Constipation and exposure to stressful life events in 10–16 year olds: a Sri Lankan experience

Abstract

INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding its aetiology. The majority have functional constipation. Emotional stress is considered to be associated with functional gastrointestinal diseases including constipation. AIMS AND METHODS: The aim of this study was to assess the association between constipation and exposure to stressful life events in Sri Lankan school children and adolescents. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10–16 years, in five randomly selected schools, in three geographically and socioeconomically different provinces in Sri Lanka. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2699 (97.4%) were included in the analysis (1368 (50.6%) males, mean age 13.17 years, SD 1.72 years). According to Rome III criteria 416 (15.4%) had constipation and they were compared with 2278 children without defaecation disorders (eg, constipation, diarrhoea, functional faecal retention, non-retentive faecal soiling, etc). The prevalence of constipation was higher in those who were exposed to at least one stressful life event during the previous 3 months (odds ratio (OR) 0.38, p,0.0001). During univariate analysis the stressful life events associated with constipation were change in school or address, corporal punishment in school, separation from their best friend, preparation for government exams, exam failure, being bullied at school, sibling birth, severe illness or death in a family member, loss of job by a parent, separation or divorce of parents, parent remarriage to a step-parent, hospitalisation of the child himself/herself for other illness, frequent punishment by parents, father’s alcoholism, domestic fights and living in an area affected by ongoing separatist war (p,0.005). During multiple logistic regression analysis, separation from the best friend (adjusted OR 0.737, p = 0.016), severe illness in a family member (adjusted OR 0.588, p = 0.001), loss of job by a parent (adjusted OR 0.55, p = 0.017), frequent punishment by parents (adjusted OR 0.581, p = 0.005) and living in a war-affected area (adjusted OR 0.666, p = 0.0001) remained to be significantly associated with constipation. CONCLUSION: Childhood constipation was significantly higher in those exposed to stressful life events. Modulation of gut motility through the brain–gut axis probably delays colonic transit causing constipation