Characterization of ulcerative colitis-associated constipation syndrome (proximal constipation)

Sally L. James, Daniel R. van Langenberg, Kirstin M. Taylor, Peter R. Gibson

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5 Citations (Scopus)


Background: The syndrome of constipation with other abdominal symptoms (“proximal constipation”) in ulcerative colitis (UC) is commonly recognized by practitioners but is poorly described, with no recognized definition and little understanding with regard to prevalence and effect of therapies on disease outcomes. This study aimed to address these issues in a cross-sectional, consecutive series of patients with UC. Methods: A working definition of proximal constipation was established. Consecutive patients were recruited, and their disease activity, recent medications, and investigations plus abdominal symptoms were assessed at a study visit. Relevant clinical data were also extracted from medical records. Results: Of 125 patients with UC, (mean age 47, range 14–84 years, 61 male), 58 (46%) fulfilled the definition of proximal constipation. The main symptoms were reduced stool frequency (69%), hard stools (43%), abdominal pain (40%), excessive flatus (29%), straining (24%), and sensation of incomplete emptying (14%). Proximal constipation was associated with female gender (OR 3.45 [1.45–8.24]), left-sided (OR 2.84 [1.14–7.11]) and concurrently active disease (OR 5.56 [1.96–16.67]), but not age, disease duration or therapy. A total of 88% had an increase in anti-inflammatory therapy, with the use of laxatives or fiber supplements in 63% compared with 1.4% of those without proximal constipation. Conclusions: Proximal constipation is common, and its risk increases in active and distal disease, especially in women. Validation of its definition and evaluation of therapeutic strategies are needed. A new term “ulcerative colitis-associated constipation syndrome” is proposed to more accurately depict its nature.

Original languageEnglish
Pages (from-to)217-222
Number of pages6
JournalJGH Open
Issue number5
Publication statusPublished - Oct 2018


  • anti-inflammatory therapy
  • constipation
  • fiber
  • functional gastrointestinal disorder
  • transit time
  • ulcerative colitis

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