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 gastro-intestinal (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.