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 Table of Contents 
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 673-676  

Prevalence of constipation among central region population, Riyadh and Qassim provinces, Saudi Arabia, 2018-2019


1 Medical College, Majmaah University, Al Majmaah, Saudi Arabia
2 Medical College, Dar Al Uloom University, Riyadh, Saudi Arabia

Date of Web Publication28-Feb-2019

Correspondence Address:
Mr. Mohammed Alhassan
Shaqra City, Riyadh Region
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_369_18

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  Abstract 


Background: Due to the lack of data and studies concerning the prevalence of constipation in Saudi Arabia, this study aimed at determining the level of prevalence among central region population in Saudi Arabia, specifically in Riyadh and Qassim provinces. Aims: To determine the prevalence of constipation, to estimate the overall prevalence of constipation among the society, and to identify risk factors of constipation. Materials and Methods: In this cross-sectional study, 543 individuals were covered, both males and females in the targeted areas. A standardized questionnaire was used to cover eight different aspects concerning constipation. SPSS package was used to analyze the data collected from the sample. Results: The results of the scoring system showed that the prevalence of constipation among the sampled individuals is only 4.4%, whereas those whose result indicates no suffering from constipation represented 95.6%. Constipation is more prevalent among females (79.2%) rather than males (20.8%). Moreover, constipation is more sever among those who are between 20- and 35-year old, while it reaches 0% among old people (over 51 years). Riyadh residents are more likely to suffer from constipation rather than Qassim residents. In Riyadh, 83.3% suffered from constipation, whereas the percentage in Qassim was 16.7%. The results show also that constipation is more prevalent among those who eat fiber-rich food once in a week, who are getting stressed all the time, nonsmokers, and who get dehydrated and do not carry a bottle of water. There is a significant relationship between suffering from constipation and only two variables, which are regularity of being stressed and regularity of getting dehydrated. The test value for these two variables were (0.0) in the two cases. Conclusion: The prevalence of constipation is relatively very low among population of central region in Saudi Arabia.

Keywords: Central region, constipation, emergency, family medicine, Qassim, Riyadh


How to cite this article:
Alhassan M, Alhassan A, Alfarhood A, Alotaibi K, Alrashidy N, Alshalhoub K, Almeshal M. Prevalence of constipation among central region population, Riyadh and Qassim provinces, Saudi Arabia, 2018-2019. J Family Med Prim Care 2019;8:673-6

How to cite this URL:
Alhassan M, Alhassan A, Alfarhood A, Alotaibi K, Alrashidy N, Alshalhoub K, Almeshal M. Prevalence of constipation among central region population, Riyadh and Qassim provinces, Saudi Arabia, 2018-2019. J Family Med Prim Care [serial online] 2019 [cited 2019 Nov 15];8:673-6. Available from: http://www.jfmpc.com/text.asp?2019/8/2/673/253015




  Introduction Top


Constipation does not have a consensus definition, neither ideal disease markers. Therefore, history and physical examination become the major determinant of the diagnosis. Although physicians and patients may interpret it differently, a widely used definition of constipation by medical personnel is to define constipation as less than three bowel movements per week or according to Rome III criteria. While patients often equate constipation with stool consistency, feelings of incomplete emptying, straining, and urge for defecation.[1],[2]

A healthy person is often assumed to have one bowel action each day, and there have been suggestions that a daily habit is not only natural but also necessary. According to BMJ, a range of normality lays between one bowel action every few weeks or months to 24 bowel actions a day.[3]

Although constipation is usually preventable, it presents as a perpetual problem in healthcare with painful and debilitating consequences. A prerequisite to prevention is assessment of risk of a condition occurring so that interventions can be individualized in an attempt to prevent it.[4]

A wide variation of prevalence was reported.[5] The direct impact of constipation on health-related quality of life (HRQOL) has been highlighted in several studies.[6],[7] Various validated instruments have been used to demonstrate that patients with constipation have lower HRQOL when compared with the general population.[6]

For example, A multinational survey conducted in seven countries (France, Germany, Italy, England, South Korea, Brazil, and the United States) that enrolled 2,870 participants revealed that constipation resulted in similarly impaired HRQOL scores in each of the countries surveyed.[7]

Moreover, In the United States, the prevalence of constipation is around 15%. Similar studies from western countries like Canada reported that chronic constipation affected nearly 2%–27% of the Canadian population, whereas studies from China, India, and Japan reported a prevalence of 8%, 17%, and 28%, respectively.[8],[9],[10]

Unfortunately, studies concerning the prevalence of constipation in Saudi Arabia are scarce. One of the studies that was performed in Saudi Arabia to determine the irregularities of bowel function among Saudi adults showed that 18% of the respondents experienced abnormal bowel habits. Due to the absence of uniform diagnostic criteria, there is a discrepancy in the reported rates.[5] While another study compared between three types of questionnaires, Mansoura Numerolphabetic Constipation Score (MNCS), Wexner and KESS scores suggest that MNCS was the most accurate between the three ways. Moreover, it can be used as an indicator of surgery (stages C and D indicating surgical intervention).[11] However, Wexner is one of the most commonly used subjective scores out there,[12] so we will use it as well to compare between those two scores.

This study attempts to use a standardized questionnaire to define the level of prevalence among population of the central region in Saudi Arabia. The targeted sample was located in two provinces, which are Riyadh and Qassim. This report, first, represents the methodology used in analyzing the collected data, and then it represents the results explicitly. Finally, it compares the results based on the questionnaire with other similar studies.


  Materials And Methods Top


The study is a cross-sectional study using an online questionnaire to collect data from sample, which was calculated to be 384. But, we managed to get 543 individuals. Targeted area was central region of Saudi Arabia as the questionnaire covered two provinces, namely, Riyadh and Qassim and covered both males and females.

The questionnaire covered eight aspects concerning constipation, including, frequency of bowel movements, difficulty: painful evacuation effort, completeness: feeling incomplete evacuation, pain: abdominal pain, time: minutes in lavatory per attempt, assistance: type of assistance, failure: unsuccessful attempts for evacuation per 24 h, and history: duration of constipation (year).

Statistical Package for Social Sciences (SPSS) software was used to analyze the data collected form the questionnaire.


  Results Top


In total, 543 individuals responded to the questionnaire, of which 64.3% were females and 35.7 were males. The dominant age was (20–35 years) as it represented 63.9% of the sample, followed by 18.6% of the sample are <20 years, 15.5% between 36 and 50 years and only 2% over 50. The residents of Riyadh dominated the sample as they represented 82.1% of the sample, whereas only 17.9% were in Qassim.

Based on statistical analysis, eight variables were selected for the scoring system. These items include frequency of bowel movements, painful evacuation, incomplete evacuation, abdominal pain, length of time per attempt, assistance for defecation, unsuccessful attempts for evacuation per 24 h, and duration of constipation [Table 1]. A scoring range of 0–4 (with the exception of “assistance for defecation,” which is 0–2) was derived. The global score was obtained by adding each individual score. A score of >15 was the definition of the symptom “constipation” in this study.
Table 1: Relation between suffering from constipation and other variables

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The results of the scoring system showed that the prevalence of constipation among the sampled individuals is only 4.4%, while those whose result indicates no suffering from constipation represented 95.6% [Figure 1].
Figure 1: Percentage of sample who suffer from constipation

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The result [Table 1] shows that constipation is more prevalent among females (79.2%) rather than males (20.8%). Moreover, constipation is more sever among those who are between 20- and 35-year old, whereas it reaches 0% among old people (over 51 years).

Riyadh residents are more likely to suffer from constipation rather than Qassim residents. In Riyadh, 83.3% suffered from constipation, whereas the percentage in Qassim was 16.7%.

The results show also that constipation is more prevalent among those who eat fiber-rich food once a week, who are getting stressed all the time, nonsmokers, and who get dehydrated and do not carry a bottle of water. The percentages of suffering from constipation among the previously mentioned categories were 29.1%, 62.5%, 95.8%, and 37.5%, respectively.

Chi-square test was used to determine the correlation between suffering from constipation and the variables in [Table 1]. The results of the test showed that there is a significant relationship between suffering from constipation and only two variables, which are regularity of being stressed and regularity of getting dehydrated. The test value for these two variables were (0.0) in the two cases.

On the other hand, none of the remaining variables had significant relationship with suffering from constipation.


  Discussion Top


There are number of studies discussed the prevalence of constipation among different types of populations. In this study, suffering from constipation was not severe as only 4.4% of the sample suffered from constipation. In a study in a city in Brazil, the prevalence of constipation reached 25.2%, the severity of constipation was higher among females (37.2%) rather than males (10.2%), which is consistent with the results of our study.[13]

Similarly, different studies show that females are more likely to suffer from constipation rather than males. As the results of the studies of Jun et al. (2006) in South Korea,[14] Mendoza-Sassi et al. (2006) in Brazil,[15] and Adibi et al. (2007) in Iran[16] have proven this conclusion. In these three studies, the prevalence on constipation among targeted population ranged from 9.6% to 22.1%.

Constipation in women seems to be more common for reasons, such as pregnancy and childbirth, Women's hormonal changes as well as behavioral factors, history of physical and emotional abuse, and may be related to the digestive system disorders.[13] Although the prevalence of constipation in the sample is small relatively, we might consider doing and encouraging other medical staff and raise the issue to the ministry of health in Saudi Arabia to conduct awareness campaigns and regulations about sedentary life style, increase fibers in the diet, get hydrated, and try to avoid the risk factors of constipation.


  Conclusion Top


The aim of this study was to determine the prevalence of constipation among central region population. The results show that the prevalence is relatively low, as it equals only 4.4% of the sample. Moreover, stress and dehydration are key factors concerning suffering from constipation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Leung L, Ruitta T, Kotecha J, Rosser W. Chronic constipation: An evidence-based review. J Am Board Fam Med. 2011;24:436-51.  Back to cited text no. 1
    
2.
Gray JR. What is chronic constipation? Definition and diagnosis. Can J Gastroenterol 2011;25(Suppl B):7B-10B.  Back to cited text no. 2
    
3.
Connell AM, Hiltont C, Irvine G, Lennard-Jones JE, Misiewicz JJ. Variation of bowel habit in two population samples. Br Med J 1965;2:1095-9.  Back to cited text no. 3
    
4.
Salari, R., Yousefi, M., Salari, M. Pharmacological treatment of chronic constipation: A literature review. Rev Clin Med 2016;3:128-32.  Back to cited text no. 4
    
5.
Alhusainy YA, Tarakji AR, Alhowaish NY, Alorabi HZ, Alsebti AA, AlJutaili HS, et al. Symptoms and prevalence of constipation among adult population of Riyadh city: An internet based survey. Egypt J Hosp Med 2018;70:1317-22.  Back to cited text no. 5
    
6.
Norton C. Constipation in older patients: Effects on quality of life. Br J Nurs 2006;15:188-92.  Back to cited text no. 6
    
7.
Wald A, Scarpignato C, Kamm MA, Mueller-Lissner S, Helfrich I, Schuijt C, et al. The burden of constipation on quality of life: Results of a multinational survey. Aliment Pharmacol Ther 2007;26:227-36.  Back to cited text no. 7
    
8.
Tamura A, Tomita T, Oshima T, Toyoshima F, Yamasaki T, Okugawa T, et al. Prevalence and self-recognition of chronic constipation: Results of an internet survey. J Neurogastroenterol Motil 2016;22:677-85.  Back to cited text no. 8
    
9.
Chu H, Zhong L, Li H, Zhang X, Zhang J, Hou X. Epidemiology characteristics of constipation for general population, pediatric population, and elderly population in China. Gastroenterol Res Pract 2014;2014:532734.  Back to cited text no. 9
    
10.
Rajput M, Saini SK. Prevalence of constipation among the general population: A community- based survey from India. Gastroenterol Nurs 2014;37:425-9.  Back to cited text no. 10
    
11.
Emile S, Youssef M, Thaber W, Omar W, Abd El-Hamed TM, Elshobaky A, et al. Mansoura numeroalphabetic constipation score in obstructed defecation syndrome (ODS): Validation of a new score. Int J Adv Res 2015;3:264-75.  Back to cited text no. 11
    
12.
Sharma S, Agarwal BB. Scoring systems in evaluation of constipation and obstructed defecation syndrome (ODS). JIMSA 2012;25:57-9.  Back to cited text no. 12
    
13.
Schmidt FM, Santos VL, Domansky Rde C, Barros E, Bandeira MA, Tenório MA, et al. Prevalence of self-reported constipation in adults from the general population. Rev Esc Enferm USP 2015;49:443-52.  Back to cited text no. 13
    
14.
Jun DW, Park HY, Lee OY, Lee HL, Yoon BC, Choi HS, et al. A population-based study on bowel habits in a Korean community: Prevalence of functional constipation and self-reported constipation. Dig Dis Sci 2006;51:1471-7.  Back to cited text no. 14
    
15.
Mendoza-Sassi R, Béria JU, Fiori N, Bortolotto A. Prevalence of signs and symptoms, associated sociodemographic factors and resulting actions in an urban center in southern Brazil. Rev Panam Salud Publica 2006;20:22-8.  Back to cited text no. 15
    
16.
Adibi P, Behzad E, Pirzadeh S, Mohseni M. Bowel habit reference values and abnormalities in young Iranian healthy adults. Dig Dis Sci 2007;52:1810-3.  Back to cited text no. 16
    


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