Research Article

Contribution of Colonoscopy in the Diagnosis of Chronic Constipation in Dakar (Senegal)

Cissokho Moustapha Leon¹*, Gueye Mamadou Ngone², Thioubou Mame Aisse³, Diouf Gnagna³ and Dia Daouda³

¹Cheikh Anta DIOP University, Senegal

²Assane Seck University of Ziguinchor, Senegal

³Department of Internal Medicine and Hepato-Gastroenterology, Idrissa Pouye General Hospital, Dakar, Senegal

Submission:June 01, 2026;Published:June 16, 2026

*Corresponding author: Cissokho Moustapha Leon; Cheikh Anta DIOP University, Senegal

How to cite this article: Cissokho Moustapha L, Gueye Mamadou N, Thioubou Mame A, Diouf G, Dia D . Contribution of Colonoscopy in the Diagnosis of Chronic Constipation in Dakar (Senegal). Adv Res Gastroentero Hepatol, 2026; 22(4): 556093.DOI: 10.19080/ARGH.2026.22.556093.

Abstract

Introduction: Chronic constipation is a very common symptom affecting approximately 14 to 18% of the world's population. In sub-Saharan Africa, data on the prevalence, causes, and management of chronic constipation remain limited. Our objective was to study the epidemiological characteristics, the prevalence of observed colonic abnormalities, to identify clinical factors associated with the presence of colonic lesions, and to analyze histological data from biopsies.

Patients and Method: We conducted a retrospective study between January 2017 and June 2024 in the digestive endoscopy unit of the Internal Medicine and Hepatogastroenterology Department at the Idrissa Pouye General Hospital in Grand Yoff. We included all patients with chronic constipation who underwent a colonoscopy.

Results: We collected data from 481 colonoscopy reports. The mean age of the patients was 57 years [13-90] with a male-to-female ratio of 1.15. Chronic constipation was predominantly isolated (43.2%). It was associated with rectal bleeding (18.9%), diarrhea (12.7%), abdominal pain (11.6%), weight loss (10.4%), proctalgia (2.9%), abdominal bloating (1.2%), and melena (1%). Bowel preparation involved the use of polyethylene glycol (PEG) or Fortran’s in 99.6% of cases. Colonoscopy was performed without sedation in 99.5% of cases. The diagnoses were functional bowel disorders in 405 patients (84.2%), neoplasia in 25 patients (5.2%), dolichocolon in 3.8% of patients, extrinsic compression in 4 patients (0.8%), microscopic colitis in 6 patients (1.2%), eosinophilic colitis in 5 patients (1%), ulcerative colitis in 4 patients (0.8%), and nonspecific colitis in 14 patients (2.9%). Furthermore, proctological lesions were observed in 239 patients (49.7%).

Conclusion: Chronic constipation affects all ages, with a slight male predominance. The most common etiology is functional bowel disorders. Colorectal cancer screening relies on colonoscopy, which is very limited in the sub-region.

Keywords: Colonoscopy; Chronic constipation; Colorectal cancer; Dakar

Abbreviations: PEG: Polyethylene Glycol; IBD: Inflammatory Bowel Disease

Introduction

Chronic constipation is an extremely common symptom, affecting approximately 14-18% of the world's population [1]. Chronic constipation is a very common symptom, affecting about 14-18% of the world's population. It is defined as a digestive disorder that corresponds to dissatisfaction during defecation, due either to infrequent bowel movements, or to difficulty exonerating, or both, that has persisted for at least six months [2]. The etiological diversity of this condition, ranging from simple functional intestinal disorders to potentially serious organic pathologies such as colorectal cancer, makes it a complex clinical entity to understand. In this context, total colonoscopy, although invasive in nature, occupies a central place in the etiological diagnosis and management of chronic constipation. It allows direct exploration of the colonic mucosa, the detection of suspicious macroscopic lesions, as well as the performance of targeted biopsies that can reveal subtle histological abnormalities. In developing countries, particularly in sub-Saharan Africa, data on the prevalence, causes, and management of chronic constipation remain limited. Hence the interest of this work, whose main objective was to evaluate the contribution of colonoscopy in the etiological diagnosis of chronic constipation in a digestive endoscopy center in Dakar (Senegal).

Patients and Method

This is a retrospective study covering the period from January 2017 to June 2024, conducted in the digestive endoscopy center of the Idrissa Pouye General Hospital in Dakar. All patients who underwent colonoscopy for the exploration of chronic constipation and a full report were included. Preparation for colonoscopy was based on a 2-liter intake of polyethylene glycol (Fortrans®) with a so-called split-dose strategy sometimes combined with magnesium sulfate-based solutions (Normacol®). Data collected included age, sex, indications for examination, level of colonic exploration, tolerance to examination, endoscopic findings, and histopathological findings of biopsies, where available.

Results

Four hundred and eighty-one patients have undergone a colonoscopy for chronic constipation, which represents 32.8% of the colonoscopic examinations performed in our establishment. The population concerned was composed of 257 men and 224 women (sex ratio of 1.15). Their average age was 57 years (extremes at 13 and 90 years). The most represented age group was between 60 and 69 years old (Figure 1). Chronic constipation was isolated in 43.2% of cases (208 patients). It was associated with other symptoms in a significant proportion: rectorrhagia in 18.9%, diarrhea in 12.7%, abdominal pain in 11.6%, weight loss in 10.4%, proctalgia in 2.9%, abdominal bloating in 1.2% and melena in 1%. The colonic formula was based on the use of polyethylene glycol (PEG) or Fortrans in 99.6% of cases. The split dosing protocol resulted in good preparation in 93% of cases. The Boston score was accurate in 83.8% of patients with a mean of 8. Colonoscopy was performed without sedation in 99.5% of cases and was well tolerated in 62.6% of situations. Colonoscopy was complete in 91.5% of patients. In 8.5% of cases (41 patients), the cecum could not be reached, due to stenosis (4 cases) or poor tolerance (20 cases). The last ileal loop was catheterized in only 8.5% of patients.

Colonoscopy was abnormal-free in 331 patients, or 68.8% of the sample. Neoplastic-like lesions were found in 5.2%, while colonic polyps were identified in 15%. Colic diverticula were observed in 9.3%, and inflammatory lesions suggestive of inflammatory bowel disease (IBD) were found in 5%. An aspect of dolichocolon was reported in 3.7% and suspected extrinsic compression in 0.8%. In addition, proctological lesions were frequently observed, affecting 239 patients, or 49.7% of the total. The proctological lesions found are reported in Table 1. Histologically, biopsies were performed in 169 patients, or 35.1% of the sample. Of these, only 121 anatomopathological results could be used, representing 71.6% of the biopsied cases. The analysis revealed a consistent appearance with ulcerative colitis in 4 patients. Microscopic colitis was identified in 6 patients, corresponding to 18.6% of colitis cases, while eosinophilic colitis was observed in 5 patients, or 13.9%. Colorectal cancer was confirmed in 7 of 17 patients with suspicious endoscopic lesions, including 6 cases of adenocarcinoma and one case of neuroendocrine carcinoma. The polyps observed in 34 patients were adenomatous in 47% of cases, hyperplastic in 38.2% and inflammatory in 17.6%. Among adenomatous polyps, low-grade dysplasia was observed in 20.6% of patients, while high-grade dysplasia was present in 26.5%. Finally, histopathological examination was normal in 24 of the 43 patients who had macroscopically normal colonoscopy, i.e. 55.8%. The diagnosis made after endoscopic and histological examinations is reported in Table 2.

Discussion

The mean age of patients was 57 years (range at 13 and 90 years). These results are consistent with the data reported in the literature [3,4,5]. The high average age observed in patients with chronic constipation can be explained by several converging factors. On the one hand, the prevalence of constipation tends to increase with age and, on the other hand, this predominance of elderly subjects in colonoscopic explorations can also be explained by the fact that, in this age group, chronic constipation is more readily considered as a warning symptom. Clinically, chronic constipation was isolated in 208 patients, representing 43.2% of the population. It was associated with a variety of clinical symptoms, including rectorrhagia in 18.9%. These results are in line with trends observed in the literature, where chronic constipation is reported as isolated in 17.9% to 49.4% of cases depending on the series [6,4]. Similarly, its association with rectorrhagia varies between 5.7% and 26.5% depending on the study [6,4]. The high frequency of isolated constipation reflects a proactive clinical approach using colonoscopy to explore persistent functional disorders and detect possible underlying lesions early, even without associated warning signs. The association with symptoms such as rectorrhagia suggests a targeted selection of patients with signs suggestive of organic pathology. This mixed pattern of indication could be influenced by the increasing availability of endoscopic resources, the awareness of practitioners of colorectal pathologies, and a shift in practices towards more anticipatory medicine.

Colonoscopy was complete in 440 patients, i.e. a cecal intubation rate of 91.5%, testifying to an overall satisfactory technical quality. This result is part of an encouraging dynamic observed in some African series. For example, in a study conducted in Nigeria, Akere et al. [7] reported an overall completion rate of 85%. These performances, although variable, reflect a gradual improvement in endoscopic practices on the continent, despite logistical constraints and disparities in training and access to sedation. Comparatively, our results are also superimposed on those reported in the international literature. Obusez et al. documented a cecal intubation rate of 89%, while Baker et al. observed a rate of 84.5%, confirming that the technical performance achieved in our series is in line with recommended international standards. Colonoscopy was normal in 331 patients, or 68.8% of cases. This rate is in line with the data reported in several African and international studies. Indeed, Konaté et al. in Senegal, Hammami et al. in Tunisia, and Mjoli et al. in South Africa observed normal colonoscopy rates of 66%, 69.5% and 60.4%, respectively, reflecting an overall agreement with our study population [6,4,3]. This high rate of normal examinations is mainly explained by the predominance of chronic functional constipation in our cohort, which falls under functional constipation functional constipation or constipation-predominant irritable bowel syndrome (IBS-C), according to the Rome IV criteria. These clinical entities are generally not accompanied by any macroscopic abnormalities on colonoscopy. In addition, the low proportion of warning signs among our patients also contributes to this limited diagnostic yield, as confirmed by several studies that have shown that the absence of warning signs significantly reduces the relevance of the colonoscopic indication in the context of chronic constipation [8,9].

Suspicious lesions of neoplasia were identified in 5.2% of patients, a frequency comparable to that reported in the literature, which varies between 5.6% and 6.3%. Although relatively low, this proportion underlines the essential role of colonoscopy in the screening and diagnosis of neoplastic pathologies, even in the absence of suggestive symptoms. Indeed, the symptomatic overlap between functional disorders and the initial manifestations of some colorectal cancers can lead to a misleading clinical presentation, where constipation is sometimes the only telltale symptom. In addition, colonic polyps were detected in 15% of patients, a rate slightly higher than those reported in the literature, which range from 4.2% to 12.6% [6,4,5,10]. This observation reinforces the interest of colonoscopy not only as a diagnostic tool, but also as a means of preventing colorectal cancer by excising precancerous lesions. This preventive dimension is all the more crucial in our context, where systematic screening programs remain underdeveloped. An aspect of dolichocolon was observed in 3.7% of patients. This rate is lower than that reported by Hammami et al. in Tunisia, which was 8%. This difference could be explained by the composition of our study population, which is predominantly male, whereas dolichocolon is more frequently observed in women. Finally, extrinsic compression was demonstrated in four patients, i.e. 0.8% of cases. This rate is close to that reported in Côte d'Ivoire, where a frequency of 0.4% was observed. It should be remembered that endoscopy alone does not always make it possible to characterize the nature of the compression, thus requiring additional use of imaging depending on the clinical context.

In our study, colonoscopy combined with colonic biopsies resulted in a diagnosis of inflammatory bowel disease (IBD) in 0.8% of the total population studied. All of the cases identified were consistent with ulcerative colitis (UC), with no cases of Crohn's disease diagnosed. Although this frequency is low, it remains consistent with data from the regional and international literature [6,11]. The atypical presentation of UC as chronic constipation, rather than bloody muddy diarrhea or emergency defecatory, may be explained by the distal location of the inflammation. Several studies have described crude or non-typical forms of UC, particularly in colitis limited to the rectum, where constipation may dominate the clinical picture [12,13]. The absence of Crohn's disease in our series may reflect a lower regional prevalence. In sub-Saharan Africa, the distribution of IBD shows a clear predominance of UC, as confirmed by several African series, where Crohn's disease is rarely diagnosed. In addition, microscopic colitis was identified in 1.2% of patients. Although this proportion is modest, it is in line with the available epidemiological data, which report a variable but significant prevalence in patients with chronic constipation. All microscopic colitis observed in our series was lymphocytic-like, which is consistent with data suggesting a predominance of this form in chronic constipation. It has made it possible to highlight in our digestive endoscopy center in Dakar a diversity of colorectal lesions that are sources of constipation. After the sub-Saharan Africa [14,15]. Eosinophilic colitis was found in 1% of patients, a rate similar to that reported by Samake et al. in Mali. This rare, often underestimated entity is characterized by abnormal infiltration of the colonic mucosa by eosinophils in the absence of parasitosis or other causes of hyper eosinophilia. In our context, the high frequency of chronic parasitic infections and certain dietary exposures could contribute to the occurrence of these infiltrates, complicating the differential diagnosis with intestinal parasitosis or drug reactions.

Conclusion

Colonoscopy is the ideal exploration to perform in case of chronic constipation. In our digestive endoscopy center in Dakar, 32.8% of colonoscopies were indicated for the exploration of constipation. The cancer rate diagnosed in these patients is around 5.2%.

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