Constipation affects up to one in seven adults and one in three children,1 representing a significant burden on the NHS and an even greater one on families in England where one or more members are suffering from the condition.
In 2017/18, 71,430 people, equivalent to 196 people a day, were admitted to hospital with constipation in England.1 Clearly, a lot of worrying and suffering takes place before reaching the hospital admission stage and its impact on quality of life should not be underestimated.
The Bowel Interest Group (BIG) has analysed the issue with the objective of raising awareness of the scale of constipation. Poor bowel health and chronic constipation affects millions of people and prevents them from fully enjoying their lives. Often this suffering is utterly needless and could be avoided through a better understanding of the subject that, unfortunately, remains taboo with nearly one in five people too embarrassed to even talk to their GP about it.
A conservative estimate is that there are around 6.5 million people in the UK today with some form of bowel problem; that’s 1 in 10 of us.1 One of the most important factors when it comes to adult constipation is embarrassment; a YouGov survey of 2352 people asked them about their knowledge of the issue and how they would tackle it and discovered 19% of respondents rated talking about constipation as embarrassing as discussing erectile dysfunction.1
The same survey also found that understanding of what constipation is was also lacking. Respondents did not clearly understand what a healthy bowel would entail and therefore struggled to identify constipation.
Embarrassment is clearly an issue driving up the number of unplanned emergency admissions for constipation, but data suggests that constipation is a wide-spread issue with GPs seeing on average 6.3 patients with constipation each week according to a GP survey carried out by the Bowel Interest Group. The same survey found that over two million minutes a week are spent in consultations for constipation, equivalent to over 200,000 GP appointments a week.1
How do you know if you have constipation?
Another issue is that the problem is simply not taken seriously enough; a survey by YouGov revealed that a significant proportion of the population does not think constipation is a serious health issue. 35% of people said they would wait to see if their symptoms cleared up before speaking to their GP. Nearly one in 10 people who would seek advice from a healthcare professional would wait between two weeks and a month (after first noticing constipation symptoms) before talking to them.1
Constipation can enormously diminish quality of life; in addition to causing chronic pain and urinary tract infections (UTIs), haemorrhoids, anal fissures or rectal prolapse. An often-underestimated aspect is the devastating impact that constipation can have on mental health with reports showing that 40% of patients with constipation experience an anxiety disorder and 38% depression.1
For those with an existing health condition, constipation can be a secondary health issue, cruelly adding to their health complications. Constipation makes it hard for people to travel, work and socialise freely, resulting in a knock-on effect on mental wellbeing, damaging confidence and self-esteem.
Up to 80% of patients in specialist constipation clinics are female. Women have a higher incidence of constipation for a number of reasons, including pelvic floor disorders. This is reflected in constipation related hospital admissions where 60% are female and this likely reflects the willingness of women to seek healthcare.1 In addition to this, pregnancy, already a sensitive time when the body is undergoing many rapid changes, is linked to an increase in constipation.
While one in seven adults is affected by constipation, the condition affects up to one in three children.1 Although NICE clearly sets out guidelines on management of children with constipation and states that: “A diagnosis of idiopathic constipation, in which the constipation cannot be explained by anatomical or physiological abnormalities, can only be made through a full assessment, including detailed history-taking and a physical examination by a healthcare professional,”2 especially when associated with other conditions, constipation in children can easily go unrecognised.
Older adults are five times more likely to have constipation. In patients aged 65 and older, approximately 26% of men and 34% of women complain of constipation.1 This is due to a number of factors such as drug-induced, medical comorbidity, a decrease in physical activity and fluid intake.
Unfortunately, constipation is seen as a low priority condition that is easily tackled. The reality is that not talking about constipation makes the issue seem low priority when it actually affects large numbers of the population in an often highly damaging way. To see the number of unplanned emergency admissions reduce and improve overall health and happiness among constipation sufferers requires a national change in the diagnosis and management of constipation throughout the NHS. Constipation can restrict participation in everyday activities that many of us take for granted, such as socialising, enjoying hobbies, going to work and maintaining relationships. The right advice and treatment from the GP can help patients return to enjoying their lives.
Dr Benjamin Disney, Consultant Gastroenterologist, University Hospitals Coventry and Warwickshire NHS Trust