Hong Kong Healthcare Market Research and Consulting’s Gastrointestinal Health of Working Women Survey: 1/3 of women experience lengthened defecation time during the pandemic, exceeding 5 minutes in more than half of the women

• 90% are stressed out
  during the pandemic; 70% have no shortened working hours

HONG KONG
SAR – Media OutReach – 6
July 2021 – Women account for more than 50% ^{(Note 3)} of the labor population in Hong Kong.
During the pandemic, many working people experience sudden changes in their job
and living environment, possibly affecting their defecation habit. Some studies
have shown that women experience more serious constipation problems than men ^(Note
2).The Hong Kong
Consortium for Medical, Nursing and Healthcare Development (“MNHD”) (香港醫療護理發展協會)
and the Hong Kong Society of
Gastrointestinal Motility Limited (“HKSGM”) (香港腸胃動力學會)
commissioned the Medical Research and PR consulting company, the Hong Kong Healthcare Market Research and
Consulting Ltd. (“HKHMR”) (香港醫護市場調查及策劃)
to conduct a questionnaire survey intended to understand changes in working
women’s defecation habits during the pandemic and focus on women’s constipation problems.

 

In order to
gain an insight into changes in working women’s defecation habits compared to
before the pandemic, HKHMR dispatched
investigators to distribute 209 questionnaire copies in 81 enterprises from
April to May, 2021. 181 effective
questionnaires were successfully collected.

 

According to
the results of questionnaire surveys conducted in Hong Kong ^{(Note 4)},
compared to before the COVID-19 outbreak, 22.1%
of the respondents experienced a
decrease in defecation frequency. Among them, more than 50% (52.5%) experienced a decrease of three times or more a week. In terms of the number of
times, more than 30% (30.9%) of the
people experienced longer average defecation time in the toilet than before the
pandemic. The survey also showed that 12.2%
of the respondents experienced symptoms
of constipation ^{(Note 4)}. At the same time, the ratio was higher
for respondents with children
compared to that of respondents with no
children, accounting for 15% (14.7%)
and 10% (10.6%) respectively. As for
the daily habits of the respondents, 61.9%
of the working female respondents worked
46 hours or longer per week. Compared to before the pandemic, about 70% (65.2%) of the respondents disagree
with “shortened working time”, 85.1% believe their stress increased, and 82.3%
believe their exercise time decreased.
According to director, Wong Mong-Shuen of the HKHMR, “The figures reflect major
impacts on working women’s defecation time and their significantly increased
stress.” This indicates that their defecation habits may be associated with
changes in defecation. Among women with constipation, the ratio is higher in
women with children than women without children. The survey shows Swomen with
two jobs have a more serious constipation problem, which should be taken
seriously.”

 

Constipation is manifested by granular or sausage-like
feces, which is mainly caused by improper daily habits.

According to
Gastroenterology
specialist, Dr. Chau Tai Nin (周泰年), the consultant of
MNHD, “Everyone can conduct an initial
constipation evaluation through a self-assessment questionnaire ^{(Note 5)}.
Generally speaking, defecating three
times daily to three times a week and within five minutes each time is
considered normal ^{(Note 6)}. In addition, everyone can observe their
feces according to “Bristol stool scale” and gain an insight into the degree of
constipation”. Constipation ^{(Note 1)} refers to diminished muscle
contraction function of the colon, which causes a slowdown in the peristalsis
of feces in the colon and retention in the intestines. In time, the moisture in
the stool is absorbed by the colon, the feces harden, and discharge becomes
difficult. Dr. Chau pointed out that “Improper
daily habits mostly cause constipation problems in adults, especially stress that cannot be ignored. Lack of
exercise, insufficient dietary fiber and water intake, and frequently holding
back the desire to defecate all may result in constipation. Additionally, drug
administration and disease may also cause constipation.”

 

According to
a survey on pandemic prevention and control measures and constipation conducted
in Mexico, 25% of respondents
exercise less due to community lockdowns and activity restriction measures,
leading to the emergence of constipation-related symptoms ^{(Note 7)}.
Dr. Chau said, “This finding coincides with the current survey results.
Everyone with a constipation problem should take it seriously and consult a
doctor. Medical diagnoses such as colonoscopies, rectal x-rays during
defecation, hematological tests, anorectal tests, and so on, will aid in
deriving a confirmed diagnosis of constipation and in determining the severity
to take the correct actions”.

 

Hormone-driven women are prone to more serious constipation.
Allot time for “drinking water” during work.

According to
gastroenterology specialist, Dr. Sze Wan Chee
(施蘊知), the honorary secretary of HKSGM,
“Women are more prone to constipation
than men ^{(Note 8)}. This is because female hormones are more
likely to affect peristalsis than male hormones. Menstruating or pregnant women
are more likely to experience constipation”. Dr. Sze suggests that women find
time to drink water and go to the toilet, such as drinking water every hour, going to the toilet every three hours,
or dividing their work into several
stages to drink water after completing each stage“. At the same time, Dr.
Sze also advises everyone to move around
regularly to avoid sitting for prolonged periods. When everyone is unable
to exercise outdoors, everyone can spread a yoga mat and perform simple
stretching and muscle exercises daily to release life stress and move the limbs
from time to time. In addition, women can also slightly elevate their legs in the toilet to facilitate defecation ^(Note
6). Of course, it is also necessary to consume high-fiber foods, such as oats and legumes. ^{Table 1}

 

PEG and psyllium alleviate constipation. People aged over 50
with constipation problems should seek medical attention immediately.

If the
constipation problem fails to be solved even after improvement on daily habits,
consult a doctor to see if medication is needed for handling constipation.
First-line pharmaceuticals such as PEG
without electrolytes, methylcellulose, and psyllium can increase defecation
frequency and alleviate abdominal pain. PEG, in particular, is less likely to
cause bloating, flatulence, and other side effects ^{(Note 6)}. Dr. Sze
recommends that “People aged over 50 who experience constipation should seek
medical attention as soon as possible or join the “Colorectal Cancer Screening Program” funded by the government to
determine if they have colorectal cancer.

 

Women with two jobs are confronted by “triple pressure”.
Advocate the promotion of flexible work assignments by employers.

According to
Professor Wong Kwok
Shing (汪國成教授),
concurrently the Chairman of MNHD
and the Dean of Hong Kong Nang Yan College of Higher Education School of
Nursing and Health Care (香港能仁專上學院醫療及護理學院), “During
the pandemic, many working women have resorted to a home office, thus the
reduced mobility. Some face salary, work, and manpower reduction, resulting in
increased working hours and other issues. Let us not forget that the husbands
of these working women are also currently working and facing double pressure.
The many classes suspension earlier have compelled women with schooling
children to accompany their children throughout visualized learning at home,
which is a triple pressure.” Ms. Yu working in an insurance company and with
three children, has had constipation for three years. She shared, “I defecate
about once every other day. My feces are hard. I have tried eating fruit and
drinking plenty of water, but they don’t seem to work, as constipation may be
stress-induced. Although my work is more flexible, I need to accompany my
children learning from an iPad while working during the pandemic. I am under
tremendous pressure”. It is hoped that the general public and employers be more
considerate of working women’s stress and encourage them to work at home or
have a flexible work schedule. Working women should also pay attention to their
physical and psychological health and adhere to proper daily habits to maintain
their intestinal health despite the pandemic.

 

 

Table 1 Easy to understand guide for
gastrointestinal health during the pandemic ^{(Note1 & 6)}

1.	Dividing work into several stages to drink water after completing each stage.
2.	Find time to go to the toilet (once every 2-3 hours).
3.	Eat more high-fiber food such as oats and legumes.
4.	Perform simple stretching and muscle exercises.
5.	Use a footrest during defecation. Slightly elevate both legs.
6.	Drink a cup of water after getting up and before eating to help eliminate feces in the intestines.
7.	Do not deliberately hold back the desire to defecate.

Remark:

(Note 1) Department
of Health (2014). Surveillance and Epidemiology. April, 2014.

(Note 2) Corsetti M, Brown S, Chiarioni G,
Dimidi E, Dudding T, Emmanuel A, Fox M, Ford AC, Giordano P, Grossi U,
Henderson M, Knowles CH, O’Connell PR, Quigley EMM, Simren M, Spiller R, Whelan
K, Whitehead WE, Williams AB, Scott SM. Chronic constipation in adults:
Contemporary perspectives and clinical challenges. 2: Conservative,
behavioural, medical and surgical treatment. Neurogastroenterol Motil. 2021 Feb
1:e14070. doi: 10.1111/nmo.14070. Epub ahead of print. PMID: 33522079.

(Note 3) Census
and Statistics Department (2020). Woman and Men in Hong Kong, Key Statistics
(2020). 30^th July, 2020.

(Note 4) Correct to one decimal points.

(Note 5) “Rome Criteria IV” from Wu, J. C.,
Chan, A. O., Cheung, T. K., Kwan, A. C., Leung, V. K., Sze, W. C., & Tan,
V. P. (2019). Consensus statements on diagnosis and management of chronic
idiopathic constipation in adults in Hong Kong. Hong Kong Med J, 25(2), 142-8.

(Note 6) Hong
Kong Society of Gastrointestinal Motility Limited. June, 2020.

(Note 7) Remes-Troche, Jose & Coss-Adame,
Enrique & Amieva-Balmori, Mercedes & Velarde Ruiz Velasco, Jose &
Flores-Rendón, Angel & Gómez-Escudero, O. & Rodríguez-Leal, María &
Durán-Rosas, Cristina & Pinto-Gálvez, Samanta & Priego Parra, Bryan &
Triana Romero, Arturo. (2020). Incidence of “new-onset” constipation and
associated factors during lockdown due to the coronavirus-19 pandemic..
10.21203/rs.3.rs-77783/v1.

(Note 8) McCrea GL, Miaskowski C, Stotts NA,
Macera L, Paul SM, Varma MG. Gender differences in self-reported constipation
characteristics, symptoms, and bowel and dietary habits among patients
attending a specialty clinic for constipation. Gend Med. 2009 Apr;6(1):259-71.
doi: 10.1016/j.genm.2009.04.007. PMID: 19467522.