Prevalence of Constipation: Agreement among Several Criteria and Evaluation of the Diagnostic Accuracy of Qualifying Symptoms and Self-reported Definition in a Population-based Survey in Spain

Abstract

The aims of this study were to estimate the prevalence of chronic constipation and to evaluate the diagnostic accuracy of the symptoms and the self-reported definition of constipation. A cross-sectional survey was conducted in the general community in 1999. A questionnaire comprising 21 items was developed and mailed to a random sample of 489 subjects who were aged between 18 and 65 years and who belonged to a Spanish population. In the 349 subjects (71%) responding to the questionnaire, the prevalence of self-reported constipation was 29.5% (95% confidence interval (CI): 24.9, 34.3) versus 19.2% (95% CI: 15.1, 23.3) and 14.0% (95% CI: 10.4, 17.7) based on Rome I and Rome II criteria, respectively. Agreement was good between self-reported and Rome I criteria (kappa: 0.68) and between Rome I and Rome II criteria (kappa: 0.71), and it was moderate between self-reported and Rome II criteria (kappa: 0.55). Female gender was identified to be a risk factor for constipation; fiber intake and physical exercise were found to be protective factors. Likelihood ratios were higher for the presence of anal blockage and straining and for the absence of hard stools. Chronic constipation is a highly prevalent problem, especially in women. Different prevalence estimates of constipation were observed using different criteria, although agreement between them was acceptable. Anal blockage, straining, and hard stools show the greatest accuracy for the diagnosis of constipation.

Dietary intake in relation to self-reported constipation among Japanese women aged 18–20 years

“…The proportion of the subjects who were considered 'constipated' in the present study seemed to be relatively high (26%); some of those may not be classified as 'constipated' according to symptombased criteria such as Rome I and Rome II criteria (Thompson et al, 1999). In fact, the prevalence of self-reported constipation was much higher compared with the prevalence based on Rome I and Rome II criteria in a study of Spain (30 vs 19 and 14%) (Garrigues et al, 2004). Thus, whether the same associations we observed would hold for constipation according to symptom-based criteria is not known, which should be addressed in future studies.…”

“…The reported prevalence of constipation ranges from 2 to 30% in Western countries, depending on the definition applied (Garrigues et al, 2004;Higgins and Johanson, 2004). In Japan, the prevalence of constipation, defined as p3 bowel movements weekly, also seems to be relatively high (6-25%) (Hirai and Takezoe, 1997;Hirai et al, 2001).…”

Association between dietary fiber, water and magnesium intake and functional constipation among young Japanese women

“…A constipation questionnaire was developed based on a previous study (Garrigues et al, 2004) and incorporated into the 20-page questionnaire for lifestyle during the previous 6 years. We used the definition of functional constipation recommended by an international workshop on the management of constipation (Rome I criteria) (Whitehead et al, 1991).…”

“…We used the definition of functional constipation recommended by an international workshop on the management of constipation (Rome I criteria) (Whitehead et al, 1991). Although the Rome I criteria were modified in 1999 to the Rome II criteria (Thompson et al, 1999), epidemiologic studies have consistently shown that the latter may be too restrictive for the diagnosis of constipation (Pare et al, 2001;Garrigues et al, 2004), and we therefore used the former. The following four questions were used to assess Rome I-defined functional constipation: (1) Do you strain during a bowel movement?…”

“…Constipation is a common health problem (Wong et al, 1999;Pare et al, 2001;Garrigues et al, 2004;Higgins and Johanson, 2004), and diet is considered a major modifiable lifestyle factor associated with this condition (Locke et al, 2000;Talley, 2004). The favorable effect of dietary fiber on constipation is widely accepted and several (Dukas et al, 2003;Sanjoaquin et al, 2004), although not all (Campbell et al, 1993;Towers et al, 1994;Murakami et al, 2006), observational studies have indicated an inverse relation between dietary fiber intake and constipation.…”