Chronic Constipation in the United States: Results From a Population-Based Survey Assessing Healthcare Seeking and Use of Pharmacotherapy

Abstract

OBJECTIVES: Chronic idiopathic constipation (CIC) is characterized by unsatisfactory defecation and difficult or infrequent stools. CIC affects 9%–20% of adults in the United States, and although prevalent, gaps in knowledge remain regarding CIC healthcare seeking and medication use in the community. We recruited a population-based sample to determine the prevalence and predictors of (i) individuals having discussed their constipation symptoms with a healthcare provider and (ii) the use of constipation therapies. METHODS: We recruited a representative sample of Americans aged 18 years or older who had experienced constipation. Those who met the Rome IV criteria for irritable bowel syndrome and opioid-induced constipation were excluded. The survey included questions on constipation severity, healthcare seeking, and the use of constipation medications. We used multivariable regression methods to adjust for confounders. RESULTS: Overall, 4,702 participants had experienced constipation (24.0% met the Rome IV CIC criteria). Among all respondents with previous constipation, 37.6% discussed their symptoms with a clinician (primary care provider 87.6%, gastroenterologist 26.0%, and urgent care/emergency room physician 7.7%). Age, sex, race/ethnicity, marital status, employment status, having a source of usual care, insurance status, comorbidities, locus of control, and constipation severity were associated with seeking care (P < 0.05). Overall, 47.8% of respondents were taking medication to manage their constipation: over-the-counter medication(s) only, 93.5%; prescription medication(s) only, 1.3%; and both over-the-counter medication(s) and prescription medication(s), 5.2%. DISCUSSION: We found that 3 of 5 Americans with constipation have never discussed their symptoms with a healthcare provider. Furthermore, the use of prescription medications for managing constipation symptoms is low because individuals mainly rely on over-the-counter therapies.

Epidemiologic Burden and Treatment of Chronic Symptomatic Functional Bowel Disorders in the United States: A Nationwide Analysis

“…Data collection within NAMCS is robust, data quality is routinely monitored, and we used a range of statistical methodologies to capture the scope of both the epidemiologic burden and treatment of FBDs. Our estimates of pharmacotherapy use are aligned with recent studies conducted using other methodologies: for example, in a prospective population-based survey, Oh et al 43 estimated that 47.8% of patients used medications to manage chronic constipation, which is almost identical to our estimate of 47.4%. However, there may be important underreporting of behavioral nonpharmacologic counseling in the NAMCS survey, particularly because patient report forms can be completed by medical office personnel or US Census Bureau staff reviewing the medical chart.…”

Impact of Opioid Consumption in Patients With Functional Gastrointestinal Disorders

“…Another limitation is the possibility that some patients used over the counter drugs. In the United States, half of patients with constipation used over the counter medication and only two patients out of five sought the advice of a healthcarer ( Oh et al, 2020 ). In France many laxatives can be used without prescription, to avoid this problem we looked for all reported treatment in the medical chart but patients may have omitted to report some of them.…”

Cost of Constipation

“…This study shows that the introduction of new treatment options for constipation was soon followed by an increased use in clinical practice. While the findings may overestimate the role of secretagogues in managing constipation, as we did not capture the widespread use of over-the-counter preparations, 16 it reflects the behavior of prescribing health care providers. Furthermore, constipation is common and often chronic.…”

“…This point is quite relevant, as surveys demonstrated that about half of the persons with constipation are using some form of active treatment, mostly relying on over-the-counter preparations. 16 This number will likely be even higher in cohorts seeking medical attention and enrolling into clinical trials. Treatment benefits can be seen with laxatives as well as secretagogues.…”