Female-specific characteristics in the occurrence and treatment of constipation

Complaints relating to acute or chronic constipation are among the most frequent symptoms mentioned in the pharmacy in the context of self-medication. Recent scientific research provides an insight into gender-specific differences in constipation, particularly regarding severity, personal well-being and response to therapeutic interventions. 

An online survey of 5,000 participants addressed the issue of how episodes of acute constipation affected the daily life of patients [1]. Questions included enquiries about symptoms and well-being. According to the survey results, the occurrence of typical symptoms such as straining when going to the toilet (71.5% versus 60.3%), bloating (63.2% versus 42.4%) or long periods between bowel movements (55.4% versus 40.7%) was reported more frequently by women than men. The number of symptoms and their average severity were higher in women. Women appeared to suffer more frequently than men from a constipation episode lasting more than one day (82.2% versus 68.0%).

In answer to the question of how an episode of constipation impacted on daily life, the most frequent response cited by both genders was “I feel physical discomfort” (75.5% versus 65.5%). However, on more detailed questioning, there were marked differences between men and women in the perception of the physical impairments (see Figure). The aspect showing the greatest differences concerned the symptom of the distended stomach, which occurred more often in women and which led to greater emotional discomfort: “I don’t feel attractive”.

Another scientific publication also focussed on gender differences in relation to the treatment of constipation. The response of women and men to treatment with stimulant laxatives (bisacodyl/sodium picosulfate) was investigated on the basis of combined study data in a total of 718 patients [2]. Both drugs were guideline-compliant, effective and well tolerated [3]. The observation period was 4 weeks. The results showed a marked improvement in bowel function in both genders after treatment with the laxative compared with the subjects given placebo. It worth noting that stool frequency – especially at the start of laxative use – increased more in women than in the male study participants. 

The ingestion of bisacodyl/sodium picosulfate improved the health-related quality of life (HRQoL) in both sexes. Women benefitted more from taking the medication, particularly with regard to the points “Satisfaction” and “Physical discomfort”. 

Summary: Recent scientific research indicates that symptoms of constipation occur more frequently in women than in men and the consequences of these episodes of constipation have greater physical and emotional impacts on women than on men. The response to ingestion of a laxative occurs more rapidly in women and the improvement in health-related quality of life also appears to be more marked in women.

_{Conflict of interest: S. Landes is an employee of Sanofi.} 

_{Disclosure: Publication funded by Sanofi Aventis Deutschland GmbH.}