Everyone knows if they are backed up in the colon, right? Leave it to the British to confuse the matter! Actually, in this case, they are trying to clear the waters of diagnosis by evaluating what the public considers as constipation. This study’s lead author, Dr. Eirini Dimidi, Research Associate of Kings College of London, surveyed 2,557 individuals in the general public, 411 general British practitioners, and 365 GI specialists. 934 of the public self-reported having constipation. Their results were intriguing.
Their public respondents met the formal medical diagnosis of constipation 94% of the time if they self-reported constipation. They met the formal Rome IV guidelines (a set of criteria agreed upon by a group of doctors meeting to create a consensus statement) for constipation. However, in the 1,623 respondents who denied having “constipation”, 29% met the Rome IV criteria when questioned specifically about symptoms. It appears that many have constipation but don’t recognize it.
Which aspects of constipation were least likely to be considered a problem worthy of diagnosis. Both the general public and general practitioner lagged in considering infrequent bowel movements as a problem. Overall, the best agreement between the public, generalists, and specialists came in terms of abdomen discomfort, rectal symptoms, hard and infrequent stools, flatulence, fecal incontinence, and sensory problems.
From this study, several practical points can be gleaned. First, our patients don’t always recognize when they are constipated. What they have perceived as normal for a lifetime, may actually be chronic undiagnosed constipation. Second, some symptoms perceived by our patients as constipation may have been ignored by other providers.
Functional medicine doctors know 1) there is a high rate of constipation therapy failure; 2) that constipation can be a surface marker of multiple different root causes; and 3) our gut interacts and influences the rest of our health. Combining the article take home points with functional medicine wisdom means that we can go a long way in restoring our patients to a healthier more abundant life simply by asking about their bowel habits.
“Change a life by asking about poop”, now that is a headline to ponder.
Original Reference:
Perceptions of Constipation Among the General Public and People With Constipation Differ Strikingly From Those of General and Specialist Doctors and the Rome IV Criteria. Dimidi, Eirini, PhD; Cox, Camilla, MSc; Grant, Robert, MSc; Scott, S. Mark, PhD; Whelan, Kevin, PhD. American Journal of Gastroenterology: June 4, 2019 – Volume Publish Ahead of Print – Issue – p. doi: 10.14309/ajg.0000000000000267
Thanks to Science Daily:
King’s College London. “Research redefines constipation.” ScienceDaily. ScienceDaily, 5 June 2019. .
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.