Hemorrhoids, incontinence and more can result, research shows
A very private health problem, it turns out, is associated with potentially significant and costly complications. In a review of the scientific evidence, researchers found that constipation might lead to or boost the risk for more serious complications such as hemorrhoids, anal fissures, fecal incontinence, colonic conditions and urologic disorders.
Dr. Nicholas J. Talley, chairman of internal medicine at Mayo Clinic Jacksonville, said that few people appreciate the seriousness of constipation because symptoms can vary greatly, from mild to severe.
"Most people have mild intermittent symptoms, and they should not worry, although some do become excessively concerned," said Talley, who is also a professor of medicine and epidemiology at Mayo's College of Medicine. "Others suffer in silence, because it's embarrassing to talk about your bowels."
Roughly 12 to 19 percent of the population in North America -- as many as 63 million people -- suffer from constipation, according to the review.
In the United States, the direct cost of treating constipation is about $235 million a year, another study has found. Inpatient care was responsible for 55 percent of the cost, even though constipation is treated mainly in outpatient settings.
People who experience two or more symptoms for at least three months for six months or longer are considered to have "functional constipation." Symptoms include straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, manual maneuvers to help with defecation and less than three unassisted defecations a week.
For some people, being constipated is just the prelude to other problems affecting their anus, colon or urinary tract. Could there be a link?
To help demystify the matter, Talley and his colleagues conducted a literature search for relevant studies published between 1980 and 2007. Their findings were published earlier this year in Clinical Gastroenterology and Hepatology.
Though the role of constipation in diverticular disease and colon cancer remains unclear, case-control studies -- which compare one group of people with a health condition to another group without it -- have shown a significant association between constipation and hemorrhoids. Interventional studies, which have involved dietary changes and medicinal therapies to minimize constipation, also have suggested a cause-and-effect relationship.
At least an association has been shown between constipation and other conditions, too. Studies of people with rectal prolapse, in which the rectum becomes stretched and protrudes from the anus, suggest such a relationship. More than 50 percent of people with anal fissures, which are small splits or tears in anal tissue, also have constipation. And fecal incontinence, the second most common cause for nursing home admissions, often occurs along with constipation, the researchers noted.
There also appears to be a causal relationship between constipation and urologic disorders.
Despite such connections, the number of medications approved by the U.S. Food and Drug Administration to treat chronic constipation is limited, according to a review in a supplement to the Journal of Managed Care Pharmacy.
One of the newer medications, Amitiza (lubiprostone), is the only FDA-approved medication for the treatment of adults with chronic constipation for which there is no known cause.
"Lubiprostone appears to be very effective; however, a relatively high percentage suffer from nausea when they take the drug on an empty stomach," said James C. Eoff III, executive associate dean and professor of clinical pharmacy at the University of Tennessee College of Pharmacy in Memphis. "For the ones who take it with food, the percent effectiveness ratings are very good."
But there are new options in the pipeline. One is a drug called linaclotide, the first compound in a new class of laxative agents. "This would be a very effective alternative to treatment of chronic constipation," Eoff noted.
Another, called prucalopride, works by increasing motility and transit in the colon. "The most recent findings indicate this may be a safe and effective treatment for chronic constipation and hopefully for IBS-C -- irritable bowel syndrome with constipation," he added.
As for preventing constipation, Talley said he's found that a well-balanced diet, exercise, a regular toileting pattern and not avoiding the urge to go when nature calls can help.
"Lifestyle is key for most," he said.
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