Source: Addiction  |  Posted 8 years ago

Constipation is a significant withdrawal symptom experienced by 1 in 6 people who quit smoking, according to a large British study on abstaining smokers.

Anecdotal evidence has suggested that constipation is associated with tobacco withdrawal; however, it is not included in the DSM-IV tobacco withdrawal symptoms due to lack of systematic data.

More information about this possible side effect is necessary in order for clinicians to provide appropriate counselling to people wishing to quit smoking.

Peter Hajek, MA, PhD, and colleagues at the University of London, United Kingdom, evaluated whether constipation is a potential tobacco withdrawal symptom.

The study included 1,067 patients at a smokers' clinic who quit smoking for at least 1 week. Withdrawal treatment also included nicotine replacement or bupropion therapy. Smoking status was assessed weekly by self-report and by carbon monoxide in end-expired breath. Withdrawal discomfort was evaluated by the 5-point Mood and Physical Symptoms Scale (MPSS).

Significant increases in constipation were reported after withdrawal. The increase in constipation score (+0.2) at week 1 was similar to classic withdrawal symptoms, such as irritability (+0.2), restlessness (+0.2), depression (+0.1), difficulty concentrating (+0.04) and sleep disturbance (+0.03).

Increased constipation was reported after just 1 week of withdrawal, and the greatest severity of symptoms was noted at 2 weeks. This increased score persisted in the 514 patients who remained smoke-free at 4 weeks.

More patients reported an increase in constipation during withdrawal than a decrease (39% vs. 22%, []P[] < .01). Furthermore, 10% of patients who had no or low constipation before quitting reported being very or extremely constipated after cessation.

Further analysis revealed that patients taking bupropion had significantly greater increases in constipation up to week 2 after withdrawal than those taking nicotine replacement. Younger patients also reported greater constipation.

The authors conclude that "stopping smoking is accompanied by an increase in constipation." They also note that clinicians should be aware of the possibility that 1 in 6 quitters develop constipation, and that for about 1 in 11 the problem can be severe.