Mamta Rajput, MSc Nursing, MSc Applied Psychology Sushma Kumari Saini, PhD, MSc Nursing
Prevalence of Constipation Among the General Population A Community-Based Survey From India
ABSTRACT Constipation is a frequent health problem leading to great discomfort to the person and affects his or her quality of life. It is considered to be highly prevalent in the general population, but there is little data supporting the findings. This study was undertaken with an objective to assess the prevalence of constipation and its associated factors among the general population of Dadu Majra Colony, UT, Chandigarh, India. A total of 505 individuals were interviewed through structured questionnaire based on ROME II criteria for constipation. Results revealed that the prevalence of selfreported constipation within the last 1 year was 24.8% whereas 16.8% of participants had constipation according to the Rome II criteria. Most of the subjects (83%) were within the age group of 18–59 years with mean age (years) of 38.64 ± 15.57. Constipation was significantly more frequent in females than in males (20% vs. 13%) and in nonworking population than in working population (20% vs. 12%). Poor dietary habits, lesser fluid intake per day, and lesser physical activity were found to be significant factors leading to the constipation. About 18% of constipated subjects reported physicians’ consultation, whereas 8% reported the use of laxatives to relieve their constipation.
C
onstipation is a symptom, not a disease. The word “constipation” has several meanings, and the way it is used may differ not only between patients but also between different cultures and regions. It is generally considered to be a disorder characterized by persistent difficult or incomplete defecation (Lindberg et al., 2010, p. 3; Moharana & Moharana, 2011, p. 5). To standardize the definition and assessment of constipation, ROME diagnostic criteria have been developed in the recent years, which assess it in relation to symptoms such as
Received March 31, 2012; accepted June 25, 2013. About the authors: Mamta Rajput, MSc Nursing, MSc Applied Psychology, is Nursing Tutor, College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. Sushma Kumari Saini, PhD, MSc Nursing, is Lecturer, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, India. The authors declare no funding or conflict of interest. Correspondence to: Mamta Rajput, MSc Nursing, MSc Applied Psychology, College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 342005 ([email protected] or [email protected]). DOI: 10.1097/SGA.0000000000000074
VOLUME 37 | NUMBER 6 | NOVEMBER/DECEMBER 2014
straining; lumpy or hard stools; sensation of incomplete evacuation; sensation of anorectal obstruction/ blockage; manual maneuver to facilitate (e.g., digital evacuation support of the pelvic floor); and/or fewer than three defecations per week (Heish, 2005, p. 2277; Moharana & Moharana, 2011, p. 6; Wong, Sharon, Chia, Goh, & Ye, 1999). Constipation is a very common problem in the community. Population-based studies conducted throughout the world have estimated that approximately 1%–40% of otherwise healthy people report one or more symptoms of constipation (Galvez et al., 2006; Mugie, Benning, & Lorenzoc, 2011). Generally constipation is reported more frequently in women and older people (Chang et al., 2006; Chiarelli, Brown, & McElduff, 2000; Dukas, Willett, & Giovannucci, 2003; Sonnenberg & Koch, 1989). Another study conducted by Bytzer et al. (2001) reported high prevalence of constipation in low-income groups and in individuals with lower education. Constipation is a heterogeneous disorder, with multiple causes and risk factors such as lesser physical activity, poor dietary pattern, faulty lifestyle, and use of over-the-counter medications (Thompson et al., 2000; Locke, Pemberton, & Phillips, 2001; López et al., 2006; 425
Copyright © 2014 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-12-00033_LR 425
19/11/14 8:31 PM
Prevalence of Constipation Among the General Population
Moharana & Moharana, 2011; Sandler, Jordan, & Shelton, 1990; Sharma, 2006). Frequent onset of number of symptoms of constipation leads to a great number of medical visits and generating important healthcare costs (Martin & Barghout, 2004; Sonnenberg & Koch, 1989). Despite the high prevalence, morbidity, and substantial cost as a result of physician visits, this common health problem has received a very little attention. Moreover, most of the surveys conducted are simply based on participants’ self-report of constipation or nonconstipation, and, in many cases, the study samples comprise volunteers or nonrandom samples and are therefore not representative of the general population. It is, therefore, important to know the magnitude of the problem, as well as the associated factors involved. This survey was designed and conducted with the purpose of determining the importance of constipation as a health problem and its associated factors among general population in an Indian setting.
Questionnaires were completed for each individual by personal interviews. The survey period spanned from September 2009 to December 2009.
Results SPSS version 16.0 for Windows (SPSS, Inc., Chicago, IL) was used for data analysis. Descriptive (frequency, mean, standard deviation) and inferential statistics (chi-square test) were calculated.
Sociodemographic Details About 505 participants were enrolled in the study with a mean age of 38.64 years. Most of them were females (57%). Around one-fourth of the total sample had their basic education up to fifth standard. Occupationwise, about 60% of the participants were nonworking. Almost an equal number of participants were vegetarian (intake of green leafy vegetables, fruits, cereals) and nonvegetarian (intake of meat, chicken) (Table 1).
Methods Participants A total of 505 individuals (males and females) living in Dadu Majra Colony, UT, Chandigarh, were included in the study. Participants were aged between 9 and 68 years with mean age of 38.64 years (SD = 15.57). The socioeconomic status of participants ranged from lower class to middle class. All the participants were of Indian origin.
Measures The data were collected using structured questionnaire, which consisted of two sections. Part A was concerned with sociodemographic details, and Part B collected information on bowel habits and factors associated with constipation. Constipation was defined using Rome II criteria, which require at least two of the six characteristics of constipation to be present for 12 weeks (not necessarily consecutive) in the preceding 12 months. The questionnaire was validated by experts in the field of nursing and public health.
Procedure Participants were recruited for the study after doing house-to-house survey. Before data collection, participants were given detailed information regarding survey and informed verbal consent was taken from them. Thereafter, details of bowel habits were collected from the participants along with information on demographic feature. The details related to other factors such as dietary patterns (vegetarian—i.e., intake of green leafy vegetables, fruits, cereals—and nonvegetarian—i.e., intake of meat, chicken), exercise, and the use of laxatives to relieve constipation were also noted. 426 Copyright © 2014 Society of Gastroenterology Nurses and Associates
TABLE 1. Sociodemographic Characteristics of General Population (N = 505) Variable
n (%)
Age (years)
Prevalence of Constipation Among the General Population A Community-Based Survey From India
ABSTRACT Constipation is a frequent health problem leading to great discomfort to the person and affects his or her quality of life. It is considered to be highly prevalent in the general population, but there is little data supporting the findings. This study was undertaken with an objective to assess the prevalence of constipation and its associated factors among the general population of Dadu Majra Colony, UT, Chandigarh, India. A total of 505 individuals were interviewed through structured questionnaire based on ROME II criteria for constipation. Results revealed that the prevalence of selfreported constipation within the last 1 year was 24.8% whereas 16.8% of participants had constipation according to the Rome II criteria. Most of the subjects (83%) were within the age group of 18–59 years with mean age (years) of 38.64 ± 15.57. Constipation was significantly more frequent in females than in males (20% vs. 13%) and in nonworking population than in working population (20% vs. 12%). Poor dietary habits, lesser fluid intake per day, and lesser physical activity were found to be significant factors leading to the constipation. About 18% of constipated subjects reported physicians’ consultation, whereas 8% reported the use of laxatives to relieve their constipation.
C
onstipation is a symptom, not a disease. The word “constipation” has several meanings, and the way it is used may differ not only between patients but also between different cultures and regions. It is generally considered to be a disorder characterized by persistent difficult or incomplete defecation (Lindberg et al., 2010, p. 3; Moharana & Moharana, 2011, p. 5). To standardize the definition and assessment of constipation, ROME diagnostic criteria have been developed in the recent years, which assess it in relation to symptoms such as
Received March 31, 2012; accepted June 25, 2013. About the authors: Mamta Rajput, MSc Nursing, MSc Applied Psychology, is Nursing Tutor, College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. Sushma Kumari Saini, PhD, MSc Nursing, is Lecturer, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, India. The authors declare no funding or conflict of interest. Correspondence to: Mamta Rajput, MSc Nursing, MSc Applied Psychology, College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 342005 ([email protected] or [email protected]). DOI: 10.1097/SGA.0000000000000074
VOLUME 37 | NUMBER 6 | NOVEMBER/DECEMBER 2014
straining; lumpy or hard stools; sensation of incomplete evacuation; sensation of anorectal obstruction/ blockage; manual maneuver to facilitate (e.g., digital evacuation support of the pelvic floor); and/or fewer than three defecations per week (Heish, 2005, p. 2277; Moharana & Moharana, 2011, p. 6; Wong, Sharon, Chia, Goh, & Ye, 1999). Constipation is a very common problem in the community. Population-based studies conducted throughout the world have estimated that approximately 1%–40% of otherwise healthy people report one or more symptoms of constipation (Galvez et al., 2006; Mugie, Benning, & Lorenzoc, 2011). Generally constipation is reported more frequently in women and older people (Chang et al., 2006; Chiarelli, Brown, & McElduff, 2000; Dukas, Willett, & Giovannucci, 2003; Sonnenberg & Koch, 1989). Another study conducted by Bytzer et al. (2001) reported high prevalence of constipation in low-income groups and in individuals with lower education. Constipation is a heterogeneous disorder, with multiple causes and risk factors such as lesser physical activity, poor dietary pattern, faulty lifestyle, and use of over-the-counter medications (Thompson et al., 2000; Locke, Pemberton, & Phillips, 2001; López et al., 2006; 425
Copyright © 2014 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
GNJ-D-12-00033_LR 425
19/11/14 8:31 PM
Prevalence of Constipation Among the General Population
Moharana & Moharana, 2011; Sandler, Jordan, & Shelton, 1990; Sharma, 2006). Frequent onset of number of symptoms of constipation leads to a great number of medical visits and generating important healthcare costs (Martin & Barghout, 2004; Sonnenberg & Koch, 1989). Despite the high prevalence, morbidity, and substantial cost as a result of physician visits, this common health problem has received a very little attention. Moreover, most of the surveys conducted are simply based on participants’ self-report of constipation or nonconstipation, and, in many cases, the study samples comprise volunteers or nonrandom samples and are therefore not representative of the general population. It is, therefore, important to know the magnitude of the problem, as well as the associated factors involved. This survey was designed and conducted with the purpose of determining the importance of constipation as a health problem and its associated factors among general population in an Indian setting.
Questionnaires were completed for each individual by personal interviews. The survey period spanned from September 2009 to December 2009.
Results SPSS version 16.0 for Windows (SPSS, Inc., Chicago, IL) was used for data analysis. Descriptive (frequency, mean, standard deviation) and inferential statistics (chi-square test) were calculated.
Sociodemographic Details About 505 participants were enrolled in the study with a mean age of 38.64 years. Most of them were females (57%). Around one-fourth of the total sample had their basic education up to fifth standard. Occupationwise, about 60% of the participants were nonworking. Almost an equal number of participants were vegetarian (intake of green leafy vegetables, fruits, cereals) and nonvegetarian (intake of meat, chicken) (Table 1).
Methods Participants A total of 505 individuals (males and females) living in Dadu Majra Colony, UT, Chandigarh, were included in the study. Participants were aged between 9 and 68 years with mean age of 38.64 years (SD = 15.57). The socioeconomic status of participants ranged from lower class to middle class. All the participants were of Indian origin.
Measures The data were collected using structured questionnaire, which consisted of two sections. Part A was concerned with sociodemographic details, and Part B collected information on bowel habits and factors associated with constipation. Constipation was defined using Rome II criteria, which require at least two of the six characteristics of constipation to be present for 12 weeks (not necessarily consecutive) in the preceding 12 months. The questionnaire was validated by experts in the field of nursing and public health.
Procedure Participants were recruited for the study after doing house-to-house survey. Before data collection, participants were given detailed information regarding survey and informed verbal consent was taken from them. Thereafter, details of bowel habits were collected from the participants along with information on demographic feature. The details related to other factors such as dietary patterns (vegetarian—i.e., intake of green leafy vegetables, fruits, cereals—and nonvegetarian—i.e., intake of meat, chicken), exercise, and the use of laxatives to relieve constipation were also noted. 426 Copyright © 2014 Society of Gastroenterology Nurses and Associates
TABLE 1. Sociodemographic Characteristics of General Population (N = 505) Variable
n (%)
Age (years)
