Outcome of behavioural treatment for idiopathic chronic constipation

Intern Med J. 2014 Sep;44(9):858-64. doi: 10.1111/imj.12490.


Background/aim: Behavioural therapy is effective in patients with chronic intractable constipation despite standard treatment, but long-term results in unselected patients are unclear. This study investigates the effects of behavioural therapy on symptoms, subjective well-being, and the physical and mental quality of life.

Methods: Patients who had failed standard care for idiopathic chronic constipation underwent behavioural therapy in a specialist clinic. Symptom severity and quality of life were assessed before and after therapy using the 'Constipation Scoring System' and the Short-Form 36 questionnaire. The primary outcome was subjective perception of improvement. Secondary outcomes were symptoms of constipation and quality of life scores.

Results: Of 233 consecutive patients with self-reported constipation (median symptom duration 5-10 years, median age 44 years, females 86%), 180 (77%) completed treatment in a median of three (range 1-7) sessions. One hundred and sixty-five patients (71% of all referrals or 92% of those completing treatment) reported subjective improvement. Median bowel frequency improved from once every 2-7 days to 1-3 per day (P = 0.05). Pain and bloating improved in more than 80% of patients. The Short-Form 36 physical (P < 0.05) and mental (P < 0.05) composite scores improved significantly. Patients with a longer duration of symptoms were less likely to complete treatment. Digital evacuation prior to treatment was a predictor of poor outcome.

Conclusion: Behavioural therapy is associated with significant improvement in symptoms of chronic constipation and quality of life. Non-drug therapies that successfully treat patients with functional gut disorders resistant to standard treatment are needed in the mainstream provision of care.

Keywords: behavioural therapy; biofeedback therapy; constipation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Behavior Therapy* / methods
  • Biofeedback, Psychology*
  • Chronic Disease
  • Constipation / physiopathology
  • Constipation / psychology
  • Constipation / therapy*
  • Female
  • Humans
  • Male
  • Mental Health
  • Middle Aged
  • Prospective Studies
  • Quality of Life*
  • Surveys and Questionnaires
  • Treatment Outcome