Constipation and Constipation-predominant Irritable Bowel Syndrome: A Comparative Study Using Rome III Criteria

Objective: The aim of the present study is to compare functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C) in adolescents. Methods: A school-based survey was conducted involving adolescents ages 13 to 18 years. A set of validated questionnaires including Rome III questionnaire for functional gastrointestinal disorders in children/adolescents, somatization inventory, quality of life inventory, and childhood traumatic events inventory were used for data collection. FC and IBS-C were defined using Rome III criteria. Results: A total of 1792 adolescents (975 boys [45.4%]) were included in the analysis. Prevalence of FC and IBS-C were 7.7% and 1.6%, respectively. Bowel habits such as stool frequency < 3 per week (10% vs 44.9%, P < 0.0001), hard stools (20% vs 40.5%, P < 0.05), painful defecation (33.3% vs 56.5%, P < 0.05), large diameter stools (23.3% vs 50.7%, P < 0.01), stool withholding behavior (20% vs 44.2%, P < 0.05), were more commonly associated with FC than did IBS-C. Occurrence of fecal incontinence (0% vs 8%, P = 0.21), urgency (56.7% vs 66.7%, P = 0.65), and straining (56.7% vs 36.9%, P = 0.47) was not significantly different between IBS-C and FC. Exposure to physical abuse, emotional abuse, and sexual abuse was equally prevalent among adolescents with FC and IBS-C. There was no difference between somatization scores, and health-related quality of life between the 2 groups. Conclusions: Although bowel habits related to stool withholding are more prevalent in FC, than in IBS-C, they are more likely to be a spectrum of a disorder rather than 2 separate entities.