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Jill Davies: Head of Nutrition Research Centre, South Bank University, London, UK
It is difficult to state with any authority the true prevalence of constipation. This is due to the fact that the term "constipation" means different things to different people. Definitions in the literature abound (Department of Health, 1991; Devroede, 1993; Thompson et al., 1992) but there are practical difficulties in applying these in the clinical setting. For example the definition put forward by Thompson and colleagues (1992) requires a three-month record of bowel habit, with two or more of the following for at least three months (constipation according to the Rome criteria):
(1) straining at defecation at least 1/4 of the time;
(2) lumpy and/or hard stools at least 1/4 of the time;
(3) sensation of incomplete evacuation, at least 1/4 of the time; and
(4) two or fewer bowel movements in a week.
The Department of Health's (DoH) definition that "constipation is characterised by infrequent bowel habit (less than three times a week), transit time of five days or more and stool weight below 50g/day" necessitates the collection of stools for at least one week, willingness of subjects to swallow 60 radio opaque markers over three consecutive days, weighing and radiography of stools as well as disposal of specimens.
Not withstanding these difficulties it is widely accepted that women complain of constipation more than men. According to the DoH (1991) women also have on average lower stool weights than men. Furthermore, complaints of constipation become more common when stool weights fall below 100g/day (DoH, 1991).
A number of studies have shown changes in bowel habit in the direction of constipation in association with the luteal phase of the menstrual cycle (Table I). It...