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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 PhD1; Cox, Camilla MSc1; Grant, Robert MSc2; Scott, S. Mark PhD3; Whelan, Kevin PhD1

American Journal of Gastroenterology: July 2019 - Volume 114 - Issue 7 - p 1116–1129
doi: 10.14309/ajg.0000000000000267

OBJECTIVES: To compare the perceptions of constipation among the general population (with and without constipation), general and specialist doctors, and the Rome IV criteria.

METHODS: A cross-sectional survey using a self-administered questionnaire where participants were asked to report symptoms perceived to be most important for a diagnosis of constipation. Participants also judged 10 case studies in which constipation was either present or absent according to Rome IV criteria.

RESULTS: Two thousand five hundred fifty-seven members of the general population (934 with self-reported constipation and 1,623 without constipation), 411 general practitioners (GPs) and 365 gastroenterology specialists completed the questionnaire. Of the 934 with self-reported constipation, 877 (94%) met Rome IV criteria for functional constipation, whereas of the 1,623 who did not self-report constipation, 473 (29%) actually met Rome IV criteria. Infrequent bowel movements were perceived as important for diagnosing constipation by less than a third of the constipated general population (26%), compared with 41% of GPs and 65% of specialist doctors (P < 0.001). Principal component analysis revealed 7 symptom clusters, with most symptoms not being part of formal diagnostic criteria. Using case studies, correct diagnosis of constipation ranged from 99% down to as low as 39%, depending upon the number and type of symptom present.

DISCUSSION: The general population's perceptions of constipation differ strikingly from those of GPs and specialist doctors, and there is limited agreement between public perceptions of constipation and Rome IV criteria. These findings emphasize the need to educate doctors and the general population regarding the symptoms of constipation, and realign diagnostic criteria to address those symptoms patients perceive to be important.

1Department of Nutritional Sciences, King's College London, London, United Kingdom;

2BayesCamp Ltd, Honorary Research Fellow, Kingston University and St. George's, University of London, Faculty of Health, Social Care & Education, Kingston upon Thames, United Kingdom;

3Wingate Institute for Neurogastroenterology, Centre for Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom.

Correspondence: Kevin Whelan. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at

Received October 03, 2018

Accepted March 12, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.
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