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)}

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.

About us

Co-Host: Hong Kong Consortium for Medical, Nursing and Healthcare Development (MNHD) https://www.mnhd.com.hk/

Co-Host: The Hong Kong Society of Gastrointestinal Motility (HKSGM)

Supporting: Hong Kong Nang Yan College of Higher Education http://www.ny.edu.hk/web/home.html

Medical Market Research and Public Relations Consultant: Hong Kong Healthcare Market Research and Consulting Ltd https://www.hkhmrc.com/