuatory disorder as slow-transit constipation and vice versa, but could not effectively discriminate between patients with single and mixed pathologies. CONCLUSION: This new scoring system is a valid technique to assist in the diagnosis of constipation and is the first study using appropriate statistical methodology to demonstrate a discriminatory ability of multiple symptoms in constipation. At present, symptom analysis does not adequately differentiate major pathophysiologic subgroups for use in clinical practice.

Adult↗