Prashant Raj. Bhatt, MD1, Shoon Lei. Oo, MD1, Bharathan Radhakrishnan, MD1, Yuying Luo, MD2, Theodore Hutt, 3, Laurie Keefer, PhD, FACG4, Miranda A.L. van Tilburg, PhD5, Sonia Grego, PhD6 1Cape Fear Valley Medical Center, Fayetteville, NC; 2Mount Sinai West & Morningside, New York, NY; 3Case Western Reserve University, Fuquay Varina, NC; 4Icahn School of Medicine at Mount Sinai, New York, NY; 5Cape Fear Valley Health, Fayetteville, NC; 6Coprata, Durham, NC Introduction: Straining during bowel movements (BMs) is a common symptom of constipation, often causing complications like hemorrhoids and anal fissures. Despite its prevalence, little research has focused on straining in adults with constipation. This study assessed patients’ perceptions of straining to inform future behavioral interventions. Methods: Adults with self-reported constipation were recruited nationwide via Cint USA, Inc. The survey captured constipation symptoms, attitudes, beliefs, and behaviors related to straining and toileting habits. Quality checks included attention and consistency items to ensure response validity. Results: A total of 124 participants completed the survey (mean age: 40.8 ± 13.1 years; 62.4% female; 78.2% White; 8.9% Hispanic; 54.0% with constipation >1 year). Straining was common, with 49.6% reporting straining during at least one out of four BMs; Only 7.1% reported never straining. Average duration of straining was 5.0±7.3 minutes. Additional maladaptive toileting behaviors, which may be associated with straining, were also common (see Table 1). Other symptoms, such as neurologic symptoms, often associated with straining, were reported by fewer than 10% of patients (see Table 1). Despite its high prevalence, straining was rated as only moderately helpful in generating a bowel movement (5.3 ± 2.6 on a 1–10 scale).
Only 37% felt constipation impacted daily activities, and 23% expressed concern about the long-term effects of straining. Hemorrhoids (7.5%) were the most cited concern, with a few mentions of prolapse and cardiovascular risk. Interest in strategies to manage constipation and reducing straining was high (59% and 57%, respectively), with 75.0% strongly or somewhat agreeing that reducing straining would benefit them. Discussion: Straining is a common and burdensome symptom of chronic constipation. While only 1 in 4 patients expressed concerns about its long-term effects, the majority showed interest in interventions to reduce straining. Patients with chronic constipation frequently engage in maladaptive toileting behaviors, which could be addressed through targeted behavioral interventions regarding the risk associated with straining and other toileting behaviors.
Figure: Table 1: Maladaptive toileting behaviors and symptoms associated with straining
Disclosures: Prashant Bhatt indicated no relevant financial relationships. Shoon Oo indicated no relevant financial relationships. Bharathan Radhakrishnan indicated no relevant financial relationships. Yuying Luo: Ardelyx – Grant/Research Support. Theodore Hutt indicated no relevant financial relationships. Laurie Keefer: AbbVie – Consultant. Ardelyx – Consultant. Eli Lilly – Consultant. Janssen – Consultant. Pfizer – Consultant. Reckitt Health – Consultant. Trellus Health – Owner/Ownership Interest, Stock-publicly held company(excluding mutual/index funds). Miranda van Tilburg indicated no relevant financial relationships. Sonia Grego: Coprata – Owner/Ownership Interest.
Prashant Raj. Bhatt, MD1, Shoon Lei. Oo, MD1, Bharathan Radhakrishnan, MD1, Yuying Luo, MD2, Theodore Hutt, 3, Laurie Keefer, PhD, FACG4, Miranda A.L. van Tilburg, PhD5, Sonia Grego, PhD6. P0778 - Burden of Straining in Constipation: Patient Perspectives, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
