Introduction: Even though patients with inflammatory bowel diseases (IBD) typically present with diarrhea and can be an important consideration in clinical scoring systems, some may develop constipation. The prevalence and clinical scenarios in which constipation is seen in IBD patients has not been well described. We aim to evaluate the prevalence of constipation in IBD patients and assess the phenotypic characteristics of those IBD patients that develop it.
Methods: Using a retrospective case-control study, we enrolled 500 patients with a confirmed diagnosis of IBD seen in an outpatient tertiary referral IBD clinic. IBD outpatients seen at a tertiary referral clinic least once in 12 months were included. We excluded patients with a known partial or complete bowel obstruction, those with short gut, colectomies, and an ostomy. Data collected included disease phenotype, clinical and endoscopic disease activity, medication, and previous surgeries. The primary outcome was constipation, defined as subjectively as less than three bowel movements per week and the secondary outcome was constipation per the more stringent Rome IV criteria.
Results: Out of a total of 500 patients included, 50.1% met the subjective criteria for constipation and 27.4% met Rome IV criteria. Female patients were found to significantly (p< 0.001) have at least 2 Rome IV constipation modalities compared to men. Constipated patients significantly (p< 0.001) used more laxatives and fiber. There was a significant (p< 0.001) increase in constipation among patients who were using opioids, as they also scored in at least two Rome IV criteria. No significant association was seen between constipation and active IBD activity, disease characteristics, prior surgeries, or medication use.
Discussion: We found that a large proportion of IBD patients deal with constipation regardless of disease activity, prior surgery, or medication use. Rates of IBD patient constipation is tied to female sex and opioid use which is also seen in the general population. The prevalence does not seem driven by inflammation or post-surgical anatomy, so other etiologies such as slow transit and pelvic dysfunction should be considered. Identifying underlying etiologies of constipation is important as they can guide appropriate therapy.
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