Differences between painless and painful constipation among community women.
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.
Bharucha
Adil E
AE
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Locke
G Richard
GR
Zinsmeister
Alan R
AR
Seide
Barbara M
BM
McKeon
Kimberly
K
Schleck
Cathy D
CD
Melton
L Joseph
LJ
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