Digestive Diseases and Sciences

, Volume 56, Issue 9, pp 2688–2695 | Cite as

Impact of Chronic Constipation on Health-Related Quality of Life, Work Productivity, and Healthcare Resource Use: An Analysis of the National Health and Wellness Survey

  • Shawn X. SunEmail author
  • Marco DiBonaventura
  • Fanta W. Purayidathil
  • Jan-Samuel Wagner
  • Omar Dabbous
  • Reema Mody
Original Article



There has been limited research addressing the effects of constipation on work productivity and healthcare resource use.


To assess the effect of chronic constipation on health outcomes and healthcare resource use.


Using data from the 2007 National Health and Wellness Survey (NHWS), chronic constipation patients (n = 1,430) were propensity score-matched to controls (n = 1,430) on demographic and clinical characteristics. Differences between groups in health-related quality of life (SF-12v2), work productivity and activity impairment, and resource use in the last 6 months were examined. Mediation analyses were conducted in order to determine whether the relationship between constipation and resource use was caused by a reduction in health status.


Chronic constipation patients reported significantly lower levels of health-related quality of life (physical component summary score: 39.57 vs. 43.73; mental component summary score: 43.19 vs. 47.86, all P-values < 0.01) and significantly higher levels of loss of work productivity and activity impairment (absenteeism: 9.08% vs. 5.20%; presenteeism: 29.52% vs. 19.09%; overall work impairment: 33.65% vs. 21.56%; activity impairment: 46.58% vs. 33.90%, all P-values < 0.01) compared to the matched controls. Chronic constipation patients also reported significantly more provider (7.73 vs. 5.63) and emergency room visits (0.52 vs. 0.30) in the past 6 months (all P-values < 0.01). Mediation analyses suggested that increased resource use among chronic constipation patients were partially a result of reduced health status.


Compared to matched controls, chronic constipation patients reported greater economic and humanistic burden. Alleviating the humanistic burden associated with constipation may have economic benefits.


Chronic constipation Health-related quality of life Work productivity Healthcare resource use 



This research was funded by Takeda Pharmaceuticals North America, Deerfield, IL.


  1. 1.
    National Digestive Diseases Information Clearinghouse (NDDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Constipation. NIH Publication No. 07-2754. July 2007. Available online at: Retrieved 10 March 2010.
  2. 2.
    Borum ML. Constipation: evaluation and management. Prim Care. 2001;28:577–590.PubMedGoogle Scholar
  3. 3.
    Johanson JF. Review of the treatment options for chronic constipation. Med Gen Med. 2007;9:25.Google Scholar
  4. 4.
    Sandler RS, Drossman DA. Bowel habits in young adults not seeking health care. Dig Dis Sci. 1987;32:841–845.PubMedCrossRefGoogle Scholar
  5. 5.
    Harari D, Gurwitz JH, Avorn J, et al. How do older persons define constipation? Implications for therapeutic management. J Gen Intern Med. 1997;12:63–66.PubMedCrossRefGoogle Scholar
  6. 6.
    Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–1390.PubMedCrossRefGoogle Scholar
  7. 7.
    Doughty DB. When fiber is not enough: current thinking on constipation management. Ostomy Wound Manage. 2002;48:30–41.PubMedGoogle Scholar
  8. 8.
    Cofré LP, Germain PF, Medina LL, et al. Constipation in adults: an update. Rev Med Chil. 2008;136:507–516. Epub 2008 Jun 16.Google Scholar
  9. 9.
    Lembo A, Camilleri M. Chronic constipation. N Engl J Med. 2003;349:1360–1368.PubMedCrossRefGoogle Scholar
  10. 10.
    Wald A, Scarpignato C, Kamm MA, et al. The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther. 2007;26:227–236.PubMedCrossRefGoogle Scholar
  11. 11.
    Locke GR 3rd, Pemberton JH, Phillips SF. AGA technical review on constipation. American Gastroenterological Association. Gastroenterology. 2000;119:1766–1778.PubMedCrossRefGoogle Scholar
  12. 12.
    Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007;25:599–608.PubMedCrossRefGoogle Scholar
  13. 13.
    Eoff JC, Lembo AJ. Optimal treatment of chronic constipation in managed care: review and roundtable discussion. J Manag Care Pharm. 2008;14(Suppl S-a):1–15.PubMedGoogle Scholar
  14. 14.
    Dennison C, Prasad M, Lloyd A, et al. The health-related quality of life and economic burden of constipation. Pharmacoeconomics. 2005;23:461–476.PubMedCrossRefGoogle Scholar
  15. 15.
    Lacy BE, Loew B, Crowell MD. Prucalopride for chronic constipation. Drugs Today (Barc). 2009;45:843–853.Google Scholar
  16. 16.
    Belsey J, Greenfield S, Candy D, Geraint M. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmcol Ther. 2010;31:938–949.Google Scholar
  17. 17.
    Nyrop KA, Palsson OS, Levy RL, et al. Costs of health care for irritable bowel syndrome, chronic constipation, functional diarrhoea and functional abdominal pain. Aliment Pharmacol Ther. 2007;26:237–248.PubMedCrossRefGoogle Scholar
  18. 18.
    Chang L. From Rome to Los Angeles—the Rome III Criteria for the functional GI disorders. 2006 Medscape. Available online at: Retrieved on 10 March 2010. Motil 2007;19:905–11.Google Scholar
  19. 19.
    Ware JE, Kosinski M, Keller SD. SF-36 physical and mental health summary scales: A user’s manual. Boston, MA: The Health Institute; 1994.Google Scholar
  20. 20.
    Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. How to score version 2 of the SF-12 health survey. Lincoln, RI: QualityMetric Incorporated; 2002.Google Scholar
  21. 21.
    Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353–365.PubMedCrossRefGoogle Scholar
  22. 22.
    MacKinnon DP, Dwyer JH. Estimating mediated effects in prevention studies. Evaluation Rev. 1993;17:144–158.CrossRefGoogle Scholar
  23. 23.
    Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. In: Leinhart S, ed. Sociological methodology 1982. San Francisco: Jossey-Bass; 1982:290–312.Google Scholar
  24. 24.
    Samsa G, Edelman D, Rothman ML, et al. Determining clinically important differences in health status measures: A general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics. 1999;15:141–155.PubMedCrossRefGoogle Scholar
  25. 25.
    Mason HJ, Serrano-Ikkos E, Kamm MA. Psychological state and quality of life in patients having behavioral treatment (biofeedback) for intractable constipation. Am J Gastroenterol. 2002;97:3154–3159.PubMedCrossRefGoogle Scholar
  26. 26.
    Dean BB, Aguilar D, Barghout V, et al. Impairment in work productivity and health-related quality of life in patients with IBS. Am J Manag Care. 2005;11:S17–S26.PubMedGoogle Scholar
  27. 27.
    Paré P, Gray J, Lam S, et al. Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of GastroIntestinal Symptoms in Canada), a naturalistic study. Clin Ther. 2006;28:1726–1735.PubMedCrossRefGoogle Scholar
  28. 28.
    Hulisz D. The burden of illness of irritable bowel syndrome: current challenges and hope for the future. J Manag Care Pharm. 2004;10:299–309.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Shawn X. Sun
    • 1
    • 2
    Email author
  • Marco DiBonaventura
    • 3
  • Fanta W. Purayidathil
    • 3
    • 4
  • Jan-Samuel Wagner
    • 3
  • Omar Dabbous
    • 1
  • Reema Mody
    • 1
  1. 1.Takeda Pharmaceuticals International, Inc.DeerfieldUSA
  2. 2.Forest Laboratories, Inc.Harborside Financial CenterJersey CityUSA
  3. 3.Kantar HealthNew YorkUSA
  4. 4.Temple UniversityPhiladelphiaUSA

Personalised recommendations