Original Contribution
The American Journal of Gastroenterology (2006) 101, 604–612; doi:10.1111/j.1572-0241.2006.00435.x
Differences Between Painless and Painful Constipation Among Community Women
There are no competing interests to declare.
Adil E Bharucha MD1, G Richard Locke MD1, Alan R Zinsmeister PhD2, Barbara M Seide1, Kimberly McKeon MD4, Cathy D Schleck BSc2 and L Joseph Melton III MD3
- 1Division of Gastroenterology and Hepatology, Rochester, Minnesota
- 2Division of Biostatistics, Rochester, Minnesota
- 3Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota,
- 4Department of Obstetrics and Gynecology, Olmsted Medical Center, Rochester, Minnesota
Correspondence: Adil E. Bharucha, MD, Clinical and Enteric Neuroscience Translational and Epidemiological Research Program (C.E.N.T.E.R.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
Received 9 June 2005; Revised 0000; Accepted 22 October 2005.
Abstract
BACKGROUND:
In the Rome II criteria, patients with both constipation and abdominal pain (AP) (i.e., "painful constipation" (PC)), who do not satisfy criteria for irritable bowel syndrome (IBS) are included in the same functional constipation (FC) category as patients with constipation without AP (i.e., "painless constipation" (PLC)). What differences, if any, exist between FC without (i.e., PLC) and with AP (i.e., PC) are unclear.
METHODS:
To compare clinical features among PLC, PC, constipation-predominant IBS (C-IBS), and non-C-IBS, a validated questionnaire was mailed (with telephone follow-up of nonresponders) to an age-stratified random sample of 5,200 adult women in Olmsted County, Minnesota.
RESULTS:
Altogether, 2,800 women (53%) responded. The age-adjusted prevalence of PLC (7.1 per 100; 95% confidence interval (95% CI), 6.2–8.0) was higher compared to PC (0.9 per 100; 95% CI, 0.6–1.2). Compared to PLC, patients with PC reported worse general health (i.e., excellent or very good = 37.5%vs 51.2%), more somatic symptoms (mean score = 1.3 vs 0.9), and urinary urgency (% often = 58%vs 32%), and had a higher prevalence of hysterectomy. Bowel symptoms significantly impacted 
1 domain of quality of life (QOL) in 18% of PC versus 9% of PLC. In a logistic discriminant model, age, general health, impact of bowel symptoms on QOL, somatic symptoms, and urinary urgency independently discriminated between bowel subtypes.
CONCLUSIONS:
Patients with PC more closely resemble those with C-IBS than PLC. Consideration should be given to separating PC from PLC in the Rome criteria and in therapeutic trials.
