Perceptions of Constipation Vary Among Public/Physicians

The public’s perception of constipation is different than that of general practitioners and specialists, according to the results of a new study. A variety of different symptoms were listed as important for the diagnosis of constipation by the general public that are not part of current diagnostic criteria.

For example, infrequent bowel movements were most frequently reported as important by specialist doctors compared with less than half of general practitioners and less than one-third of the constipated general population. In contrast, “straining” was most the most frequently cited symptoms of constipation by the general public.

Additionally, seven clusters of symptoms important for diagnosis were identified, with the majority of these symptoms not being part of the Rome IV diagnostic criteria.

“The lack of a sole symptom used to universally diagnose constipation and the lack of consensus among the general population and by doctors highlight that constipation is viewed as a cluster of several symptoms,” Eirini Dimidi, PhD, of King’s College London, United Kingdom, and colleagues wrote in The American Journal of Gastroenterology. “Comprehensive and appropriate assessment of symptoms is still crucial for screening and identifying constipation in both the clinical and research setting.”

The study used self-administered online questionnaires asking participations to report symptoms perceived to be most important for a diagnosis of constipation. Responses were compared among the general population (with [n=924] and without constipation [n=1,623]), 411 general practitioners, and 365 specialists.

Rome IV criteria specify that patients have at least 2 of these symptoms for 3 months or longer with onset of symptoms at least 6 months before diagnosis of constipation:

·        straining during more than 25% of defecations,

·        lumpy or hard stools in more than 25% of defecations,

·        sensation of incomplete evacuation for more than 25% of defecations,

·        sensation of anorectal obstruction/blockage for more than 25% of defecations,

·        manual maneuvers to facilitate more than 25% of defecations,

·        fewer than 3 defecations per week.

Among those with self-reported constipation, 94% met Rome IV criteria for functional constipation. However, among those who reported no constipation, 29% actually met these criteria.

There was a significant difference between physicians and the public on perception of infrequent bowel movements. These were perceived as an important diagnostic criteria for constipation by 26% of the general population compared with 41% of general practitioners and 65% of specialists (P<.001). Less than half of the general population considered any of the Rome IV symptoms to be important for diagnosis of constipation.

The researchers also used a series of case studies describing the presence or absence of constipation according to Rome IV criteria. Absence of constipation was correctly identified by between 85% and 92% of the cases without constipation, but the presence of constipation was correctly identified in only 60% to 70% of the cases.

According to the researchers, the findings from this study are of major importance “as it may mean that patients who seek medical care for their constipation-related symptoms may not have their symptoms recognized as constipation by the doctor and, therefore, may not be examined, diagnosed, or managed as such”.

Dimidi E, Cox C, Grant R, et al. Perceptions of constipation among the general public and people with constipation differ strikingly from those of general and specialist doctors and the Rome IV criteria. American Journal of Gastroenterology. 2019;doi:10.14309/ajg.0000000000000267.