The use of conventional and complementary health services and self-prescribed treatments amongst young women with constipation: An Australian national cohort study

Abstract

Background

Little research has been conducted regarding the comprehensive health service utilisation in constipation care. This study investigates the comprehensive health service utilisation amongst Australian women with constipation.

Methods

This study draws upon data from the Australian Longitudinal Study on Women's Health. A total of 8074 young women were asked about their frequency of constipation, measures of quality of life, and use of a range of health services and self-prescribed treatments via two postal surveys conducted in 2006 and 2009, respectively.

Results

The prevalence of constipation was 18.5% amongst women in 2009. Constipated women had poorer quality of health than women without constipation. Women who sought help for constipation were more likely to visit multiple groups of conventional and complementary health practitioners compared to women who did not experience constipation (p < 0.005). However, women were less likely to visit a specialist for the management of constipation over time (2006 to 2009). There was an increase in the proportion of women with constipation who self-prescribed vitamins/minerals over time (p < 0.001).

Conclusion

Although only 4.5% of women sought help for their constipation, given the increasing use of multiple health services across time, more studies are required regarding the optimal treatment in constipation care.

Introduction

Constipation is a common chronic condition amongst adults, yet the perceptions of this condition vary from healthcare providers and constipated patients [1]. Patients usually experience constipation as one or more symptoms such as straining, hard stool, and infrequent defecation [2]. A literature review published in 2011 revealed the prevalence rate of constipation amongst the general population ranged from 2% to 27% [1]. Gender and age are the two main predictors of the occurrence of constipation, specifically women and older adults are more likely to experience the symptoms of constipation than men and young/middle-age adults [3], [4].

Chronic constipation is a common complaint for practitioners in the clinical settings [4], [5], and a considerable constipated patients who seek help from a general practitioner (GP) are consequently referred to a specialist or a hospital clinic for further examination, and/or consult a complementary and alternative medicine (CAM) practitioner [6], [7], [8]. CAM refers to a diverse group of health practices and products which are not associated with the medical profession or medical curriculum [9]. In general, patients with constipation are initially recommended by conventional health practitioners to have lifestyle modification (i.e. high-fibre diet and liquid intake), followed by the prescription of laxatives and other medications [10]. It is important to note that constipation-associated symptoms can also be caused by other factors such as diseases (e.g. diabetes, multiple sclerosis, Parkinson's disease, fissures, and haemorrhoids) and side effects of medications (e.g. analgesics, anti-inflammatory drugs, calcium channel blockers, iron supplements, and opioids) [11]. The secondary causes of constipation should be managed alongside idiopathic constipation, which may highlight the importance of the management of constipation-related symptoms in the clinical setting [12].

Constipation is primarily considered to involve mild symptoms, which is straightforward to manage, yet untreated constipation-related complications typically leads to a lower quality of life in comparison with the general population [11], where these patients experience impaired mental and physical health and decreased work efficiency [8], [13]. In addition to the poor quality of life, constipation also results in high healthcare service costs for patients [1]. The annual estimation of the cost regarding the visit to physicians and their prescribed laxatives for constipation ranged from 18 million dollars to 1 billion dollars in Western countries [14], [15], [16], [17]. Moreover, the imposed economic burden on the healthcare system by constipation may be underestimated as many patients with constipation purchase over-the-counter medications as well as CAM therapies and products without the involvement of physicians [14], [18], [19].

Despite these circumstances, no studies to date have been published investigating the range of health service utilisation amongst constipation sufferers over time. In response to this gap in knowledge, this paper reports the first examination of health services and self-prescribed treatment use amongst young Australian women with self-reported constipation.