Chronic constipation and co-morbidities: A prospective population-based nested case-control study

Background: Chronic constipation (CC) is common in the community but surprisingly little is known about relevant gastrointestinal (GI) and non-GI co-morbidities. Objective: The purpose of this study was to assess the epidemiology of CC and in particular provide new insights into the co-morbidities linked to this condition. Methods: In a prospective, population-based nested case-control study, a cohort of randomly selected community residents (n=8006) were mailed a validated self-report gastrointestinal symptom questionnaire. CC was defined according to Rome III criteria. Medical records of each case and control were abstracted to identify potential CC comorbidities. Results: Altogether 3831 (48%) subjects returned questionnaires; 307 met criteria for CC. Age-adjusted prevalence in females was 8.7 (95% confidence interval (CI) 7.1–10.3) and 5.1 (3.6–6.7) in males, per 100 persons. CC was not associated with most GI pathology, but the odds for constipation were increased in subjects with anal surgery relative to those without (odds ratio (OR)=3.3, 95% CI 1.2–9.1). In those with constipation vs those without, neurological diseases including Parkinson’s disease (OR=6.5, 95% CI 2.9–14.4) and multiple sclerosis (OR=5.5, 95% CI 1.9–15.8) showed significantly increased odds for chronic constipation, adjusting for age and gender. In addition, modestly increased odds for chronic constipation in those with angina (OR=1.4, 95% CI 1.1–1.9) and myocardial infarction (OR=1.5, 95% CI 1.0–2.4) were observed. Conclusions: Neurological and cardiovascular diseases are linked to constipation but in the community constipation is unlikely to account for most lower GI pathology.