Study of Types of Pathophysiologic Patterns of Chronic Constipation and Its Correlation With Clinical Features

Chronic constipation is common in India. Identifying its subtypes is essential not only to treat appropriately but also to improve quality of life.

To study chronic constipation subtypes and assess their clinical characteristics.

This was a prospective observational study. All patients above 18 years with chronic constipation (as per ROME IV criteria) meeting inclusion and exclusion criteria were recruited. Their evaluation included colonic transit study, colonoscopy, anorectal manometry & balloon expulsion test and accordingly were classified into subtypes.

The mean age of the patient was 50.60 ± 15.61 years. Normal transit constipation was commonest observed in 64.0%, followed by dyssynergic defecation in 19.9%, slow transit in 14.3% and mixed (slow transit + dyssynergic) in 1.9%. Despite complaining of constipation, 70.2% of patients had 7-14 bowel movements per week, while 2.5% reported > 21 bowel movements per week. Only 3.1% reported bowel movements of less than 3 per week. The typical symptoms are sense of incomplete evacuation reported by 93.8%, straining by 88.8%, anorectal blockage by 13%, and manual evacuation by 14.3%. There was significant association between type of constipation, stool frequency and time spent in the toilet (p-value < 0.001). In patient with dyssynergic defecation there was good correlation between digital rectal examination with manometry and balloon expulsion test (68.5% sensitivity and 96.8% specificity).

A sense of incomplete evacuation and not the number of bowel movements per week is the predominant symptom described by most patients with constipation in India. Chronic constipation should be subclassified into its subtypes for individualized treatment.