Alimentary Pharmacology & Therapeutics
Chronic constipation: a survey of the patient perspective
J. F. JOHANSON* & J. KRALSTEIN
*University of Illinois College of
Medicine and Rockford Gastroentero-
logy Associates, Rockford, IL, USA;
Novartis Pharmaceuticals Corpora-
tion, East Hanover, NJ, USA
Correspondence to:
Dr J. F. Johanson, University of
Illinois College of Medicine, 593
Spring Creek Rd, Rockford, IL 61114,
USA.
E-mail: johnfj@uic.edu
Publication data
Submitted 8 September 2006
First decision 27 September 2006
Resubmitted 18 December 2006
Accepted 18 December 2006
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd
doi:10.1111/j.1365-2036.2006.03238.x
SUMMARY
Background
Constipation is a common, often chronic, gastrointestinal motility disor-
der characterized by such symptoms as straining, hard stool, and infre-
quent defecation. Published literature is limited regarding symptom
prevalence, healthcare-seeking behaviour, and patient satisfaction with
traditional therapies for chronic constipation.
Aim
To assess the prevalence of chronic constipation among a random sam-
ple of Americans, to identify the frequency, severity and bothersome-
ness of their symptoms, and to assess satisfaction levels with traditional
treatments.
Methods
All members (N ¼ 37 004) of the Knowledge Networks Panel, represen-
tative of the US population, participated in a web-based survey. Eligi-
bility was established using a six-question screener.
Results
Of the 24 090 panellists consenting to participate, 557 met eligibility
requirements and took the 45-question survey. The most prevalent
symptom was straining (79%). Hard stool and straining were the top
two severe symptoms, and bloating, straining and hard stool were the
top three bothersome symptoms. Symptoms affected quality of life of
more than half (52%) the respondents. Among those who worked or
went to school, 12% experienced reduced productivity and a mean of
2.4 days of absence in the month before the survey. Most respondents
had used (96%) or were using (72%) constipation relief therapy; how-
ever, nearly half (47%) were not completely satisfied, mainly because of
efficacy (82%) and safety (16%) concerns.
Conclusions
Chronic constipation is common. Individual symptoms are often severe
and bothersome, and many patients are dissatisfied with traditional
treatment options, primarily because of lack of efficacy.
Aliment Pharmacol Ther 25, 599–608
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600 J . F . J O H A N S O N A N D J . K R A L S T E I N
INTRODUCTION
Constipation is a prevalent, often chronic, gastroin-
testinal (GI) motility disorder. It affects from 2% to
27% of North Americans, with most estimates con-
centrated around 15%,1 and is more common in
women than men (estimated prevalence ratio of
2.2:1).1 Rome diagnostic criteria (Rome II,2 Rome III3)
for functional constipation were developed to stan-
dardize the definition of constipation for enrolment
in clinical trials. However, there is no widely accep-
ted, clinically useful definition of constipation.
Although doctors often define constipation based on
stool frequency,4 patients define constipation as a
multisymptom disorder that includes infrequent bowel
movements, hard/lumpy stool, straining, bloating,
feeling of incomplete evacuation after a bowel move-
ment and abdominal discomfort.5
In addition to the bothersome symptoms associated
with this condition, health-related quality of life (QoL)
is negatively impacted in people with chronic consti-
pation,6, 7 and studies have shown that the degree of
symptom severity of chronic constipation correlates
negatively with the patient’s perceived QoL.8 Women
who seek medical care for constipation often have
increased psychological and social morbidities, inclu-
ding anxiety, depression, increased somatization and
decreased sexual satisfaction,9 which could contribute
to poor QoL. Population studies have shown that in
patients with chronic constipation, poor QoL was an
important predictor of healthcare utilization and resul-
tant healthcare costs.10, 11 Other studies have shown
that patients who seek medical treatment for chronic
constipation, estimated at only 25% of those affected,
are not always effectively treated and are generally
dissatisfied with treatment outcomes.5, 12
The goal of therapy for patients with chronic consti-
pation is not only to provide multisymptom relief, but
also to address the underlying pathophysiology.
Although lifestyle changes such as increased exercise,
dietary fibre and fluid intake are beneficial approaches
for some patients with constipation, the true effective-
ness of these measures in patients with chronic consti-
pation has not yet been proven.13, 14 Traditional
therapies such as fibre or osmotic and stimulant laxa-
tives often have limitations because they generally do
not target the multiple symptoms associated with
chronic constipation, nor do they address the underly-
ing cause(s). Further, though many of these treatments
adequately alleviate one symptom of constipation,
they may exacerbate another. For example, fibre
improves stool form and frequency but may worsen
the symptoms of gas and bloating.14
The published medical literature is limited regarding
symptom prevalence, healthcare-seeking behaviour
and patient satisfaction with traditional therapies for
chronic constipation. Moreover, no direct data have
been published on patient perception of treatment out-
comes. The purpose of this survey, in the form of a
web-based questionnaire, was to evaluate patients who
sought care for the symptoms of chronic constipation
in the previous year. Specific survey goals included
assessment of the prevalence and variety of chronic
constipation symptoms; identification of the fre-
quency, severity and bothersomeness of commonly
reported constipation symptoms; and determination
of patients’ levels of satisfaction with traditional
therapies.
METHODS
Panellist recruitment and selection
All members of the Knowledge Networks Panel (N ¼
37 004), which is representative of the total US popu-
lation and tracks age, race, geographic region, employ-
ment status and other demographic elements, were
recruited to participate in this web-based survey.
Recruitment and interviewing were conducted between
31 March and 23 April 2004. The web-enabled panel
was composed of members of households with and
without Internet access, and all members were provi-
ded the same equipment for participation in Internet
surveys. The surveys were self-administered and
accessible any time of day for a designated period.
Panellists received notice in their password-protected
e-mail accounts when assigned surveys were available
for completion. Survey responses were confidential,
and identifying information was never revealed. Par-
ticipants had the option to leave the panel at any
time.
To ensure that the panel was probability-based rep-
resentative of the US population, panellists were
recruited through random-digit telephone dialling.
Panel sample weights were adjusted to US census
demographic benchmarks, and the sample design
weights were calculated based on specific design
parameters. Weighting adjustments were applied to the
ª 2007 The Authors, Aliment Pharmacol Ther 25, 599–608
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final survey data to reduce the effects of non-sampling
error (variance and bias).
Eligibility
Everyone who agreed to participate in the survey was
asked to complete an online, self-administered, six-
question screener to evaluate whether they met entry
criteria.
Inclusion criteria
Recruits were eligible to participate in this study if
they were proficient in the English language, were
18 years of age or older, experienced at least two
symptoms of constipation in the year before the sur-
vey as defined by Rome II criteria2 (Table 1; the need
for manual manoeuvres to facilitate defecation was
not used as a criterion for constipation in this survey
because of the high degree of patient misinterpret-
ation), sought doctor care for constipation symptoms
in the year before the survey, and had not been diag-
nosed as having irritable bowel syndrome (IBS) or any
GI disease of organic cause with associated constipa-
tion.
Exclusion criteria
Recruits were not eligible to participate in the survey
if they were pregnant during the survey or had been
Table 1. Rome II criteria for functional constipation2 and survey inclusion criteria
Rome II criteria
The presence of 2 or more of the following for
at least 3 months, which need not be
consecutive, in the past 12 months:*
Straining in >25% of defecations
Lumpy or hard stool in >25% defecations
Sensation of incomplete evacuation in >25% of
defecations
Sensation of anorectal obstruction/blockade in >25%
defecations
Manual manoeuvres to facilitate >25% defecations (e.g.
digital evacuation, support of the pelvic floor)
<3 defecations per week
* Loose stool is not present, and criteria
are insufficient for irritable bowel syndrome
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pregnant in the year before the survey. Patients were
specifically asked whether they had been diagnosed by
a doctor as having cancer or an organic GI disease
[e.g. diverticulitis, diverticulosis, inflammatory bowel
disease (IBD), Crohn’s disease], IBS with constipation
(IBS-C), or spastic or irritable colon. Participants
reporting abdominal pain, which is the hallmark
symptom of IBS, were not excluded unless they had
been diagnosed by a doctor as having IBS-C or spastic
or irritable colon. Therefore, some participants with
abdominal discomfort/pain were included because they
did not have a doctor diagnosis of IBS or spastic
colon. Anyone taking tegaserod, which was not
approved by the US Food and Drug Administration for
chronic idiopathic constipation at the time of the sur-
vey, was also excluded.
Survey administration
Panellists meeting entry criteria completed an online,
self-administered, 45-question survey. Participants were
directed to read and understand an informed consent
document, after which they were given the option of
continuing with the survey. Panellists were also advised
that their participation was voluntary and that they had
the option of not answering specific questions.
As part of the survey, participants were asked to
report on the presence, duration, frequency, severity,
bothersomeness and impact on QoL of a variety of
constipation-related symptoms, including straining,
Survey inclusion criteria
The presence of 2 or more of the following in the year
before the survey:
Straining in >25% of defecations
Lumpy or hard stool in >25% defecations
Sensation of incomplete evacuation in >25% of
defecations
Sensation of anorectal obstruction/blockade
in >25% defecations
<3 defecations per week
Participants with abdominal discomfort who did not have
a doctor diagnosis of irritable bowel syndrome or
spastic colon were included
602 J . F . J O H A N S O N A N D J . K R A L S T E I N

hard stool, abdominal discomfort, bloating, infrequent

Table 2. Participant demographics
bowel movements and feeling of incomplete evacu-
ation after a bowel movement. They were also asked Number of
to report on treatments, treatment satisfaction and participants Percentage
optimal product attributes.
Total 557 100
Sex
Ethical and legal aspects Male 243 43.6
Female 314 56.4
Surveys were conducted according to the globally Age (years)
accepted standards of good clinical practice (as defined 18–34 87 15.6
in the ICH E6 Guideline for Good Clinical Practice, 1 35–49 147 26.4
50–64 171 30.7
May 1996) in agreement with the latest version of the
65+ 152 27.3
Declaration of Helsinki, in accordance with HIPPA, Ethnicity
and in keeping with local regulations. Study protocols White non-Hispanic 456 81.9
and all associated materials were reviewed and Black 46 8.2
approved by a central institutional review board (New Hispanic 39 7.0
England Institutional Review Board). Other 16 2.9

Statistical analysis experiencing two or more symptoms of constipation

Summary statistics such as mean values, standard
deviations, minimums, quartiles, maximums for con-
tinuous variables, counts and percentages for categor-
ical variables and confidence intervals (when
appropriate) were used. Consistent with the explorat-
ory, hypothesis-generating nature of the study, statisti-
cal tests (i.e. v2-tests for categorical variables and
t-tests for continuous variables) were conducted at the
nominal 0.05 level, with no attempt to control for
multiple testing. Statistical modelling techniques (e.g.
regression, ANOVA, survival analysis) were used to char-
acterize the nature and strength of relationships
observed between data elements.
RESULTS
Demographics
Of 37 004 members of the Knowledge Network Panel
who were contacted, 27 923 responded to the invita-
tion e-mail, 24 090 consented to continue and 557
were deemed eligible to participate in the survey. More
than half (56%) of the 557 eligible participants were
women, and most (73%) were between 18 and 64 years
of age and were white (82%; Table 2).
Screener results
When screening consenting participants for eligibility,
19% (4680 of 24 090) of the respondents reported
per year. Of this percentage, most (n ¼ 4548) were not
pregnant or had not been pregnant in the year before
the survey. Consistent with published reports,5 only
25% (1147 of 4548) of those meeting inclusion criteria
to this point reported seeking care for their constipa-
tion symptoms within the year before the survey.
Finally, 557 of these 1147 patients had not been diag-
nosed as having IBS or any GI diseases of organic
cause with associated constipation, had at least two
symptoms of constipation in the year before the sur-
vey, and were not taking tegaserod at the time of the
survey.
Survey results
Duration and frequency of symptoms
Of the 557 eligible respondents, 30% (168 of 557)
reported having had symptoms of constipation for
1 year or less, 26% (147 of 557) reported having
them 2–3 years, 16% (89 of 557) reported having
them 4–5 years, 6% (33 of 557) reported having them
6–9 years and 21% (117 of 557) reported having them
10 years or more (Figure 1). The mean number of
years respondents had constipation was 4.2. Most
(72%) respondents reported having symptoms of con-
stipation between 1 and 6 days a week, and 35%
reported having them 2 or 3 days a week. The mean
number of days per week respondents had constipation
symptoms was 3.2  0.09 days. No differences were
observed between men and women.

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Figure 1. Number of years respondents (n ¼ 557) experi-
enced constipation.
Range of symptoms
Respondents reported a wide range of symptoms, and
many reported more than one symptom (Figure 2).
Most (79%) respondents reported straining, nearly all
(90%) of whom had this symptom for more than
6 years. Seventy-one percent of respondents reported
hard stool; 84% of them had this symptom for more
than 6 years. Other reported symptoms included
abdominal discomfort (62%), bloating (57%), infre-
quent bowel movements (57%) and feeling of incom-
plete evacuation after a bowel movement (54%).
Percentages of respondents who reported having had
these symptoms for more than 6 years were 71%,
73%, 67%, and 62%, respectively. Women were more
likely than men to report bloating (63% of women vs.
50% of men). Symptom prevalence was higher among
those who experienced constipation for a long time (6
or more years) than among those who experienced
symptoms for 5 years or less.
Figure 2. Constipation symp-
toms experienced by respond-
ents (n ¼ 557).
ª 2007 The Authors, Aliment Pharmacol Ther 25, 599–608
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P A T I E N T P E R S P E C T I V E O N C O N S T I P A T I O N 603
Symptom severity and bothersomeness
Respondents were asked to rate the severity of consti-
pation as a medical condition and the severity of their
individual symptoms using the following descriptors:
not at all, not very, somewhat, very and extremely
severe. Overall, more than half (54%) of respondents
considered constipation an extremely, very or some-
what severe medical condition. In rating the severity
of their individual symptoms (respondents could
choose more than one symptom), 79% rated straining,
85% rated hard stool, 75% rated infrequent bowel
movements, 73% rated bloating, 71% rated abdominal
discomfort and 70% rated feeling of incomplete eva-
cuation after a bowel movement as extremely, very or
somewhat severe (Figure 3). In general, symptom
severity increased with the length of time patients
experienced constipation. Again, symptoms were more
severe among those who had constipation for a long
time (6 or more years) than among those who had it
for 5 years or less.
Respondents were also asked to rate the degree of
bothersomeness of their individual constipation symp-
toms using the following descriptors: not at all, not
very, somewhat, very and extremely bothersome.
Most respondents (76%) rated their constipation as
extremely, very or somewhat bothersome (Figure 3).
For individual symptoms, 86% of respondents rated
bloating, 85% rated straining, 85% rated hard consis-
tency of stool, 81% rated abdominal discomfort, 80%
rated infrequent bowel movements and 78% rated
feeling of incomplete evacuation after a bowel move-
ment as extremely, very or somewhat bothersome.
Like symptom prevalence and severity, symptoms were
more bothersome among those who experienced con-
stipation for 6 or more years than among those who
experienced it for 5 years or less.
604 J . F . J O H A N S O N A N D J . K R A L S T E I N
Bothersomeness
Impact on quality of life
More than half (52%) of respondents reported that
constipation affected their QoL somewhat, a lot or a
great deal (Figure 4). The effect of individual constipa-
tion symptoms on participants’ QoL was rated using
the following descriptors: not at all, a little, some-
what, a lot and a great deal. Bloating was reported by
the largest percentage of respondents (71%) as at least
somewhat affecting their QoL. Other symptoms repor-
Figure 3. Severity and
bothersomeness of individual
constipation symptoms.
ted to affect patient QoL (a great deal, a lot or some-
what) included abdominal discomfort (65%),
infrequent bowel movements (63%), feeling of incom-
plete evacuation after a bowel movement (63%), hard
stool (59%) and straining (59%). In addition, 69% of
respondents who worked or went to school reported
some degree of work impairment, and 73% of
respondents reported social or personal impairment
as a result of symptoms of constipation, though
most patients did not feel that constipation completely
Figure 4. Symptoms of
constipation affect quality of
life.
ª 2007 The Authors, Aliment Pharmacol Ther 25, 599–608
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prevented them from working or performing their
daily activities. Within the month preceding the sur-
vey, 12% of respondents who worked or went to
school reported missing time from work or class
(mean, 2.4 days) because of constipation symptoms.
Treatments to reduce constipation symptoms
An overwhelming majority (96%) of respondents
reported that they had at some time used treatment for
their constipation symptoms. Overall, 80% tried over-
the-counter (OTC) products, and 35% had tried pre-
scription medication. Most (72%; 385 of 533) respond-
ents reported that they were currently taking
medication for their constipation symptoms. Treat-
ments included OTC products [including laxatives
(27%) and fibre (50%)] and prescription medications
(11%), including prescription laxatives (8% of total
medications taken or 91% of total prescription medi-
cations).
Treatment satisfaction
Overall, 47% of respondents were not completely satis-
fied with their current constipation treatment. Most
(82%) respondents reported their reason for dissatisfac-
tion was efficacy related, including does not work
well (39%), inconsistent results (25%), continuous
dosage (7%), still requires laxative use (3%), not fast
acting (1%) and does not treat infrequent bowel
movements (2%). Other reasons for dissatisfaction
included safety and adverse effect concerns (16%),
price and cost issues (3%), taste (2%) or inconvenience
Figure 5. Ratings for tradi-
tional constipation treatments.
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P A T I E N T P E R S P E C T I V E O N C O N S T I P A T I O N 605
(1%). Furthermore, 9% of respondents reported missing
work or school despite their current therapy.
Those who were taking fibre at the time of the sur-
vey (n ¼ 268) were asked to rate their level of satis-
faction with this approach. Overall, 80% of these
respondents were not completely satisfied with the
ability of fibre to relieve their bloating, 79% were not
completely satisfied with the predictability of fibre,
66% thought fibre did not completely relieve the mul-
tiple symptoms of constipation and 50% thought fibre
did not completely relieve their constipation (Figure 5).
Furthermore, most (64%) respondents were not com-
pletely satisfied with the ability of fibre to improve
their QoL.
Those who were taking OTC laxatives at the time of
the survey (n ¼ 146) were asked to rate their attrib-
utes. Overall, 71% of respondents were not completely
satisfied with the predictability of OTC laxatives, 67%
did not think OTC laxatives completely relieved their
bloating, 60% did not think OTC laxatives completely
relieved the multiple symptoms of constipation and
44% did not think OTC laxatives completely relieved
their constipation (Figure 5). Moreover, most (68%)
respondents were not completely satisfied with the
ability of OTC laxatives to improve their QoL.
Those who were taking prescription laxatives at the
time of the survey (n ¼ 42) were asked to rate their
level of satisfaction with these products. Overall, 75%
of respondents were not completely satisfied with the
predictability of prescription laxatives, 52% did not
think prescription laxatives were completely effective
in relieving their bloating, 50% did not think prescrip-
tion laxatives were completely effective in relieving
606 J . F . J O H A N S O N A N D J . K R A L S T E I N
their constipation and 50% did not think prescription
laxatives were completely effective in relieving the
multiple symptoms of constipation (Figure 5). In addi-
tion, nearly half (44%) of respondents were not com-
pletely satisfied with the ability of prescription
laxatives to improve their QoL.
Optimal product attributes
Respondents rated certain key attributes of a medica-
tion for constipation as extremely or very important,
including effective relief of constipation (straining/
hard, infrequent stool; 80%), effective at improving
the quality of bowel movements (79%), well tolerated
(74%), predictable response time (73%), relief of mul-
tiple symptoms (71%), appropriate for long-term use
(71%) and effective relief of bloating (64%).
DISCUSSION
The findings from this survey are consistent with those
reported previously with regard to the high prevalence
of constipation, its multifaceted symptoms, its often-
times bothersome nature that, for many, results in a
negative impact on QoL, and the generally low level
of satisfaction with the efficacy and tolerability pro-
files of traditional treatment options.1, 6, 15, 16 Three
findings were of particular relevance to the treatment
of patients with constipation: (i) the symptom that
patients view as most bothersome often correlates
directly with the symptom they view as most severe
and prevalent; (ii) severity and bothersomeness, and
the occurrence of additional symptoms, increase as the
duration of symptoms lengthens and (iii) patients are
often poorly satisfied with symptom relief achieved
with fibre and with OTC and prescription laxatives.
The clinical implications of these findings are import-
ant to consider.
Although constipation is often regarded simply as
infrequency of bowel movements, it is actually a mul-
tiple-symptom complex that varies in chronicity and
intensity from one patient to another, necessitating an
individualized treatment approach. Although partici-
pants in this survey met inclusion criteria based on
Rome II criteria for functional constipation, among
them symptoms associated with constipation, inclu-
ding some not included in the Rome criteria, were
reported. This result is consistent with previous reports
in which patients with constipation reported a wide
variety of symptoms.5 Indeed, in this survey, straining
(79%), hard stool (71%), abdominal discomfort (62%),
bloating (57%) and feeling of incomplete evacuation
after a bowel movement (54%) were reported at fre-
quencies similar to those reported for infrequent bowel
movements (57%). The varied manifestations that
patients experience often necessitate use of multiple
medications targeted at individual symptoms, increas-
ing the potential for adverse effects and drug interac-
tions. Of the many steps involved in evaluating and
treating a patient with constipation, elucidating the
symptom that the patient views as most bothersome
is among the most important in developing a treat-
ment goal and initiating a treatment plan. This sur-
vey revealed that patients often rate the severity and
bothersomeness of individual symptoms in a rank
order similar to that for prevalence. Identifying the
key symptom(s) to target (in terms of underlying cause
and treatment options) is therefore a critical first step
in developing a realistic action plan that attempts to
minimize the number of therapeutic agents used.
The pathophysiology of some forms of constipation
has been well described, and a number of subtypes,
including normal-transit constipation, slow-transit
constipation and defecatory disorders, have been char-
acterized based on underlying pathophysiological
mechanisms.16, 17 Patients with slow-transit constipa-
tion report, among others, symptoms of straining,
hard/lumpy stool and infrequent defecation, and they
exhibit reduced gut transit when assessed using radio-
opaque markers or scintigraphy. Patients with normal-
transit constipation also report symptoms of straining,
hard/lumpy stool and infrequent defecation; however,
they exhibit normal motility upon testing. Treatment
for these patient groups is generally pharmacological.
Patients with defecatory disorders, who report exces-
sive straining, feelings of incomplete evacuation and
manual manoeuvring for a bowel movement, fre-
quently have anorectal obstruction or abnormal
coordination of pelvic and abdominal muscles (dyssy-
nergia). Biofeedback therapy or surgery is often
recommended. Although each subtype has its own
characteristics, significant overlap typically exists
among the groups. Determining the presence of these
abnormalities requires specific testing, which is usually
not undertaken in clinical practice. In this survey, the
specific subtype of constipation was not elicited. How-
ever, straining was reported as one of the most
frequent symptoms of constipation. Excessive strain-
ing, feelings of incomplete evacuation, the need to
apply perineal or vaginal pressure or the need for
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direct digital evacuation of stool are all common
symptoms observed in patients with defecatory disor-
ders. It is possible that some survey participants had
an unrecognized defecatory disorder that contributed
to their constipation. Given that patients with defeca-
tory disorders do not respond to fibre and frequently
do not improve with OTC laxatives, the inclusion of
significant numbers of participants with defecatory
disorders could have contributed to the observed lack
of efficacy of traditional treatment options. Con-
versely, the prevalence of a defecatory disorder is con-
siderably less common than normal-transit
constipation, in which straining is also a typical symp-
tom. In a population-based survey such as this, the
presence of undiagnosed defecatory disorders probably
does not contribute significantly to the lack of satis-
faction with traditional therapy observed in this study.
For many patients, constipation is a chronic condi-
tion. In this survey, almost one quarter (21%) of
respondents reported experiencing symptoms for
10 years or more. A notable finding regarding the dur-
ation of any symptom was that the severity and both-
ersomeness, as well as the occurrence of additional
symptoms, increased as symptom duration lengthened.
This observation may reflect several factors, including
development of constipation-associated complications
and increasing abnormality over time. The clinical
implication of these findings is that patients with
chronic symptoms of constipation often require more
aggressive therapy, including the use of prescription
products.
Constipation imposes a heavy economic burden on
patients and society, with sales of laxatives alone
accounting for several hundred million dollars each
year.16 Despite the common view of constipation as a
disorder that can be self-treated with the large arm-
amentarium of OTC treatment options, poorly con-
trolled constipation-related symptoms account for
approximately 2.5 million doctor visits per year, with
85% of patients receiving prescriptions during these
visits.18 This survey confirmed the fact that many peo-
ple are disappointed with the efficacy and safety pro-
files of traditional treatment approaches. Respondents
tried a variety of OTC and prescription agents, and
only half were satisfied with any particular option. For
most, a lack of efficacy was the leading reason for
dissatisfaction. Severe slow-transit constipation that
is refractory to traditional pharmacological therap-
ies could be one of the reasons for the observed
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P A T I E N T P E R S P E C T I V E O N C O N S T I P A T I O N 607
dissatisfaction among patients.16, 17 Regardless, a need
clearly exists for effective, well-tolerated treatment
options that target multiple symptoms of constipation.
When asked what product attributes were most import-
ant to them, respondents rated effective relief of con-
stipation symptoms (straining; hard/lumpy, infrequent
stool), improvement in quality of bowel movements,
tolerability, predictable response time, multisymptom
relief, long-term use and efficacy in alleviating bloat-
ing as most imperative. Treatments that fulfil at least
several of these attributes are likely to play an import-
ant role in the treatment of constipation.
CONCLUSIONS
Results of this survey confirm that constipation is a
prevalent condition that negatively impacts patients’
daily lives, often necessitating doctor office visits and
pharmacological treatment. Proactive elucidation of
the symptoms that patients consider most bothersome
is an important step in developing a targeted treatment
plan. For numerous reasons, patients are often unsatis-
fied with the symptom relief achieved from traditional
treatment approaches, such as bulking agents and lax-
atives. These findings highlight an important unmet
need for treatment options that target the multiple
symptoms of constipation. Fortunately, the armamen-
tarium of effective, well-tolerated therapeutic options
is expanding. New and emerging treatments for consti-
pation are likely to fill an important void for many
patients, particularly those who experience symptoms
on a chronic basis and who may require a more
aggressive treatment approach.
ACKNOWLEDGEMENTS
Authors’ declaration of personal interests: Dr Johanson
is a consultant for Boehringer Ingelheim, Microbia,
Prometheus, Sucampo, Takeda and Theravance and a
member of the speakers bureaus for Novartis, Sucampo
and Takeda. Jeffrey Kralstein is an employee of Novar-
tis Pharmaceuticals Corporation.
Declaration of funding interests: this study was
funded in full by Novartis. The writing of this paper
was funded in part by Novartis. Initial data analyses
were undertaken by Knowledge Networks and received
funding from Novartis. Writing support was provided
by Cathy R. Winter, PhD, and Maribeth Bogush, PhD,
and funded by Novartis.
608 J . F . J O H A N S O N A N D J . K R A L S T E I N
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