Details of Publication 531 for Project A307:

Koloski N, Jones M, Raghubinder G, Forder P, Talley N. Long term risk factors for the development of constipation in older community dweling women. Gastroenterol, 2011; 140(5): 359-360

Background: Although constipation is a relatively common heterogeneous condition, its etiopathogenesis is still poorly understood. While concurrent diseases, medications and some lifestyle factors such as alcohol, diet deficient in fluid and fibre and immobility have been implicated, there is very little prospective data on the role of these and other factors such as psychological state in the development of constipation over time especially in older women living independently in the community. We aimed to determine risk factors for new onset constipation in a large population based cohort of older Australian women over a 9 year period. Methods: Participants were 12,762 women (aged 70-75 years) who participated in the first survey of the Australian Longitudinal Study on Women's Health in 1996. Of these women, n =3716, aged 79-84 years also completed a follow-up survey in 2005. Both the first and follow-up survey asked women “Have you had constipation in the past 12 months?” The following baseline variables were asked in the first survey. Demographic factors included nationality, educational, marital and socioeconomic status. Lifestyle factors assessed included smoking, alcohol intake, body mass index, number of live births and a history of a prolapse repair. The number of stressful life events in the past year was assessed as was depression using the Centre for Epidemiological Studies-Depression scale (CES-D). Domains of quality of life were assessed using the valid SF-36. Results: Of the 3716 women who responded to the first and follow-up survey, we found 1501 (40.3%) developed constipation over the9 year period. Univariately, we found an increased number of live births, increased number of stressful life events, lower socioeconomic status and reduced functioning in the following SF 36 domains: general health, bodily pain, mental health, physical and social functioning, role emotional and physical and vitality to be significantly associated with new onset constipation. However in a multiple regression model that included these significant variables we found the rate of constipation in those women who have given birth versus those who had not (43% vs 34%; OR= 1.1; 95%CI 1.0-1.1, P=0.003) and reduced functioning on the SF-36 subscales for vitality (M=6.4 vs M=6.8; OR=0.9; 95%CI 0.9-1.0, P=0.000) and bodily pain (M=6.8 vs M=7.4; OR=0.9; 95%CI0.9-1.0, P=0.001) were independent risk factors for developing constipation among women who did not report constipation on the first survey.Conclusions: Constipation is an extremely common problem among older community dwelling women and causes decrement in health related quality of life. Our prospective data suggests factors related to childbirth and generally being unwell as reflected by poor quality of life are risk factors for developing new onset constipation among older women.