Digestive Diseases and Sciences

, Volume 53, Issue 10, pp 2702–2709 | Cite as

Obstructive Defecation in Middle-aged Women

  • Madhulika G. VarmaEmail author
  • Stacey L. Hart
  • Jeanette S. Brown
  • Jennifer M. Creasman
  • Stephen K. Van Den Eeden
  • David H. Thom
Original Paper


Obstructive defecation, a significant contributor to constipation, is frequently reported in middle-aged women, yet few population-based studies have established prevalence in this group. We analyzed data from the Reproductive Risks for Incontinence Study at Kaiser, a population-based cohort of racially diverse women, 40–69 years old, to describe the prevalence of obstructive defecation and identify associated risk factors. The Reproductive Risks for Incontinence Study at Kaiser is a randomly selected cohort of 2,109 women in the Kaiser Medical System. Obstructive defecation, determined by self-report, was defined as difficulty in passing stool, hard stool, straining for more than 15 min, or incomplete evacuation, occurring at least weekly. Age, race, income, education, drinking, health status, parity, pelvic organ prolapse, urinary incontinence, number of medications, hysterectomy, surgery for pelvic organ prolapse, colectomy, irritable bowel syndrome, and body mass index were assessed for both their univariate and multivariate association with obstructive defecation. Multivariate logistic regression was used to determine the independent association between associated factors and the primary outcome of obstructive defecation. Obstructive defecation that occurred at least weekly was reported by 12.3% of women. Significant independent risk factors included irritable bowel syndrome [odds ratio 1.78, (95% confidence interval 1.21–2.60)], vaginal or laparoscopic hysterectomy [2.01 (1.15–3.54)], unemployment [2.33 (1.39–3.92)], using three or more medications [1.81 (1.36–2.42)], symptomatic pelvic organ prolapse [2.34 (1.47–3.71)], urinary incontinence surgery [2.52 (1.29–4.90)], and other pelvic surgery [1.35 (1.03–1.78)]. We concluded that obstructive defecation is common in middle-aged women, especially those with a history of treatment for pelvic floor conditions. Women who had undergone laparoscopic/vaginal hysterectomies or surgery for pelvic organ prolapse or urinary incontinence had a nearly two times greater risk of weekly obstructive defecation. Demographic factors, with the exception of employment status, were not significant, indicating that obstructive defecation, although widespread, does not affect any particular group of women.


Constipation Obstructive defecation Epidemiology Risk factors Prevalence 



The Reproductive Risk of Incontinence Study in Kaiser (RRISK) was funded by the National Institutes of Diabetes and Digestive and Kidney Diseases, grant # R01-DK53335.


  1. 1.
    Everhart JE, Go VL, Johannes RS, Fitzsimmons SC, Roth HP, White LR (1989) A longitudinal survey of self-reported bowel habits in the United States. Dig Dis Sci 34(8):1153–1162PubMedCrossRefGoogle Scholar
  2. 2.
    Chang L, Toner BB, Fukudo S et al (2006) Gender, age, society, culture, and the patient’s perspective in the functional gastrointestinal disorders. Gastroenterology 130(5):1435–1446PubMedCrossRefGoogle Scholar
  3. 3.
    Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L (2001) An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 96(11):3130–3137PubMedCrossRefGoogle Scholar
  4. 4.
    Stewart WF, Liberman JN, Sandler RS et al (1999) Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol 94(12):3530–3540PubMedCrossRefGoogle Scholar
  5. 5.
    Higgins PD, Johanson JF (2004) Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 99(4):750–759PubMedCrossRefGoogle Scholar
  6. 6.
    Sonnenberg A, Koch TR (1989) Physician visits in the United States for constipation: 1958 to 1986. Dig Dis Sci 34(4):606–611PubMedCrossRefGoogle Scholar
  7. 7.
    American College of Gastroenterology Chronic Constipation Task Force (2005) An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol 100(Suppl 1):S1–S4CrossRefGoogle Scholar
  8. 8.
    Dennison C, Prasad M, Lloyd A, Bhattacharyya SK, Dhawan R, Coyne K (2005) The health-related quality of life and economic burden of constipation. Pharmacoeconomics 23(5):461–476PubMedCrossRefGoogle Scholar
  9. 9.
    Leong SA, Barghout V, Birnbaum HG, et al (2003) The economic consequences of irritable bowel syndrome: a US employer perspective. Arch Intern Med 163(8):929–935PubMedCrossRefGoogle Scholar
  10. 10.
    Lembo A, Camilleri M (2003) Chronic constipation. N Engl J Med 349(14):1360–1368PubMedCrossRefGoogle Scholar
  11. 11.
    Drossman DA, Li Z, Andruzzi E et al (1993) U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 38(9):1569–1580PubMedCrossRefGoogle Scholar
  12. 12.
    Sonnenberg A, Koch TR (1989) Epidemiology of constipation in the United States. Dis Colon Rectum 32(1):1–8PubMedCrossRefGoogle Scholar
  13. 13.
    Zutshi M, Hull TL, Bast J, Hammel J (2007) Female bowel function: the real story. Dis Colon Rectum 50(3):351–358PubMedCrossRefGoogle Scholar
  14. 14.
    Heaton KW, Radvan J, Cripps H, Mountford RA, Braddon FE, Hughes AO (1992) Defecation frequency and timing, and stool form in the general population: a prospective study. Gut 33(6):818–824PubMedCrossRefGoogle Scholar
  15. 15.
    Dukas L, Willett WC, Giovannucci EL (2003) Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol 98(8):1790–1796PubMedCrossRefGoogle Scholar
  16. 16.
    Klingele CJ, Bharucha AE, Fletcher JG, Gebhart JB, Riederer SG, Zinsmeister AR (2005) Pelvic organ prolapse in defecatory disorders. Obstet Gynecol 106(2):315–320PubMedGoogle Scholar
  17. 17.
    Talley NJ, Jones M, Nuyts G, Dubois D (2003) Risk factors for chronic constipation based on a general practice sample. Am J Gastroenterol 98(5):1107–1111PubMedCrossRefGoogle Scholar
  18. 18.
    Irvine EJ, Ferrazzi S, Pare P, Thompson WG, Rance L (2002) Health-related quality of life in functional GI disorders: focus on constipation and resource utilization. Am J Gastroenterol 97(8):1986–1993PubMedCrossRefGoogle Scholar
  19. 19.
    Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82(5):703–710PubMedCrossRefGoogle Scholar
  20. 20.
    Thom DH, van den Eeden SK, Ragins AI et al (2006) Differences in prevalence of urinary incontinence by race/ethnicity. J Urol 175(1):259–264PubMedCrossRefGoogle Scholar
  21. 21.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483PubMedCrossRefGoogle Scholar
  22. 22.
    Surrenti E, Rath DM, Pemberton JH, Camilleri M (1995) Audit of constipation in a tertiary referral gastroenterology practice. Am J Gastroenterol 90(9):1471–1475PubMedGoogle Scholar
  23. 23.
    Arya LA, Novi JM, Shaunik A, Morgan MA, Bradley CS (2005) Pelvic organ prolapse, constipation, and dietary fiber intake in women: a case-control study. Am J Obstet Gynecol 192(5):1687–1691PubMedCrossRefGoogle Scholar
  24. 24.
    Jelovsek JE, Barber MD, Paraiso MF, Walters MD (2005) Functional bowel and anorectal disorders in patients with pelvic organ prolapse and incontinence. Am J Obstet Gynecol 193(6):2105–2111PubMedCrossRefGoogle Scholar
  25. 25.
    Altman D, Zetterstrom J, Lopez A, Pollack J, Nordenstam J, Mellgren A (2004) Effect of hysterectomy on bowel function. Dis Colon Rectum 47(4):502–508; discussion 508–509PubMedCrossRefGoogle Scholar
  26. 26.
    Bharucha AE, Locke GR, Zinsmeister AR et al (2006) Differences between painless and painful constipation among community women. Am J Gastroenterol 101(3):604–612PubMedCrossRefGoogle Scholar
  27. 27.
    Garry R, Fountain J, Brown J et al (2004) EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess 8(26):1–154PubMedGoogle Scholar
  28. 28.
    Garry R, Fountain J, Mason S et al (2004) The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 328(7432):129PubMedCrossRefGoogle Scholar
  29. 29.
    Holmgren C, Nilsson S, Lanner L, Hellberg D (2005) Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence. Obstet Gynecol 106(1):38–43PubMedGoogle Scholar
  30. 30.
    Varma MG, Brown JS, Creasman JM et al (2006) Fecal incontinence in females older than aged 40 years: Who is at risk? Dis Colon Rectum 49(6):841–851PubMedCrossRefGoogle Scholar
  31. 31.
    Koloski NA, Talley NJ, Boyce PM (2000) The impact of functional gastrointestinal disorders on quality of life. Am J Gastroenterol 95(1):67–71PubMedCrossRefGoogle Scholar
  32. 32.
    Drossman DA, Corazziari E, Talley NJ et al (2000) The Rome II modular questionnaire. In: Drossman DA, Corazziari E, Talley NJ et al (eds) The functional gastrointestinal disorders. Degnon, McLean, VA, pp 670–688Google Scholar
  33. 33.
    Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006) Functional bowel disorders. Gastroenterology 130(5):1480–1491PubMedCrossRefGoogle Scholar
  34. 34.
    Rothbarth J, Bemelman WA, Meijerink WJ et al (2001) What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 44(1):67–71PubMedCrossRefGoogle Scholar
  35. 35.
    Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O (2005) Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 40(5):540–551PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Madhulika G. Varma
    • 1
    Email author
  • Stacey L. Hart
    • 2
  • Jeanette S. Brown
    • 3
  • Jennifer M. Creasman
    • 4
  • Stephen K. Van Den Eeden
    • 5
  • David H. Thom
    • 6
  1. 1.Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of PsychologyRyerson UniversityTorontoCanada
  3. 3.Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Kaiser Permanente Division of ResearchOaklandUSA
  6. 6.Department of Family and Community MedicineUniversity of California, San FranciscoSan FranciscoUSA

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