Epidemiology of constipation in children and adults: A systematic review

doi:10.1016/j.bpg.2010.12.010

Best Practice & Research Clinical Gastroenterology

Volume 25, Issue 1, February 2011, Pages 3-18

https://doi.org/10.1016/j.bpg.2010.12.010 Get rights and content

Abstract

We aimed to review the published literature regarding the epidemiology of constipation in the general paediatric and adult population and to assess its geographic, gender and age distribution, and associated factors. A search of the Medline database was performed. Study selection criteria included: (1) studies of population-based samples; (2) containing data on the prevalence of constipation without obvious organic aetiology; (3) in paediatric, adult or elderly population; (4) published in English and full manuscript form. Sixty-eight studies met our inclusion criteria. The prevalence of constipation in the worldwide general population ranged from 0.7% to 79% (median 16%). The epidemiology of constipation in children was investigated in 19 articles and prevalence rate was between 0.7% and 29.6% (median 12%). Female gender, increasing age, socioeconomic status and educational level seemed to affect constipation prevalence.

Introduction

Constipation is a common problem worldwide. Because only a minority of patients suffering from constipation seeks health care, its exact prevalence is difficult to ascertain. As a consequence, reports of its prevalence have varied widely, ranging from 0.7% to 29.6% in children [1] and from 2% to 35% in adults in Europe, Oceania and North America [2], [3]. Constipation accounts for 2.5 million physician visits annually in the United States [4] and it contributes significantly to health care financial burden, with a cost of $2757 for diagnostic work up per patient and $3362 per treated child per year [5], [6]. Higher expenses in paediatrics are mainly due to more expensive outpatient, emergency room and prescription drug costs [6]. Constipation has a significant impact on quality of life, affecting both physical and emotional well-being [7], [8], [9], [10], [11], [12]. Due to the aforementioned factors, constipation should be considered a major public health issue both in the paediatric and adult population and knowledge of its epidemiology is highly relevant to primary care providers, gastroenterologists and health care policy makers.

We performed a systematic review on the worldwide published literature to identify the prevalence of constipation in the general paediatric and adult population in order to summarize its geographic, gender and age distribution, and associated socioeconomic factors.

Section snippets

Methods

A literature search was performed on October 2010 to identify published studies on the subject of epidemiology of constipation in children and adults. The Medline database was searched from 1966 to present, using the following medical subject heading (MeSH) terms ‘Constipation/epidemiology’ [Mesh] OR (‘Constipation’ [Mesh] AND (epidemiology OR questionnaires OR prevalence OR incidence OR natural history OR registry)). The results were limited to human studies and English language publications.

Results

A total of 1209 citations were identified by the Medline database search. After the initial evaluation, 80 were judged potentially eligible. Review of the full manuscripts selected 58 articles that met our inclusion criteria. Ten other candidate articles were identified by reviewing the references of the relevant articles. Thus, a total of 68 articles were included in our review (Table 1) [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30],

Discussion

Based on a systematic review of the literature we found that the prevalence of constipation in the worldwide general population is very variable, ranging from 2.5% to 79% in adults and ranging from 0.7% to 29.6% in children. These rates are consistent with published reviews about the epidemiology of constipation in North America, Europe and Oceania [2], [3]. Our up-to-date and comprehensive review shows that prevalence rates range widely between countries and continents, but that in general,

Conflict of interest

None.

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Cited by (642)

Prevalence and determinants of constipation in children in Asia: a systematic review and meta-analysis
2024, eClinicalMedicine
Constipation is prevalent worldwide, significantly increasing healthcare costs and diminishing the quality of life in children affected. Current studies have yielded mixed results regarding the factors associated with constipation, and mainly focusing on patients outside of Asia. Moreover, most of these studies lack focus on the paediatric population. This study aimed to identify the prevalence and associated factors of constipation among children in Asia.
In this systematic review and meta-analysis, we systematically searched PubMed, Scopus, and Cochrane for cohort and cross-sectional studies published from database inception up to October 12, 2022, and continued with manual searching until September 2, 2023. Eligible studies were those that included children in Asia aged 0–18 years old suffering from idiopathic constipation, with prevalence value provided in the English abstract. The analysis included clinical and general population. Children with organic constipation, who had undergone gastrointestinal surgery, or with congenital defects were excluded, as these factors affect the incidence of constipation. Data included in the analysis were extracted from published reports only. The extracted data were pooled using random-effects model to analyse the prevalence of constipation in children in Asia. This study is registered with PROSPERO, CRD42022367122.
Out of 4410 systematically searched studies and 36 manually searched ones, a total of 50 studies were included in the final analysis, encompassing data from 311,660 children residing in Asia. The pooled prevalence of constipation was 12.0% (95% CI 9.3–14.6%, I² = 99.8%). There was no significant difference in constipation prevalence observed by sex and geographical location. Nonetheless, adolescents and children aged 1–9 years exhibited a significantly higher prevalence constipation compared to infants (p < 0.0001) Additionally, significant differences in constipation rates were observed across various diagnostic methods, population sources, and mental health conditions.
Despite the high heterogeneity resulting from varying diagnostic tools or definitions used among studies, our review adds to the literature on constipation among children in Asia. It reveals a notably high prevalence of constipation in this demographic. Diagnostic methods, age, and compromised mental health emerged as significant influencers of constipation among children in Asia, highlighting potential strategies to mitigate constipation prevalence in children in Asia.
The National Science and Technology Council, Taiwan.
Diagnostic and therapeutic approach to children with chronic refractory constipation: Consensus report by the SIGENP motility working group
2024, Digestive and Liver Disease
Constipation is a common problem in children, accounting for about 3% of all primary care visits and up to 25% of referrals to paediatric gastroenterologists. Although polyethylene glycol often proves effective, most children require prolonged treatment and about 50% of them have at least one relapse within the first 5 years after initial recovery. When conventional treatment fails, children are considered to have refractory constipation.
Children with refractory constipation deserve specialist management and guidance. Over the last decades, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed. The present review analyses the possible diagnostic investigations for children with refractory constipation, focusing on their actual indications and their utility in clinical practice. Moreover, we have also analytically reviewed medical and surgical therapeutic options, which should be considered in selected patients in order to achieve the best clinical outcome.
Perceptions, Definitions, and Therapeutic Interventions for Occasional Constipation: A Rome Working Group Consensus Document
2024, Clinical Gastroenterology and Hepatology
Functional constipation is the most common of the disorders of gut-brain interaction, affecting approximately 12% of the world population. Although classically considered a chronic condition, many individuals experience shorter yet repetitive bouts of constipation representing a different clinical entity. There has been increased interest in this latter disorder, which has recently been classified as occasional constipation. This Rome Foundation working group document reflects the consensus of an international team of specialists who summarized currently available research to provide a working definition of and treatment algorithm for occasional constipation. The recommendations herein are based on current evidence, accounting for gaps in the literature as well as international variance in definitions and health seeking behaviors for constipation.
The committee members reviewed the scientific literature, focusing specifically on occasional constipation, with the understanding that as a new entity, a paucity of data would be available. We used Rome IV research and clinical definitions to establish the framework for our definition of occasional constipation. Where possible, treatment recommendations were determined on the basis of the earliest extractable data from functional constipation studies, focusing on positive results within the first 2 weeks of treatment. We used the Delphi method to create consensus with 100% agreement between the authors.
An evidence-based review of the literature resulted in the definition of occasional constipation as follows: “individuals who experience the presence of at least 1 functional constipation symptom, in the absence of alarm signs or symptoms, occurring at irregular and infrequent intervals, which is bothersome enough to induce a patient to seek medical management.” Medical management whether seeking medical care or self-treatment was left to the individual’s discretion, and we did not include time anchors because these thresholds require further investigation. Polyethylene glycol and stimulant laxatives are recommended as first-line interventions, whereas magnesium-containing compounds are suggested in individuals failing to respond to these therapies. There are insufficient data to make recommendations for using fiber or stool softeners. Prescription laxatives should be reserved for individuals with chronic constipation.
Occasional constipation is a unique clinical entity characterized by infrequent but recurrent symptoms. Data are limited because consensus definitions have been lacking. Establishing a standardized definition and therapeutic recommendations provides a framework for future studies focusing on epidemiologic and symptoms-based outcomes. Further studies are needed to confirm and refine these recommendations.
Constipation in hospitalized psychiatric patients: An underestimated common phenomenon. Retrospective epidemiological study in an adult psychiatric hospital setting
2024, Encephale
Constipation is more common in patients with mental disorders than in the general population. However, its frequency in hospitalized patients, its association with drugs and how teams become aware of it and take care of it are not fully identified.
The retrospective study included 141 male and 127 female new patients admitted for routine treatment at France's largest psychiatric hospital between November 15 and December 11, 2017. A physician reviewed electronic medical records to diagnose constipation and record variables of interest: socio-demographic factors, diagnosis, drugs prescribed and taken. We calculated an anticholinergic impregnation score (AIS) for each patient by using a validated French scale. Patients were then classified into two groups by state of constipation defined by the physician. Univariate and multivariate analyses were used to study the frequency of constipation, factors associated with it and its management.
The prevalence of constipation was 38% (95% CI 32–44). Associated factors were taking antipsychotics and the burden of anticholinergic treatment. On multiple regression analysis, the only remaining factor was anticholinergic treatment: AIS ≥ 5 was associated with constipation (odds ratio 1.80 [95% CI 1.07–3.14], P = 0.027). Only 44.0% of patients were prescribed a preventive laxative, systematically in half of the cases. Above all, only 11.2% were administered this laxative (i.e., 25% of that prescribed). Digestive transit was poorly recorded in the table of constants (34.7%). We found one case of sub-occlusion as a severe case.
Constipation is common in psychiatric inpatients. The more the patient is prescribed drugs with a pronounced anticholinergic effect, the greater the risk. Alongside the preventive measures common to all psychiatric patients which must be promoted (concerning diet, physical activity, etc.), polymedication with this type of anticholinergic must be better monitored to prevent complications: prescription and administration of a preventive laxative, monitoring transit in the table of constants. Thus, a better knowledge of the subject and specific training are essential.
La constipation est plus fréquente chez les patients souffrant de troubles mentaux que dans la population générale et peut conduire si non diagnostiquée à des complications sévères voire fatales. Cependant, sa fréquence chez les patients hospitalisés, les facteurs qui y sont associés, en particulier médicamenteux et la manière dont les équipes la prennent en charge ne sont pas entièrement identifiés.
Une étude rétrospective a inclus 268 nouveaux patients, 141 hommes et 127 femmes, admis en hospitalisation temps plein dans le plus grand hôpital psychiatrique de France entre le 15 novembre et le 11 décembre 2017. Un somaticien a relu tous les dossiers médicaux électroniques pour diagnostiquer la constipation et recueillir les variables d’intérêt : facteurs sociodémographiques, diagnostics psychiatriques et somatiques, médicaments prescrits et administrés. Nous avons calculé un score d’imprégnation anticholinergique (AIS) pour chaque patient en utilisant une échelle française validée. Les patients ont ensuite été classés en deux groupes selon le diagnostic de constipation défini par le médecin. Des analyses univariées et multivariées ont été utilisées pour estimer la fréquence de la constipation, les facteurs qui y sont associés et sa prise en charge.
La prévalence de la constipation était de 38 % (IC95 % 32–44). La constipation était plus fréquente en cas de prise d’antipsychotiques et selon l’imprégnation anticholinergique. En analyse de régression multiple, seule l’imprégnation anticholinergique – score AIS ≥ 5 – était associée à la survenue de constipation (OR 1,80 [IC95 % 1,07–3,14], p = 0,027). Par ailleurs, seuls 44,0 % des patients se sont vu prescrire un laxatif à titre préventif, de manière systématique dans la moitié des cas. Surtout, seulement 11,2 % des patients ont reçu in fine ce laxatif (soit 25 % de ceux prescrits). Le transit digestif était inscrit dans le tableau des constantes pour seulement 34,7 % des patients. Nous avons observé un cas de sub-occlusion sur notre période d’observation.
La constipation est courante chez les patients hospitalisés en psychiatrie. Plus le patient se voit prescrire des médicaments ayant un effet anticholinergique prononcé, plus le risque est grand. Au côté des mesures préventives communes à tous les patients de psychiatrie qui doivent être encouragées (touchant le régime alimentaire, l’activité physique…), la polymédication avec ce type d’anticholinergiques doit être mieux surveillée pour prévenir les complications : prescription et administration d’un laxatif préventif, suivi du transit dans le tableau des constantes. Ainsi, une meilleure connaissance du sujet et une formation spécifique sont indispensables.
Using machine learning methods to analyze the association between urinary polycyclic aromatic hydrocarbons and chronic bowel disorders in American adults
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The etiology of chronic bowel disorders is multifaceted, with environmental exposure to harmful substances potentially playing a significant role in their pathogenesis. However, research on the correlation between polycyclic aromatic hydrocarbons (PAHs) and chronic bowel disorders remains limited. Using data from the National Health and Nutrition Examination Survey (NHANES) conducted in 2009–2010, we investigated the relationship between 9 PAHs and chronic diarrhea and constipation in U.S. adults. We employed unsupervised methods such as clustering and Principal Component Analysis (PCA) to identify participants with similar exposure patterns. Additionally, we used supervised learning techniques, namely weighted quantile sum (WQS) and Bayesian kernel machine (BKMR) regressions, to assess the association between PAHs and the occurrence of chronic diarrhea and chronic constipation. PCA identified three principal components in the unsupervised analysis, explaining 86.5% of the total PAH variability. The first component displayed a mild association with chronic diarrhea, but no correlation with chronic constipation. Participants were divided into three clusters via K-means clustering, based on PAH concentrations. Clusters with higher PAH exposure demonstrated an increased odds ratio for chronic diarrhea, but no meaningful connection with chronic constipation. In the supervised analysis, the WQS regression underscored a positive relationship between the PAH mixture and chronic diarrhea, with three PAHs significantly impacting the mixture effect. The mixture index showed no correlation with chronic constipation. BKMR analysis illustrated a positive trend in the impact of four specific PAHs on chronic diarrhea, given other metabolites were fixed at their 50th percentiles. Our results suggest a clear association between higher PAH exposure and an increased risk of chronic diarrhea, but not chronic constipation. It also underscores the potential role of specific PAHs in contributing to the risk of chronic diarrhea.
Chronic constipation and its associated factors in patients with type-2 diabetes: A multicenter cross-sectional study
2023, Diabetes Research and Clinical Practice
Diabetes is one of the global public health concern and constipation is frequently seen among gastrointestinal symptoms in diabetes. Despite the fact that constipation is common, doctors and/or patients disregard it. This study aimed to determine the prevalence and contributing factors of constipation in patients with diabetes.
Multi-center cross-sectional study was carried out and the data was analyzed using STATA 14. Binary and multilevel logistic regressions were also carried out to identify associated to factors. Factors having a p-value of less than 0.05 were deemed statistically significant in the final model.
206 diabetics participated in the survey. The mean age of the participants was 52.7 years (SD ± 11.9). The prevalence of constipation was 16% (95% CI: 10.97–21.07). Age (AOR = 13.56; 95% CI: 1.71, 107.21), females (AOR = 4.58; 95% CI: 1.76, 11.87), the duration of the diabetes (AOR = 3.16; 95% CI: 1.21, 8.24), and psychological distress (AOR = 12.49, 95% CI: 1.53, 101.8) were significant factors.
The magnitude of constipation was considerable, and it was linked to psychological distress, longer-lasting diabetes, being a woman, and ageing. Patients with type-2 diabetes need to receive careful treatment in order to reduce the severity of the condition and its additional complications.

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1Epidemiology of constipation in children and adults: A systematic review

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Conflict of interest

J Pediatr

Gastroenterology

Dig Liver Dis

J Pediatr

Am J Gastroenterol

Am J Gastroenterol

Am J Gastroenterol

Am J Gastroenterol

Am J Gastroenterol

Gastroenterology

Gastroenterology

J Pediatr

Gastroenterology

Res Dev Disabil

Gastroenterology

Gastroenterology

Am J Geriatr Pharmacother

Epidemiology of childhood constipation: a systematic review

Am J Gastroenterol

Epidemiology of constipation in Europe and Oceania: a systematic review

BMC Gastroenterol

Epidemiology of constipation in North America: a systematic review

Am J Gastroenterol

Physician visits in the United States for constipation: 1958 to 1986

Dig Dis Sci

Chronic constipation – is the work-up worth the cost?

Dis Colon Rectum

The health-related quality of life and economic burden of constipation

Pharmacoeconomics

The burden of constipation on quality of life: results of a multinational survey

Aliment Pharmacol Ther

Chronic childhood constipation is associated with impaired quality of life: a case-controlled study

J Pediatr Gastroenterol Nutr

Definitions, epidemiology, and impact of chronic constipation

Rev Gastroenterol Disord

Quality of life in patients with different types of functional constipation

Scand J Gastroenterol

Infant nutritional factors and functional constipation in childhood: the Generation R study

Am J Gastroenterol

Association between constipation and stressful life events in a cohort of Sri Lankan children and adolescents

J Trop Pediatr

Bowel habits and toilet training in a diverse population of children

J Pediatr Gastroenterol Nutr

Increased prevalence of constipation in pre-school children is attributable to under-consumption of plant foods: a community-based study

J Paediatr Child Health

Factors associated with childhood constipation

J Paediatr Child Health

A prospective community-based study of gastroenterological symptoms in school-age children

J Pediatr Gastroenterol Nutr

Prevalence rates for constipation and faecal and urinary incontinence

Arch Dis Child

Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children

Acta Paediatr

Functional gastrointestinal disorders in African American children in primary care

J Pediatr Gastroenterol Nutr

A community-based study of the prevalence of constipation in young children and the role of dietary fibre

Hong Kong Med J

Functional gastrointestinal disorders in children: an Italian prospective survey

Pediatrics

Prevalence of chronic constipation in children at a primary health care unit

J Pediatr (Rio J)

Constipation in school-aged children at public schools in Rio de Janeiro, Brazil

J Pediatr Gastroenterol Nutr

Survey of laxative use by adults with self-defined constipation in South America and Asia: a comparison of six countries

Aliment Pharmacol Ther

A Greek survey of community prevalence and characteristics of constipation

Eur J Gastroenterol Hepatol

Obesity and functional constipation; a community-based study in Iran

J Gastrointestin Liver Dis

Chronic gastrointestinal symptoms and quality of life in the Korean population

World J Gastroenterol

A multinational survey of prevalence and patterns of laxative use among adults with self-defined constipation

1
Epidemiology of constipation in children and adults: A systematic review