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Chronic constipation (CC) is a disorder of the gastrointestinal tract and characterised by infrequent and difficult passage of stool over a prolonged period. According to the widely accepted Rome III criteria for describing CC, the patient should have two or more of the following symptoms at least a quarter of the time for the last 3 months while symptom onset was more than 6 months ago: straining, lumpy or hard stools, a sensation of incomplete evacuation, a sensation of ano-rectal obstruction or blockage and/or fewer than three defecations per week.
What causes the disorder?
The constipated patient population can be split in three distinct groups: patients with primary constipation (without other underlying diseases or whose constipation is not caused by use of medication), patients constipated as a result of regular use of opioid pain medication and patients with severe constipation resulting from other disorders that impair the neurological stimulation of the bowels such as Parkinson disease, diabetes, multiple sclerosis (MS) or spinal cord injury (SCI).
Patients with slow or normal transit constipation display general motor abnormalities of the colon (and upper gut).
Impact and treatment
As a patient, the discomfort of chronic constipation can significantly affect your quality of life; it is likely to impair your ability to work and participate in daily activities. In different publications you can read that among patients who experience constipation, 12% report work absenteeism (equivalent of mean rate of 2.4 days per month) and 60% report work impairment due to constipation symptoms.
Chronic constipation is a disease affecting a significant portion of the general population. Depending on the definition of chronic constipation, some sources indicate rates in Europe and the U.S. between 15%, and 27%. Based on various epidemiological studies and models, Movetis estimates that 34 million patients in Europe and at least 23 million patients in the U.S. - predominantly women and the elderly - suffer from chronic constipation.
Some patients can be successfully treated with lifestyle modification, dietary changes and increased fluid and fibre intake. For patients who fail to respond to these approaches, physicians typically recommend laxatives, most of which are available over the counter.
Risk factors identified with the use of laxatives include the disturbance of one’s electrolyte (minerals) balance, with symptoms of vomiting, as well as muscle weakness and dehydration. Prolonged use of laxatives, especially the stimulant varieties, may intensify and perpetuate the condition of constipation.
Unmet need
Chronic constipation is a complex condition to manage. Patients have a diverse symptomatology and only a limited number of treatment options are available. The majority of the patient population is female (between 35 and 50 years) or elderly. Many patients are dissatisfied with laxatives and therefore continue to access the health care system, in search for other types of treatments that will more adequately provide relief from their persistent and distressing constipation symptoms such as infrequent bowel movements, abdominal pain, bloating, straining and defecation urge with inability to evacuate.
Ref. Johanson J. and Kralstein J. Chronic Constipation: a survey of the patient perspective. Alimentary Pharmacology & Therapeutics 2007;25:599-608
