Definitions, epidemiology, and impact of chronic constipation

Constipation, however it is defined, is a common problem in the community. The exact prevalence of constipation depends on the definition used; prevalence estimates range from 2% to 28%. The prevalence of constipation has been stable because the onset and disappearance rates over time are similar, but accurate data on the incidence of constipation are lacking. Approximately one third of those individuals with constipation seek health care; this is an expensive fraction due to investigational and medication costs. The evidence that life-style factors are causally linked to constipation is weak, although nonsteroidal anti-inflammatory drug use and the use of other constipation-inducing medications are important risk factors. Constipation is not of clinical importance until it causes physical risks or impairs quality of life. There is accumulating evidence that self-reported constipation and functional constipation as defined by the Rome Criteria lead to significant impairment of quality of life, with the implication that this is a serious condition in the majority of people afflicted. Constipation may have other serious consequences; an increased risk of colon cancer has been reported but could be explained by confounding. Although hemorrhoids have been attributed to constipation, this association has been questioned. The costs of testing in patients presenting with constipation has been conservatively estimated to be 6.9 billion dollars annually in the United States; treatment costs add substantially to the health care burden.