The role of chronic constipation, diarrhea, and laxative use in the etiology of large-bowel cancer

Abstract

Life-long bowel habits of 685 colorectal cancer cases and 723 age/sex frequency matched community controls were investigated as one part of a large, comprehensive, population-based study of colorectal cancer incidence, etiology, and survival, The Melbourne Colorectal Cancer Study. Self-reported chronic constipation was statistically significantly more common in cases than in controls (P = .05). Three or more bowel actions per day were reported by more cases than controls but the total number of respondents in this subset consisted of only ten cases and two controls. Otherwise, the frequency and consistency of bowel motions was similarly distributed among cases and controls. Constipation disappeared as a significant risk when simultaneously adjusted for previously determined dietary risk factors, indicating that it is the diet and not the constipation that is associated with the risk of large-bowel cancer. Additionally, a highly statistically significant association (P = .02) was found with the risk of colorectal cancer in those who reported constipation and also had a high fat intake, a finding consistent with current hypotheses of colorectal carcinogenesis. It is concluded that chronic constipation, diarrhea, and the frequency and consistency of bowel motions, as well as laxative use, are unlikely to be etiologic factors in the development of colorectal cancer. Self-reported chronic constipation is a marginally significant indicator of excess risk of large-bowel cancer and may be used as one of the indices in the screening of individuals for this cancer.

Retrospective Study on Laxative Use and Melanosis coli as Risk Factors for Colorectal Neoplasma

“…Nusko/Schncider/Müller/Kusche/Hahn Melanosis coli and Colorectal Neoplasma and Melbourne [9,10]. Our data also show no association between colorectal cancer and me lanosis coli.…”

“…or not explicitly calculated [9,10]. The Medical and Surgical Hospitals of the University of Erlangen are currently con ducting a prospective case-control study (pa tients classified into groups with colorectal cancer, adenoma and controls).…”

“…This is in accordance with a retrospective [Lübeck, unpubl.] and two case-control studies [9,10;Munich,unpubl. ] where no increased risk for colorectal cancer was found as well.…”

“…About 20% of the population is consuming laxatives regularly [2][3][4], Mutagenic effects of certain anthranoids could be shown in vitro [5][6][7][8] but the clinical relevance of these experimental re sults is not clear up to now. Epidemiologic studies gave no evidence for any association between laxative use and development of colorectal cancer in humans [9,10].…”

Constipation and Cathartics as Risk Factors of Colorectal Cancer: AMeta-Analysis

“…If the constipation risk was simultaneously adjusted for these confounding influences, constipation disap peared as a separate risk factor of colorectal cancer [31], Fourth, there is little epidemiologic evi dence for a parallelism in the behavior of con stipation and colorectal cancer. Constipation affects females two to three times more often than males, while the incidence of colorectal cancer is 1.5-to 2-fold higher among males than females [ 1 -3, 8,46,47], The incidence of colorectal cancer has risen in the past decades [1], The few available data on the temporal trends of constipation suggest a stable pattern or ever a moderate decline [48], In summary, the present meta-analysis shows a small but significant risk for colorec tal cancer associated with constipation and use of cathartics.…”