Ambulatory care for constipation in the United States, 1993-2004

OBJECTIVES: Chronic constipation is one of the most common disorders seen in primary care. In order to examine longitudinal changes in the ambulatory care that occur in constipation evaluation and management, we examined national trends in physician office visits associated with constipation between 1993 and 2004. METHODS: Data were derived from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Care Survey (NHAMCS) for 1993-2004. Patient visits were classified as encounters for constipation-related care. Analyses were performed by combining 4 yr of data (1993-1996, 1997-2000, and 2001-2004). RESULTS: Ambulatory visits for constipation increased from 4 million (95% CI 3.3-4.7 million) ambulatory visits for constipation annually during 1993-1996 period to 7.95 million (95% CI 6.6-9.4 million) visits during the 2001-2004 period. The proportion of medical visits for constipation increased for pediatricians, but decreased for adult primary care providers from 1993 to 2004. During the observed time period, the proportion of medical visits for constipation did not change for gastroenterologists. The primary treatment for constipation shifted from bulking agents (fiber) to osmotic laxatives. CONCLUSION: There has been a significant increase in physician office visits for constipation between 1993 and 2004, with the highest rate of increase in the pediatric population. Longitudinal trends indicate an increase in constipation-related visits for pediatricians. The primary treatment for constipation among medical providers shifted from using bulking agents to osmotic laxatives for unknown reasons.