Euroasian Journal of Hepato-Gastroenterology
Volume 13 | Issue 2 | Year 2023

Symptoms and Prevalence of Constipation among Adult Population of Bangladesh

Dilip Kumar Ghosh1, Debashis Kumar Sarkar2, Mukta Nath3, Parash Ullah4https://orcid.org/0000-0001-6397-9736, Mohammad Faiz Ahmad Khondaker5, Shamsuddin Al Masud Chowdhury6, Mohammad Mahmuduzzaman7

1,2,4,6,7Department of Gastroenterology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh

3Department of Anatomy, Dhaka Medical College Hospital, Dhaka, Bangladesh

5Department of Hepatology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh

Corresponding Author: Dilip Kumar Ghosh, Department of Gastroenterology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh, Phone: +880 1841235805, e-mail: dkghoshmukta@gmail.com

How to cite this article: Ghosh DK, Sarkar DK, Nath M, et al. Symptoms and Prevalence of Constipation among Adult Population of Bangladesh. Euroasian J Hepato-Gastroenterol 2023;13(2):45–49.

Source of support: Bangladesh Medical Research Council (BMRC).

Conflict of interest: Dr Mohammad Faiz Ahmad Khondaker is associated as the Editorial Board member of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of this editorial board member and his research group.

Received on: 07 July 2023; Accepted on: 09 August 2023; Published on: 22 December 2023


Background: Constipation is one of the most common gastrointestinal disorders. The prevalence of constipation is rapidly increasing globally. It has adverse effects on the patient’s quality of life including productivity and results in a high financial hardship on the healthcare system. The aim of the study was to estimate the symptoms and prevalence of constipation among the adult population of Bangladesh.

Materials and methods: It was a cross-sectional observational study based on a structured questionnaire and a checklist. In this study, three criteria were used for the diagnosis of chronic constipation (self-reported perception, Rome III criteria, and Bristol’s criteria). The study was conducted among 1,550 population between July 2019 and December 2019.

Result: The study population consisted of 1,550 respondents, among them 41.61% male and 58.39% female, and the mean age was 32.71 ± 9.72 years. In the study, 12.2% of the population was categorized to have constipation according to self-reported perception, 11.2% according to Rome III, and 10.3% reported to have been suffering from constipation according to Bristol chart.

Female gender tends to have a greater prevalence than male. In multivariate analysis for constipation, betel nut chewer, alcohol consumer, diabetes mellitus, hypertension, GI surgery, and bronchial asthma were significantly (p < 0.001) associated with constipation. According to Bristol’s criteria, the most common stool form was Type III (sausage-shaped with cracked surface) among the Bangladeshi population in this study.

Conclusion: Chronic constipation is a common problem worldwide. The findings of this study suggest that there is a high prevalence of constipation among the general population of Bangladesh. Decreasing modifiable risk factors of constipation can reduce its prevalence and burden of the disease. Bangladesh is markedly deficient in literature citing constipation prevalence and determinants. These findings may commence a call for setting priority as one of the major public health problems and demanding attention for both at the clinical and community levels.

Keywords: Bangladesh, Bristol’s criteria, Constipation, Prevalence, Rome III criteria, Self-reported perception.


The contemporary lifestyle has led to huge changes in diseases pattern and it became more noticeable with the entrance of the current century.1 Constipation is one of the most common gastrointestinal disorders faced in Inpatients and Outpatient Departments.2

Constipation is used to express a person’s perception of altered bowel movement that includes hard stools, difficulty with defecation, and a sense of incomplete evacuation. Chronic constipation is defined as when a person reports symptoms of constipation for at least three consecutive months. Chronic constipation may cause severe health issues regarding economic load for the patients and the healthcare service systems.3,4 The prevalence of constipation is rising day by day worldwide.5 But it is still underappreciated and consulted only when severely sick.6,7

There is wide variation of prevalence of the constipation from one region to another worldwide.8 In Europe, prevalence ranges from 1 to 81% in different ethnicity with a mean prevalence of 17%.9In the West, chronic constipation affected nearly 2–27% in Canada. In the United States, overall prevalence is 16%.3,10 In Asia, China, India, and Japan reported a prevalence of 8, 17, and 28% respectively.1113Considering the wide variation of the prevalence of constipation, recent studies are using Rome criteria of constipation, which are standardized for diagnosing functional gastrointestinal disorders. The latest version of this is Rome IV criteria and it was released in May 2016.14

There are different causes of chronic constipation. Among them, metabolic and endocrine derangement, electrolyte imbalance, neurological and myopathic disturbances, colorectal mechanical obstructions, and use of specific medications are the secondary causes of constipation.15In clinical practice, a small number of patients have these secondary causes. Among the types of constipation, functional constipation (FC) is the most common and it is diagnosed after the exclusion of alarm symptoms of constipation which includes anemia, significant weight loss, per rectal bleeding, or positive occult blood test (OBT), acute constipation, positive family history of colorectal carcinoma etc., and exclusion of secondary causes. There are three subgroups of functional constipation based on the pathophysiology. These are normal colonic transit (NCT), slow colonic transit (SCT), and rectal evacuation disorders.16

There are different factors associated with constipation. Previous studies revealed that female gender, poor diet habits, and lower socioeconomic status in addition to certain geographic regions, race, and ethnicity have associations with constipation. Data on constipation are scarce in Bangladesh. One population-based study trying to determine “Functional constipation - prevalence and lifestyle factors in a district of Bangladesh” showed 4.9% of the respondents experienced functional constipation.17 Due to lacking uniform diagnostic criteria; there is a discrepancy in the reported rates. Bristol’s chart and Rome III criteria are commonly used among gastroenterologists to diagnose constipation while some prefer using self-perception for constipation diagnosis in surveys.18,19

There is little data on the symptoms, prevalence and risk factors of constipation among adult population of Bangladesh. So, the present study evaluated the symptoms and prevalence of constipation among adult population of Bangladesh.


The study was conducted at Savar, one of the largest Upzilla of Dhaka district in Bangladesh with technical support from the Department of Gastroenterology of Shaheed Suhrawardy Medical College and Hospital. Total 1,550 participants were randomly selected from July 2019 to December 2019. This area, Savar has a large industrial base and it is a leading export processing zone (EPZ) the country. People from all over the country stay and work in different garments, industrial and other installations in this area. It is therefore assumed that the study population was representative of the Bangladeshi population. All the apparently healthy individuals of either sex aged 18 years or above in mentioned area were included in this study. The data collected was done by face-to-face interviews of the respondents who met the selection criteria. The instruments for data collection were a validated structured questionnaire and a checklist (Rome III criteria, Bristol criteria and Self-reporting). Data collected was done by four trained personnel and medical officers. The researchers rechecked randomly selected data to verify the collected data. Informed written consent was obtained from every respondent and interviews were held in private. Collected relevant data were compiled on a master table first and then statistical analysis was done by using window-based software with Statistical Packages for Social Sciences (SPSS-25). Results were exhibited in tables, figures, and diagrams. The research protocol was approved by the National Research Ethics Committee (NERC) of Bangladesh Medical Research Council (BMRC) before starting the study.


The study population consisted of 1,550 respondents, 41.61% male, and 58.39% female. The majority (45%) of the study population belonged to the young age-group (<30 years) and the mean age was 32.71 ± 9.72 years. The male-to-female ratio was 1:1.4. Nearly 82.3% of the sample population was married, among them 79.1% were male and 84.6% were female. In regard to the occupation of the respondents majority was from non-government employees (40%), about 24% from housewife, and about 12% from business and the rest 24% constituted other occupations like students, government employees, drivers, farmers, agri-laborers and others. On educational background 9.2% graduate and above, 19.7% secondary education completed, 36.9% of the respondents were secondary education not completed, 12.1% primary education completed, and 22% are illiterate. Most of the study populations are Muslims (90.9%) and the rest are Hindu (6.8%) and Christian (2.3%). About 70% of the respondents reported to earning a monthly income of taka less than 10,000 (Table 1).

Table 1: Demographic details of the respondents in male and female
  Male(n = 645) Female(n = 905) Total(n = 1,550)
Age (Years)      
 ≤30 263 (40.8) 434 (48.0) 697 (45.0)
 31–40 156 (24.2) 200 (22.1) 356 (23.0)
 41–50 84 (13.0) 171 (18.9) 255 (16.4)
 51–60 70 (10.9) 69 (7.6) 139 (9.0)
 >61 72 (11.2) 31 (3.4) 103 (6.6)
 Mean ± SD 33.88 ± 9.69 31.46 ± 9.60 32.71 ± 9.72
Marital status      
 Married 510 (79.1) 766 (84.6) 1276 (82.3)
 Unmarried 135 (20.9) 139 (15.4) 274 (17.7)
 Government employee 41 (6.4) 31 (3.4) 72 (4.6)
 Non-government employee 212 (32.9) 409 (45.2) 621 (40.1)
 Student 35 (5.4) 17 (1.9) 52 (3.4)
 Businessmen (Large) 150 (23.3) 0 (0.0) 150 (9.7)
 Businessmen (Small) 40 (6.2) 0 (0.0) 40 (2.6)
 Farming (landowner and farmer) 54 (8.4) 0 (0.0) 54 (3.5)
 Agriculture worker 17 (2.6) 0 (0.0) 17 (1.1)
 Driver 17 (2.6) 0 (0.0) 17 (1.1)
 Housewife 0 (0.0) 372 (41.1) 372 (24.0)
 Retired 56 (8.7) 65 (7.2) 121 (7.8)
 Others 23 (3.6) 11 (1.2) 34 (2.2)
 Muslim 599 (92.9) 810 (89.5) 1410 (90.9)
 Hindu 46 (7.1) 60 (6.6) 105 (6.8)
 Christian 0 (0.0) 35 (3.9) 35 (2.3)
Monthly family income (Taka)      
 5,000–10,000 455 (70.5) 636 (70.3) 1091 (70.4)
 10,000–15,000 151 (23.4) 230 (25.4) 381 (24.6)
 >15,000 39 (6.0) 39 (4.3) 78 (5.0)
Educational status      
 Illiterate 124 (19.2) 217 (24.0) 341 (22.0)
 Primary 90 (14.0) 98 (10.8) 188 (12.1)
 High school 254 (39.4) 318 (35.1) 572 (36.9)
 College 116 (18.0) 190 (21.0) 306 (19.7)
 University 61 (9.5) 82 (9.1) 143 (9.2)

Prevalence of Constipation

Out of 1,550 participants screened for constipation using the questionnaire (Rome III Criteria), 173 cases were found to be constipated and 1,377 individuals are non-constipated. Age-wise distribution showed that the majority of individuals associated with constipation belong to the young age-group (<30) years. The prevalence of constipation among respondents was 11.2% according to Rome III in this study, 12.2% was categorized to have constipation according to self-reported perception; but in contrast, 10.3% reported to have been suffering from constipation according to Bristol chart (Table 2).

Table 2: Prevalence of constipation
  Frequency (n) Percentage (%)
Total population 1,550  
Constipation (Bristol criteria) 159 10.3
Constipation (Rome III criteria) 173 11.2
Constipation (Self-reporting) 189 12.2

Among 1,550 respondents, most people 1,326 (85.5%) passed predominantly Bristol Type III stool; followed by 159 (10.3%), Type II, other stool forms were: 54 (3.5%) Type IV and 11(0.7%) Type V (Table 3).

Table 3: Distribution of the patients according to Bristol stool chart
  Frequency (n) Percentage (%)
Type II Sausage-shaped but lumpy. Uncomfortable to pass (Constipation) 159 10.3
Type III Like a sausage or snake but with cracks on its surface (Healthy stools) 1,326 85.5
Type IV Like a sausage or snake, smooth and soft (Healthy stools) 54 3.5
Type V Soft blobs with clear-cut-edges, passes easily (Precursor to diarrhea) 11 0.7

Risk Factors of Constipation

Bivariate analysis for constipation as a dependent variable was done separately for all three criteria. Betel nut chewers, alcohol consumption, diabetes mellitus, hypertension, GI surgery, and bronchial asthma were associated with constipation by all three methods (Table 4).

Table 4: Bivariate analysis for significant risk factors for constipation
Risk factors Constipation (n = 173) Non-constipation (n = 1,377) OR p-value
Betel nut chewer 71 (41.0) 327 (23.7) 2.23 (1.61–3.10) <0.001
Alcohol consumer 15 (8.7) 12 (0.9) 10.79 (4.96–23.48) <0.001
Dietary habit (Non-vegetarian) 6 (3.5) 65 (4.7) 0.72 (0.31–1.69) 0.458
Smoking 36 (20.8) 210 (15.3) 1.46 (0.98–2.16) 0.059
Daily water intake (<6 cups daily) 5 (2.9) 45 (3.3) 0.88 (0.34–2.25) 0.791
Voluntary physical activity (sedentary) 63 (36.4) 559 (40.6) 0.83 (0.60–1.16) 0.290
BMI (Obese) 12 (6.9) 112 (8.1) 0.84 (0.45–1.56) 0.584
Liver disease 0 (0.0) 24 (1.7)   0.100
Thyroid disorder 5 (2.9) 18 (1.3) 2.24 (0.82–6.13) 0.169
Diabetes mellitus 35 (20.2) 77 (5.6) 4.28 (2.76–6.62) <0.001
Hypertension 31 (17.9) 92 (6.7) 3.04 (1.95–4.74) <0.001
IBS 0 (0.0) 11 (0.8)   0.238
GI surgery 51 (29.5) 227 (16.5) 2.11 (1.48–3.02) <0.001
IHD 1 (0.6) 11 (0.8) 0.72 (0.09–5.62) 0.755
Bronchial asthma 20 (11.6) 18 (1.3) 9.86 (5.10–19.06) <0.001
Bold figure indicates statistically significant as p-value < 0.05

Multivariate Analysis for Constipation

Betel nut chewers, alcohol consumption, diabetes mellitus, hypertension, GI surgery, and bronchial asthma were associated with constipation (Table 5).

Table 5: Multiple logistic regression analysis for being constipation
Risk factors Constipation (n = 173) Non-constipation (n = 1,377) OR p-value
Betel nut chewer 71 (41.0) 327 (23.7) 0.63 (0.43–0.97) 0.019
Alcohol consumer 15 (8.7) 12 (0.9) 0.13 (0.05–0.31) <0.001
Diabetes mellitus 35 (20.2) 77 (5.6) 0.30 (0.16–0.56) <0.001
GI surgery 51 (29.5) 227 (16.5) 0.57 (0.38–0.84) 0.005
Bronchial asthma 20 (11.6) 18 (1.3) 0.10 (0.05–0.21) <0.001
Bold figure indicates statistically significant as p-value < 0.05


The study estimated the prevalence and symptoms of constipation among the general population of Bangladesh. Constipation can be defined as a decreased number of defecations per week, other symptoms, for example, sensation of incomplete evacuation, abdominal bloating, straining, elongated or failed attempts to defecate, hard stools, and sometimes necessity of digital disimpaction.20 Constipation is usually subjective and is termed when people have reduced frequency of stools or strain during defecation.

In this study, the majority of the study population was in the younger age-group (<30 years). Studies from Singapore raveled that constipation in the form of hard stool was more in older adults over 40 years, but constipation in the sense of straining was more in the younger age-group, 18–29 years.21 Older age-group are more affected by constipation due to their different comorbidities and side effects of different medication.22

Regarding gender, males were 41.61% and females were 58.39%. Females were more prevalent than males. In the USA, Females were 2.2 times more likely to be affected by constipation than males.23Association of constipation with the female gender is well established in the literature.24However, it is difficult to establish the exact causative mechanism, but contributing factors like hormonal causes and dietary patterns have been illustrated.23,25

There are many clinical diagnostic criteria for constipation resulting in a huge variation in its prevalence.26The present study obtained a self-reported prevalence of constipation of 12.2%. On application of the Rome III criteria, the rate was 11.2%, while estimation through the Bristol stool chart, obtained a lower rate of 10.3%. These statistics show little variation. However, since there is no single gold standard diagnostic method available, there is a need to discuss the pros and cons of the other methods used. Self-reporting method is especially individual-based and depends on the extent of the self-perception of people in the frequency of stools and the amount of straining depending on one’s bowel habits as the reference standard. Hence, there is a risk of over-reporting the symptoms although it might be considered to be normal resulting in an overestimation of results. Johanson in his review of the epidemiology of constipation demonstrated a prevalence ranging from 3 to 27%, mostly from NHS and NHANES surveys using either self-reported or Rome I/II criteria and thereby attributed the variance to the different diagnostic criteria and concluded by stating self-reporting method has a risk of attaining higher prevalence rates.27

There are different etiological and risk factors for constipation. In this study, Logistic regression analysis showed a significant risk for constipation with betel nut chewers, alcohol consumption, diabetes mellitus, hypertension, GI Surgery, and bronchial asthma (p < 0.05).

Betel nut chewing is very common in this Southeast Asia. In our study, the study population was mostly from an industrial region, where most of them are workers. Betel nut chewing and alcohol consumption increased the capacity to work. So betel nut chewing and alcohol consumption is comparatively more prevalent in this population group. There is no clear evidence that betel nut chewing and alcohol consumption causes constipation, rather betel nut chewing improves bowel movement.28,29Surgery is a known risk factor for constipation. This may be due to a different medications, opioid analgesics, and a sedentary lifestyle after surgery. Epidemiological studies revealed that abdominal and anorectal surgery were significantly associated with an increased risk of chronic constipation.30

From the perspective of comorbidities, diabetes mellitus was associated with chronic constipation (4.7–11.8%).31 Diabetes mellitus may cause constipation by complications like autonomic neuropathy. Hypertensive patients use different medications including calcium channel blockers and patient suffering from bronchial asthma lead a sedentary life and use medications that contribute to developing constipation.32


Chronic constipation is a common problem globally. The study findings suggest a high prevalence of constipation among the general population of Bangladesh. Decreasing modifiable risk factors of constipation can reduce its prevalence and burden of the disease. Bangladesh is markedly deficient in literature citing constipation prevalence and determinants. The findings of this study have important implications for future research. It has highlighted the magnitude of the disorder and has provided a pathway for designing larger population-based studies to assess its epidemiology, etiological characteristics, environmental risk factors, and the quality of life of people with constipation in Bangladesh.


The Author expresses gratitude to BMRC for the funding of this project. The patients and colleagues in the Gastroenterology Department of Shaheed Suhrawardy Medical College and Hospital are acknowledged for their cooperation.


Parash Ullah https://orcid.org/0000-0001-6397-9736


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