Chronic constipation more prevalent in urban India, says study

While the worldwide incidence of chronic constipation is 10 per cent, in urban India, gastroenterologists have found that this condition afflicts 14 per cent of the population. Also, the study, which was published in the International Journal of Basic & Clinical Pharmacology, found that men are far more prone to constipation as compared to women as the incidence was as high as 63 per cent in men as compared to 36.9 per cent in women.

The study included 925 patients constipated patients from 19 centres in Mumbai, Bengaluru, Kolkata, Jaipur, Chennai, Ahmedabad and Pune. Out of these patients, 75.6 per cent of them were diagnosed with idiopathic constipation, which means there is no visible cause for the condition. Another 24.4 per cent were suffering from constipation due to irritable bowel syndrome (IBS), which is a stomach disorder that causes other symptoms like abdominal pain, bloating and hard stools.

Speaking to THE WEEK, Dr Ramesh Roop Rai, director & professor of gastroenterology department at the National Institute of Medical Sciences, Jaipur, says, “Constipated patients who suffer from IBS had a higher absence from work due to abdominal pain. They also experience other symptoms like anxiety, stress, lack of concentration and poor sleep caused by constipation.”

“The financial loss caused by depression is tremendous and though we still don't have data on that, living with constipation caused by IBS severely affects one's quality of life and even the patient's confidence in the long run,” adds Rai.

The study says that three of four Indians with chronic constipation are aware that it could lead to other health problems like piles or haemorrhoids, anal fissures, ulcers and stomach aches. The symptoms of constipation include pain while passing hard stools, uneasiness, acidity, irritability, and loss of appetite.

Despite that, two of three people with chronic constipation were not concerned about their condition even after being unable to pass stools more than three times a week. Other findings of the study say that the incidence of chronic constipation increases, with age and 20 per cent of patients are in the age group of 45-65 years old.

While the incidence of chronic constipation is not very high in rural India, doctors blame urban Indians for poor eating habits like snacking on oily and spicy food and relying too much on junk and processed foods. In fact, constipation is more prevalent among upper and lower middle class Indians. Doctors say that sedentary lifestyle is another major cause, as 55 per cent of the constipated patients in the study were only moderately active and one fourth of them have little or no physical activity. Another worrying fact the study revealed was that 16 per cent of the constipated patients also suffer from hypertension and another 10 per cent have diabetes.

Most Indians with chronic constipation (80 per cent) looked for a solution only after facing issues multiple times and the average time taken to visit a doctor was 80 days from the time they first started suffering from the symptoms.

This is due to the fact that 60 per cent of the patients opted for home remedies for some relief. “Many of our patients would tell us that they would try popular home remedies but they will provide relief only in the case of mild constipation. For moderate to severe constipation, one needs to approach a physician for treatment,” says Rai.

While there is no definite treatment for constipation, treatment includes laxatives and a drug known as polyethyl glycol, which is prescribed twice every night and every morning for complete evacuation of the bowels.

“I always tell my patients that the Indian colon doesn't lie in the abdomen but in the brain. Basic things like drinking three to four litres of water a day and having three glasses of lukewarm water first thing in the morning can help in evacuation of the bowels. Lukewarm water helps because it sends an electrical message to the gut which then goes into a state of contraction and helps in passing stools smoothly,” explains Rai.

He further recommends avoiding white bread and switching to a diet that includes oats, green leafy vegetables and till ladoos. He further says that patients should have two spoons of isabgol following every meal to increase their fibre intake. “Stress is a major reason why so many Indians are suffering from chronic constipation other than a poor diet. By reducing stress and exercising regularly, patients will be able to fight against constipation,” he adds.