Difference in Defecation Desire Between Patients With and Without Chronic Constipation: A Large-Scale Internet Survey

Abstract

INTRODUCTION: Defecation desire (DD) is an important physiological component of normal defecation. However, knowledge of DD in the general population and in individuals with chronic constipation (CC) is lacking. We aimed to assess the prevalence of DD in the general population and individuals with CC and to understand the impact of treatment on DD among individuals with CC. METHODS: We conducted an online questionnaire survey targeting the Japanese general population in 2019. DD was reported as never, rarely, usually, or always. Individuals who self-reported constipation and met the Rome IV criteria for functional constipation but did not for irritable bowel syndrome were included in the CC group, while the same number of age-/sex-matched controls who met neither functional constipation nor irritable bowel syndrome criteria was included in the non-CC group. Individuals who reported DD as rarely or never were defined as having loss of DD (LODD). RESULTS: Of the 20,986 participants, 2,587 were included in the CC group (12.3%). LODD was significantly higher in the CC individuals than in the non-CC controls (57.4% vs 8.3%, respectively, P < 0.001, odds ratio 14.84 [95% confidence interval 12.65–17.42]). Satisfaction with treatment for constipation was lower in individuals with persistent LODD (25.9%) compared with those with improved LODD (56.5%) on treatment ( P < 0.001, odds ratio 2.48 [1.39–4.43]). DISCUSSION: LODD is common in CC and is associated with decreased satisfaction to treatment. Greater attention should be paid to DD when treating patients with CC.

Abnormal Perception of Urge to Defecate: An Important Pathophysiological Mechanism in Women With Chronic Constipation

“…The results of this study concur with previous reports in patients with constipation: Urge to defecate may be absent (14,21,22) or perceived as an abdominal sensation (14,22). The observations that in women with abnormal urge perception, viscerosensory referral area was larger (7,24,36), and a number of IBS-related symptoms (bloating, aching, cramping, colicky/griping, or sickness/nausea) were related to the urge to defecate, may suggest overlapping features with IBS with constipation (37,38).…”

“…Several studies demonstrate that patients with functional constipation report an altered or absent perception of the urge to defecate or "call to stool" (14,(18)(19)(20)(21)(22). A recent Japanese population-based study (.20,000 participants) showed that 57.4% of 2,587 individuals who met the Rome IV criteria for functional constipation reported loss of defecation desire (21).…”

Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis

“…In total, seven studies stated that they used the Rome I criteria in 6 separate countries, [16][17][18][19]23,25,40 17 the Rome II criteria in 12 separate countries, [20][21][22][23][24][25][26][27][28][29][30][31]35,36,41,45 18 the Rome III criteria in 14 separate countries, [32][33][34]37,39,[42][43][44][46][47][48][49][50][51][52][53]55,58 and five the Rome IV criteria in 35 separate countries. 9,10,54,56,57 The pooled prevalence of FC, according to the criteria used to define its presence, is provided in Table 1. Pooled prevalence was highest when the Rome I criteria were used (15.3%; 95% CI 8.1% to 24.4%), and lowest when the Rome IV ...…”

Rationale and design of a multicentre, 12-week, randomised, double-blind, placebo-controlled, parallel-group, investigator-initiated trial to investigate the efficacy and safety of elobixibat for chronic constipation

“…A web-based questionnaire-based survey reported that patients with CC had a significantly higher rate of LODD than healthy adults, with about 60% of patients losing their defaecation desire (DD), leading to the decrease of defaecation QOL. 22 Bile acids are expected to have a restorative effect on DD because they have an effect to lower the rectal sensory threshold, which is an objective index of DD. 23 24 EXB inhibits IBAT/ASBT (a transporter involved in bile acid reabsorption) in the terminal ileum.…”