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Socioenvironmental Factors Associated With Constipation in Hong Kong Children and Rome III Criteria

Tam, Yuk H.*; Li, Albert M.; So, Hung K.; Shit, Kam Y.*; Pang, Kristine K.*; Wong, Yuen S.*; Tsui, Siu Y.*; Mou, Jennifer W.*; Chan, Kin W.*; Lee, Kim H.*

Journal of Pediatric Gastroenterology & Nutrition: July 2012 - Volume 55 - Issue 1 - p 56–61
doi: 10.1097/MPG.0b013e31824741ce
Original Articles: Gastroenterology

Objective: Data regarding the prevalence of constipation in the general population of Asian children using internationally standardized definitions are scarce. Environmental factors surrounding a child's day to day living may trigger or perpetuate constipation and encourage postponement of defecation.

Methods: A territory-wide cross-sectional questionnaire survey was conducted in 2318 Hong Kong Chinese elementary school students. Constipation was defined by pediatric Rome III criteria.

Results: The mean age of the children was 9 ± 1.9 years; 51% were boys. Two hundred eighty-two children (12.2%, 95% confidence interval [CI] 10.9%–13.5%) were found to have constipation. Children ages 6 to 7 years had the highest prevalence (16.8%, 95% CI 13.8%–19.8%). There was no difference in prevalence between boys and girls (11.6% vs 12.3%; P > 0.05) and between obese and nonobese children (11.5% vs 11.1%; P > 0.05). In univariate analysis, constipation was found to be significantly more prevalent among those children who lived with neither parent, had inadequate company of parents at home, refused to pass bowel movements in school, spent long hours doing homework, had inadequate sleep, and had decreased fiber intake and frequent consumption of fast food (P < 0.05). Multivariate analysis identified refusal to pass bowel movements in school toilets (odds ratio [OR] 1.97, 95% CI 1.42%–2.74%), having dinner with one/both parents <50% of time (OR 1.52, 95% CI 1.01%–2.31%), nighttime sleep <7 hours (OR 1.87, 95% CI 1.04%–3.33%), and frequent consumption of fast food (OR 1.14, 95% CI 1.03%–1.26%) to be independent factors associated with constipation.

Conclusions: Socioenvironmental factors are associated with childhood constipation, and bringing them to the awareness of the public may help prevent or stop the progression of childhood constipation at its early stages.

*Department of Surgery, Division of Paediatric Surgery and Paediatric Urology

Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.

Address correspondence and reprint requests to Dr Yuk H. Tam, Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, Prince of Wales Hospital, Shatin, NT, Hong Kong, China (e-mail:

Received 4 October, 2011

Accepted 19 December, 2011

The study was supported by the Paediatric Surgery Research Fund of the Chinese University of Hong Kong, which has received contributions from the Pedia-Lax LF Asia (HK) Limited.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN