Chronic constipation patients unhappy with conventional treatments: survey

Conventional treatment options for chronic constipation (CC) are not effective enough to improve symptoms or satisfaction among patients, results of an internet survey in Japan have shown.

“The survey findings suggest that treatment selection that is aligned with individual symptoms and takes into consideration patient characteristics may be key to improving patients’ treatment satisfaction,” the researchers said.

The survey was conducted in 2017 and sought to determine relevant patient characteristics, treatment satisfaction, and bothersome symptoms in Japanese patients with CC treated at medical institutions. Five hundred adults were selected from 589 respondents to match the age composition ratio in Japan and participated in this study. Participants had constipation-like symptoms for ≥6 months and were taking any prescribed medication.

Of the respondents, 65.6 percent were female, and 62.6 percent had had constipation for >10 years. The most common and most bothersome symptoms in male and female patients were abdominal bloating, infrequent bowel movement, hard stool consistency, and difficulty of defecation. [J Clin Gastroenterol 2022;56:e64-e70]

Only about one in four patients (29 percent) reported being satisfied with treatment (36 percent of males and 26 percent of females): the individual major CC symptoms that had the highest level of treatment satisfaction was infrequent bowel movement (31 percent overall: 45 percent of males and 26 percent of females).

“These results are very similar to a previous survey in which 28 percent of participants with CC in Europe were satisfied with their treatment, although the treatment options were not exactly the same as those listed in this survey,” the researchers said. [Aliment Pharmacol Ther 2013;37:137-145]

The level of treatment satisfaction for most individual major CC symptoms was lower in females than in males and ranged from 16 percent to 46 percent overall by therapeutic categories. In addition, mean overall treatment satisfaction, as well as for each major symptom, decreased with increasing number of therapies, suggesting that changing treatments did not improve symptoms.

An earlier study found that more severe constipation led to lower treatment satisfaction, which might have resulted from more severe symptoms among those receiving several medications. Low overall treatment satisfaction was mostly due to conventional treatment options not being as effective as expected. [Aliment Pharmacol Ther 2020;51:629-636]

In a previous survey that used the same patient panel, the authors identified important gaps between patients’ needs and physicians’ practice regarding CC treatments. Physicians usually focused on resolving objective symptoms, such as infrequent bowel movement and hard stool consistency. On the other hand, patients were most concerned with subjective symptoms like abdominal bloating and difficulty of defecation. [Ther Res 2017;38:1101-1110]

“These gaps may contribute to the patient feeling unsatisfied with CC treatment,” the researchers said. “These observations suggest that current treatments are not tailored to individual bothersome symptoms, especially subjective symptoms, or that appropriate treatments are not available.”