Constipation: a different entity for patients and doctors

BACKGROUND: Medical definitions of constipation vary. Some are specific, based on the interval between defecations, with three days or twice weekly as the upper limit of normality. Others are vague. OBJECTIVE: This study investigates patients definitions, attitudes and management of 'constipation' and compares their definitions with physicians' criteria. METHODS: Survey of 1) 531 randomized patients of family clinics of the sick Fund of the General Federation of Labor of Israel, and 2) 100 randomized specialists and residents in family medicine. RESULTS: The present survey showed that constipation is more common in women and in the older (> 40 years) age group. The most important finding of this investigation was the wide discrepancy in the criteria used by doctors and patients to diagnose constipation. Fifty per cent of the patients defined constipation differently from accepted medical definitions--27% of the patients defined it as defecation every 2 days or less and 25% as hard stool alone. All 57 doctors who were asked the same question defined constipation as defecation every 3 or 4 days or less, sometimes in combination with hard stool. CONCLUSIONS: This study suggests that patients and doctors refer to different entities when they talk of 'constipation'. It is the doctor's responsibility to ensure that this misunderstanding is avoided so that unnecessary tests and treatment are not undertaken and, patient-doctor acrimony is avoided.