| Background and ObjectiveConstipation is a common clinical symptom caused by various etiological factors. Chronic constipation (CC) has high prevalence, occurs more frequently in women, and negatively affects patients' quality of life. The development of female constipation has close correlation with women body anatomy, physiological nature and psychological characteristics. Both the factors contributed to the serious degree of constipation and the relation between female chronic constipation and pelvic floor dysfunction (PFD) deserve further investigation. Some patients obtain unsatisfactory clinical effects or even no therapeutic efficacy responding to conventional therapies, and thus heading for hospital repeatedly. With regards to these moderate or severe CC patients, it is quite necessary to evaluate them comprehensively, from the perspectives of symptoms, psychology, pathophysiology and history of diagnosis and treatment.The objective of this study is to investigate: 1) The proportion of CC patients, particularly severe CC patients in out-patient department, and sex ratio in these patients; 2) The general epidemicological characteristics of CC patients and their age distribution. 3) The relation between female pregnancy-delivery and the serious degree of constipation. 4) The symptom spectrum of female CC outpatients; 5) The influential factors on clinical manifestation in female constipation patients complicating with pelvic floor dysfunction. 6) The psychological status and quality of life affected by constipation symptoms.Materials and Methods2007.3～5, Peking Union Medical College Hospital and other nine hospitals in Beijing did the clinical multi-center cross-sectional survey to investigate: 1) the general outpatient person-times in department of GI and CC patients person-times meeting Rome III criteria in ten hospitals. 2) demography, symptoms' spectrum, psychology and quality of life for 568 outpatients with CC who were selected randomly and consecutively in three months through specially designed questionnaire. Finally the data input and statistical analysis were completed by Excel and SPSS 13.0 respectively. Results1) CC patients constituted 3.9% of total outpatients in the same period, while severe CC patients accounted for 9.5% of total CC patients, in which the female to male ratio was 3.04:1. 2) The mean age of male patients (55.5yrs) was significant higher than female's(31yrs). The peak period of onset age in female cases was 20~29yrs, which was quite different from male patients'. 3) The severe CC group had multi-pregnancy and delivery than that of non-severe CC group significantly. 4) The patients with vaginal delivery≥3 times had higher incidence of OOC symptoms and more possibilities of SUI. 5) There's a wide symptoms' spectrum of female CC. Both Dry stool and straining were the most common symptoms. 6) The incidence of defecation by manually supporting pelvic floor was higher in female. 7) Female CC patients with SUI had higher mean value of age, BMI and course of disease comparing with the CC patients without SUI. 8) Severe CC group had higher SAS and SDS scores, higher proportions of anxiety and depression state, higher incidence of sleep disorders. But there was no significant difference between female and male. 9) The scores of quality of life evaluated by SF-36 questionnaire in CC patients, particularly in severe CC patients, were significantly lower than those in the healthy controls.ConclusionsChronic constipation is a common reason for referrals to gastroenterologists. CC occurs more frequently in women, and also owns a large proportion of severe constipation. There is a close relationship within pregnancy-delivery and the severity of CC, the symptoms of CC, the incidence of PFD. Therefore incidence of CC may reduce by strengthening the measures of female pregnancy and delivery health care. The severity of psychologic obstacle including anxiety and depress in female patients is related to the severity of constipation. Quality of life is much lower in the CC patients.
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