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

Am J Gastroenterol. 2020 Jun;115(6):895-905. doi: 10.14309/ajg.0000000000000614.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Bisacodyl / therapeutic use
  • Chronic Disease
  • Colonoscopy / statistics & numerical data
  • Constipation / drug therapy*
  • Constipation / physiopathology
  • Dietary Fiber / therapeutic use
  • Dioctyl Sulfosuccinic Acid / therapeutic use
  • Emergency Service, Hospital
  • Employment
  • Ethnic Groups / statistics & numerical data
  • Female
  • Gastroenterologists
  • Gastrointestinal Agents / therapeutic use
  • Guanylyl Cyclase C Agonists / therapeutic use
  • Humans
  • Insurance, Health / statistics & numerical data
  • Internal-External Control
  • Lactulose / therapeutic use
  • Laxatives / therapeutic use*
  • Male
  • Marital Status / statistics & numerical data
  • Middle Aged
  • Nonprescription Drugs / therapeutic use
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Peptides / therapeutic use
  • Physicians, Primary Care
  • Polyethylene Glycols / therapeutic use
  • Sennosides / therapeutic use
  • Severity of Illness Index
  • Sex Factors
  • Surface-Active Agents / therapeutic use
  • Surveys and Questionnaires
  • United States

Substances

  • Dietary Fiber
  • Gastrointestinal Agents
  • Guanylyl Cyclase C Agonists
  • Laxatives
  • Nonprescription Drugs
  • Peptides
  • Sennosides
  • Surface-Active Agents
  • Dioctyl Sulfosuccinic Acid
  • Bisacodyl
  • Polyethylene Glycols
  • Lactulose
  • polyethylene glycol 3350
  • linaclotide