Constipation in Women with High-Grade Intraepithelial Neoplasia and Cervical Cancer: Does the Extent of Cervical Lesion Invasion Influence the Severity of Constipation and Compromise Quality of Life?

Abreu, Glicia Estevam de; Palácio, Gabriel Perez; Silva, Eduarda Alvarez; Braga, Antônio Vítor Martinelli; Silva, Paulo André Lago

doi:10.1055/s-0044-1787290

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Journal of Coloproctology (Rio de Janeiro)

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Original Article • J Coloproctol 44 (2) • 2024 • https://doi.org/10.1055/s-0044-1787290 copy

Constipation in Women with High-Grade Intraepithelial Neoplasia and Cervical Cancer: Does the Extent of Cervical Lesion Invasion Influence the Severity of Constipation and Compromise Quality of Life?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Constipation is a common clinical condition, particularly among cancer patients.

Objective

To assess the prevalence and severity of CF in women with high-grade intraepithelial neoplasia (HSIL) and cervical cancer (CC), as well as the impact of this condition on their daily lives.

Methods

A cross-sectional study was conducted at a tertiary cancer center. To assess the presence and severity of constipation, the Rome IV criteria, and the Constipation Scoring System (CSS) were used. To assess the impact of constipation on daily life, the Visual Analogue Scale (VAS) was used.

Results

The study included 153 patients with HSIL or CC, with a median age of 44 (IQR 35–56) years. Constipation was reported in 54 (35.3%) patients, 33 (61.1%) of those with HSIL, and 21 (38.9%) of those with CC. In constipated patients, the median number of positive Rome IV criteria items was 3 (IQR 2–5). "Irregular or hard stools" was the most common complaint, affecting 41 (75.9%) of the patients. In patients with CC, the use of analgesic medications was associated with constipation (p = 0.016). There is no link between constipation and invasive cancer (p = 0.492). Constipation had a daily impact of 7.5 (IQR 4.75–9), with no relationship between VAS and clinical diagnosis (HSIL or CC) [7 (IQR 3-9) X 8 (5-9.5), p-value = 0.536] The more severe the constipation, the more disturbing it is to these women's daily lives.

Conclusion

Constipation is common in women with cervical lesions, affecting their daily lives regardless of their severity.

Keywords
constipation; cervical cancer; high-grade intraepithelial neoplasia; quality of life

Variable		Patients N = 153
Ethnicity N (%)
	Brown	71 (58,2)
	Black	38 (31,1)
	White	10 (8,2)
	Indigenous	1 (0,8)
	Asian	2 (1,6)
Schooling N (%)
	Incomplete High School or less	73 (59,3)
	Complete High School or more	50 (40,7)
Age years (ME/IQR)		44 (35-56)
Previous Childbirth N (%)		129 (89)
Type of Childbirth
	Vaginal	115 (79,3)
	Cesarean	39 (26,9)
Number of Childbirths (ME/IIQ)		2 (1-3)

Variables		Patients N = 54
Staging N (%)
	1B	6 (11,1)
	2A	7 (13)
	2B	11 (20,4)
	3A	10 (18,5)
	3B	8 (14,8)
	3C	3 (5,6)
	4A	4 (7,4)
	Undefined staging	5 (9,3)

Variables	HSIL N = 99	CC N = 54	p value
Age (ME/IQR)	43 (32-52)	49 (37-61,25)	0,001^* * Mann-Whitney test;
Number of Childbirths (ME/IQR)	2 (1-3)	2,5 (1,25-4)	0,11^* * Mann-Whitney test;
Type of childbirth N (%)
Vaginal	74 (76,3)	41 (85,4)	0,202^ Chi-square test.
Cesarean	25 (25,8)	14 (29,2)	0,665^ Chi-square test.
Painkiller N (%)	4 (4)	40 (74,1)	< 0,001^ Chi-square test.

Variables		Absent Constipation N= 99	Present Constipation N= 54	p value
Age (ME/IQR)		44 (33 - 57)	46,5 (36 - 53,75)	0,731^* * Mann-Whitney test;
Clinical Diagnoses N (%)				0,492^ Chi-square test.
	HSIL	66 (66,7)	33 (33,3)
	CC	33 (61,1)	21 (38,9)
Painkiller		10 (10,1)	13 (24,1)	0,021^ Chi-square test.
Number of childbirths (ME/IQR)		2 (1-3)	2 (1- 4,75)	0,173^* * Mann-Whitney test;
Scholling (%)
	Until Elementary school	38 (48,7)	26 (57,8)	0,671^ Chi-square test.
	≥ Greater then high school	40 (51,3)	19 (42,2)
Type of childbirth N (%)
	Vaginal	69 (74,2)	46 (88,5)	0,042^ Chi-square test.
	Cesarean	26 (28)	13 (25)	0,700^ Chi-square test.

Variables		Patients N = 54
Number of positive Rome IV items (ME/IQR) Roma IV Criteria		3(2-5)
Manual maneuvers to facilitate stool passage		11 (20,4)
Decreased bowel frequency		34 (63)
	Irregular or hard stools	41(75,9)
	Straining during bowel movements	33(61,1)
	Sensation of incomplete evacuation	33(61,1)
	Feeling of obstruction or blockage	33(61,1)

Variables		Patients N = 54
CSS score (ME/IQR)		10 (8-14)
Bowel Movement Frequency N (%)
	1 to 2 times every 1 or 2 days	17 (37,8)
	2 times a week or less	28 (62,2)
Straining Frequency N (%)
	Never	10 (22,2)
	Rarely	3 (6,7)
	Frequently	32 (71,1)
Incomplete Bowel Movement Frequency N (%)
	Never	10 (22,2)
	Rarely	1 (2,2)
	Frequently	34 (75,6)
Average Time Spent per Bowel Movement Attempt N (%)
	Less than 5 minutes	15 (33,3)
	Between 5 and 10 minutes	15 (33,3)
	More than 10 minutes	15 (33,4)
Need for Assistance with Bowel Movements N (%)
	None	33 (70,2)
	Stimulant laxative	5 (10,6)
	Digital assistance or enema	9 (19,1)
Number of Unsuccessful Bowel Movement Attempts in 24 Hours N (%)
	None	23 (51,1)
	1 to 3 attempts	19 (42,2)
	3 to 6 attempts	1 (2,2)
	6 to 9 attempts	2 (4,4)
Duration of Constipation N (%)
	Less than 1 year	3 (6,7)
	1 to 5 years	6 (13,3)
	5 to 10 years	2 (4,4)
	10 to 20 years	2 (4,4)
	More than 20 years	32 (71,1)

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[1] Address for correspondence Glicia Estevam de Abreu, PhD, Escola Bahiana de Medicina e Saúde Pública, Serviço Estadual de Oncologia e Secretaria de Saúde do Estado da Bahia, Centro de Coloproctologia da Bahia, Rua Eduardo José dos Santos 146, sala 905, CEP – 41940-455, Salvador, Bahia, Brazil (e-mail: gliciaabreu@bahiana.edu.br).