title: Differences between painless and painful constipation among community women.
abstract: BACKGROUND
  In the Rome II criteria, patients with both constipation and abdominal pain (AP) (i.e., "painful constipation" (PC)), who do not satisfy criteria for irritable bowel syndrome (IBS) are included in the same functional constipation (FC) category as patients with constipation without AP (i.e., "painless constipation" (PLC)). What differences, if any, exist between FC without (i.e., PLC) and with AP (i.e., PC) are unclear.
  
  
  METHODS
  To compare clinical features among PLC, PC, constipation-predominant IBS (C-IBS), and non-C-IBS, a validated questionnaire was mailed (with telephone follow-up of nonresponders) to an age-stratified random sample of 5,200 adult women in Olmsted County, Minnesota.
  
  
  RESULTS
  Altogether, 2,800 women (53%) responded. The age-adjusted prevalence of PLC (7.1 per 100; 95% confidence interval (95% CI), 6.2-8.0) was higher compared to PC (0.9 per 100; 95% CI, 0.6-1.2). Compared to PLC, patients with PC reported worse general health (i.e., excellent or very good = 37.5% vs 51.2%), more somatic symptoms (mean score = 1.3 vs 0.9), and urinary urgency (% often = 58% vs 32%), and had a higher prevalence of hysterectomy. Bowel symptoms significantly impacted > or =1 domain of quality of life (QOL) in 18% of PC versus 9% of PLC. In a logistic discriminant model, age, general health, impact of bowel symptoms on QOL, somatic symptoms, and urinary urgency independently discriminated between bowel subtypes.
  
  
  CONCLUSIONS
  Patients with PC more closely resemble those with C-IBS than PLC. Consideration should be given to separating PC from PLC in the Rome criteria and in therapeutic trials.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Adil E
authors.initials: AE
authors.lastname: Bharucha
authors.forename: G Richard
authors.initials: GR
authors.lastname: Locke
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Seide
authors.forename: Kimberly
authors.initials: K
authors.lastname: McKeon
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Schleck
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003248:Constipation / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D008910:Minnesota; D017063:Outcome Assessment, Health Care; D012016:Reference Values; D012307:Risk Factors; D013223:Statistics as Topic