Prevalence and Pathophysiology of Functional Constipation Among Women in Catalonia, Spain

BACKGROUND: Specific treatment of functional bowel disorders requires precise diagnosis. However, prevalence and subtypes of functional constipation among women are not completely understood. OBJECTIVE: Our aim was to assess the prevalence of functional constipation and investigate the subtypes of dyssynergic defecation and slow transit constipation among Spanish women. DESIGN: We performed a prospective epidemiological study in healthy young women and retrospective pathophysiological studies in 2 patient cohorts of women with functional constipation according to Rome II criteria. SETTINGS: Referral centers at Chnica Sagrada Familia, Barcelona, Spain, and Hospital de Mataro, Mataro, Spain. PATIENTS: The epidemiological study included 600 healthy young women, aged 37.1 (SD, 8.2) years. Patient cohort 1 comprised 172 women with functional constipation without symptoms of pelvic floor dysfunction, ranging in age from 18 to 45 years. Patient cohort 2 comprised 106 women with functional constipation and symptoms of dyssynergic defecation, ranging in age from 45 to 65 years. MAIN OUTCOME MEASURES: In healthy women, a questionnaire was used to determine rates of functional constipation, dyssynergic defecation, and slow transit constipation. In patients, results of anorectal manometry, EMG, and colonic transit studies were reviewed to assess subtypes of functional constipation; in addition, results of dynamic videoproctography were reviewed in cohort 2 to assess the role of structural pelvic floor disorders. RESULTS: The prevalence of functional constipation in healthy young women was 28.8%; symptoms of dyssynergic defecation were found in 8.2%, those of isolated slow transit in only 0.17%. In patient cohort 1, a total of 143 patients (83.1%) showed dyssynergic defecation: 117 patients (68.0%) had paradoxical external anal sphincter contraction and 26 (15.1%) had impaired internal anal sphincter relaxation). Slow transit constipation without dyssynergia was observed in 15 (8.7%). Up to 40.2% of patients with dyssynergia also had delayed colonic transit. In the cohort of 106 women with dyssynergic defecation, videoproctography showed impaired puborectal relaxation in 64 patients (60.4%), anterior rectocele in 65 (61.3%), and rectal prolapse in 13 (12.3%). LIMITATIONS: We could not estimate the prevalence and subtypes of irritable bowel syndrome in the epidemiological study. CONCLUSIONS: Functional constipation is extremely prevalent among young, healthy, Spanish women, dyssynergic defecation being the most prevalent subtype. Slow transit constipation without dyssynergic defecation is uncommon. Structural pelvic floor disorders are highly prevalent in middle-aged women with dyssynergic defecation.