Compared with chronic idiopathic constipation (CIC), opioid-induced and -exacerbated constipation (OIC and OEC, respectively) are less prevalent among US adults but have a higher disease burden, according to study results published in American Journal of Gastroenterology.

Using a nationally representative dataset, researchers compared disorder prevalence and symptom severity among patients with CIC vs those with OIC and OEC.

Participants aged 18 years and older were asked to complete an online survey with questions related to gastrointestinal symptoms, including constipation and bowel habits. The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS®) gastrointestinal scale (0-100 rating, with 100 being most severe) was used to assess frequency and severity of symptoms, as well as quality of life. The survey also included questions on treatment use.

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Primary study outcome was prevalence of CIC, OIC, and OEC. Secondary outcomes included constipation symptom severity, health care-seeking behaviors, medication use, and patient satisfaction.

A total of 88,607 participants completed the survey and were included in the analysis; 5334 (6.0%) had CIC, 1548 (1.7%) had OIC, and 335 (0.4%) had OEC. The majority of survey respondents were aged between 18 and 29 years and were of non-Hispanic White ethnicity.

Overall, the majority of patients with OIC and OEC vs CIC were younger, men, of a racial and ethnic minority group, not employed, used tobacco or alcohol, and were more likely to have other comorbidities.

Compared with the general population, patients with CIC, OIC, and OEC had higher PROMIS constipation scores. Individually, patients with OIC and OEC vs those with CIC had higher PROMIS scores (62.7±28.0 and 61.1±25.8 vs 53.9±26.5, respectively).

With regard to constipation and bowel movements, patients with OIC and OEC vs those with CIC reported worse and more painful symptoms, for which they were more likely to receive care (adjusted odds ratios [aORs], 2.22 and 2.20, respectively).

With regard to medication use, the majority of participants across all 3 groups received treatment with over-the-counter medications. However, patients with OIC and OEC were more likely than those with CIC to receive prescription medications (11.7% and 18.9% vs 4.3%, respectively). 

Study limitations included that the survey was only conducted in the US, potentially reducing generalizability of the findings; the dissemination of the survey was only online and excluded those without internet services; presence of selection bias; and the lack of inclusion of less common bowel symptoms and therefore, an underestimation of the prevalence of OEC.

Study authors concluded, “Further efforts are needed to educate patients and providers about the many evidence-based therapies that are currently available for constipation as well as to develop and test novel treatments.”

Disclosures: This research was supported by Ironwood Pharmaceuticals. Multiple study authors have declared affiliations to the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Liang J, Almario CV, Chey WD, Higgins CS, Spiegel BMR. Prevalence and burden of illness of Rome IV chronic idiopathic constipation, opioid-induced constipation, and opioid-exacerbated constipation in the United StatesAm J Gastroenterol. Published online June 19, 2023. doi: 10.14309/ajg.0000000000002376

This article originally appeared on Clinical Pain Advisor