Abnormal Bowel Habits Research Articles

Su2089 Validation of the Use of the ICD-10 Diagnostic Code for Irritable Bowel Syndrome in the Swedish National Patient Register

Background: Irritable bowel syndrome (IBS) is a diagnosis based on symptom criteria. In order to perform epidemiologic studies based on national health-care registers there is a need to assess the accuracy of the diagnostic code in clinical practice at different time points. Aim: To evaluate the positive predictive value of the ICD-10 (International Classification of Diseases, version 10) code for in Sweden in hospital based outpatient care during 2005 (using the Rome II criteria) and 2010 (Rome III criteria). Methods: We identified all Swedish adults that had received the ICD-10 code for as the main diagnosis during hospitalbased outpatient care in 2005 and 2010 by use of the Swedish National Patient Register. We excluded individuals from the cohort if they had been diagnosed with predefined diagnoses, incompatible with IBS, during a time span of 6 months before or after the diagnosis. The National Board of Health and Welfare generated a random sample of 300 identities. Each medical record was retrieved and read by two of the authors (N.J. and H.T.) who noted if symptoms compatible with according to Rome II criteria (2005 cohort) or Rome III criteria (2010 cohort) could be identified. Results: We received a total of 248 medical records (2005, n=127; 2010, n=121). In 173 patients (70%), the diagnosis fulfilled diagnostic criteria with a high certainty and in 75 patients (30%) it did not. The proportions of valid diagnoses were similar in 2005 (Rome II criteria, 68%) and 2010 (Rome III criteria, 72%) (p=.41). Out of the 75 cases that did not fulfill diagnostic criteria, 24 were labeled probable IBS because of insufficient medical data. There was no difference when comparing tertiary (72% correct) and secondary care (69% correct) (p=.62), but a significant difference in accuracy was noted comparing departments of internal medicine (155/210, 74%) and non internal medicine departments (18/38, 47%) (p=.001). The most common reasons for a diagnosis being judged as not valid were: insufficient patient data available in 33 patients (13%), symptoms only including abdominal pain/discomfort or abnormal bowel habit in 19 patients (8%), an obvious misuse of the diagnosis in 12 patients (5%) and too short duration of symptoms in 11 cases (4%). Conclusion: The use of the ICD-10 diagnostic code for in Swedish secondary and tertiary care has a high validity in departments of internal medicine but less so in other departments. This finding needs to be addressed when planning and interpreting epidemiologic studies of IBS.

Antinociceptive and antidiarrheal effects of pioglitazone in a rat model of diarrhoea‐predominant irritable bowel syndrome: Role of nitric oxide

Irritable bowel syndrome (IBS) is a prevalent disease characterized by abdominal pain and abnormal bowel habits. Pioglitazone is a peroxisome proliferator-activated receptor (PPAR) γ agonist and, although it is mostly used as an antidiabetic agent, it has been reported to have analgesic effects. Nitric oxide (NO), a gaseous molecule that mediates many of the effects of pioglitazone, has been implicated in the pathophysiology of IBS. The aim of the present study was to investigate the effects of pioglitazone on symptoms in a rat model of diarrhoea-predominant IBS (D-IBS).and to determine the role of NO in these effects. Diarrhoea-predominant IBS was induced by intracolonic instillation of acetic acid. Pioglitazone (2 mg/kg, i.p.) was administered on Days 7, 9 and 11 after acetic acid instillation. To investigate the mechanism involved in pioglitazone action, rats were also administered either the PPARγ antagonist GW9662 (3 mg/kg, i.p.), the NO synthase (NOS) inhibitor N(G) -nitro-l-arginine methyl ester (l-NAME; 10 mg/kg, i.p.) or the NO precursor l-arginine (250 mg/kg, i.p.) along with pioglitazone. Visceral hypersensitivity, nociceptive thresholds, defecation frequency, stool form, serum and colon NO production and inducible (i) NOS activity were assessed 1 h after the final injection of pioglitazone or dimethylsulphoxide (used as the vehicle). Pioglitazone reduced visceral hypersensitivity and defecation frequency, increased nociceptive thresholds, NO production and iNOS activity and shifted stool form towards hard stools in D-IBS rats. These effects of pioglitazone were significantly reversed by l-NAME, but not GW9662. l-Arginine augmented the effects of pioglitazone. In conclusion, pioglitazone alleviates symptoms in a rat model of D-IBS through an NO-dependent mechanism.

Perspectives on irritable bowel syndrome: where have we been? Where are we now?

Irritable bowel syndrome is a chronic functional disorder with a complex etiology and multiple overlapping symptoms. Irritable bowel syndrome is characterized by long-lasting abdominal pain or discomfort, abnormal bowel habits and typically inadequate response to many of the available therapies.

Plasma serotonin level in left-sided colonic diverticulosis: A pilot study

Abstract Neurotransmitters might participate in the development of diverticular disease. We measured fasting and postprandial serotonin levels in colonic diverticulosis patients and healthy volunteers. We demonstrated significantly lower maximal concentrations of serotonin in patients than the controls (respectively 109.8±61.4 and 251.3±44.1 ng/ml, p<0.001) as well as lower serotonin minimal values (respectively 38.4±21.8 and 124.6±41.4 ng/ml, p<0.001) and areas under time-course curves (respectively 288.8±139.8 and 739±167.4 ng/ml, p<0.001); significant difference between alternating pattern and normal bowel habit concerning fasting serotonin level, the hormone response to test meal (p=0.041) as well as minimal serotonin level (p=0.044). Bowel habit was also related to peak serotonin values following a test meal with 38.5 ng/ml in constipation, 139.5 ng/ml in diarrhea, 122.4 ng/ml in alternating pattern and 249 ng/ml in subjects with normal bowel habit (p=0.040) as well as AUC with 120.8 ng/ml in constipation, 416 ng/ml in diarrhea, 298 ng/ml in alternating pattern and 684 ng/ml in subjects with normal bowel habit (p=0.043). We demonstrated substantial differences in fasting serum serotonin levels as well as the hormone response to a test meal between colonic diverticulosis patients and healthy individuals, which seemed to be associated with abnormal bowel habits rather than presence of diverticula.

Sa1446 The Relationships Between Stress, Segmental Intestinal Permeability Changes and GI Symptoms in Soldiers During Combat Training

Introduction and aims Chronic stress in animals is known to have multiple effects on GI physiology, including increased intestinal permeability (IP), altered motility and sensation. Combat training in soldiers as a real-life chronic, mixed psychological and physical stress induced increased IP and pro-inflammatory mediators, as well as GI symptoms (1). In this study we investigated the association between specific GI symptoms, segmental IP changes and stress markers in soldiers during combat training. Methods The following investigations were performed in 37 healthy male soldiers without any pre-existing GI symptoms in the 4th week of intense combat exercises and a subsequent rest period 12 days post-training: 4-sugar segmental IP test using sucrose (gastroduodenal), mannitol (M), lactulose (L) (mainly small bowel) and sucralose (whole gut) (2), serum cortisol and CRF levels, GI symptoms assessed by IBS-SSS, and stress ratings by PSS-10. Means ± SE are shown. Results Of the previously asymptomatic soldiers, 26 (70%) developed GI symptoms during combat training. Specific symptoms were abnormal bowel habits (n=13, 35%) (8 constipation, 5 alternating constipation/diarrhoea), abdominal pain/significant discomfort (n=5, 13%), or both abdominal pain/significant discomfort and abnormal bowel habits (n=8, 22%), and 14 (38%) had an IBS-SSS >75. At resting, 11 (30%) still had GI symptoms. Urinary sucrose excretion 05h was greater during combat training than at rest (1.05±0.18% vs. 0.41±0.05% of oral dose, p<0.01), soldiers with abdominal pain/discomfort had greater sucrose excretion during training than those with changed bowel habits (2.28%±0.82% vs. 0.59%±0.08%, p<0.01) and they also had increased CRF (2.90±0.64 vs. 1.97±0.14pmol/L, p=0.05). Urinary lactulose and mannitol excretion and L/M were similar across symptom groups during combat training and at rest. 0-24h urinary sucralose excretion was higher during training than at rest (1.97%±0.09% vs. 0.66%±0.07%, p<0.01) and in soldiers with changed bowel habits during training compared to those without (2.12%±0.12% vs. 1.73%±0.13%, p<0.05) and they also showed higher cortisol levels (600.15±21.33 vs. 523.75±21.87nmol/L, p<0.05). Conclusions Chronic combat training stress resulted in GI symptoms and altered IP in previously asymptomatic healthy soldiers. Different symptom clusters are associated with distinct underlying changes in GI physiology. Increased upper GI permeability during stress was strongly linked to abdominal pain, possibly relating to altered sensory function. Elevated lower GI permeability was associated with altered GI motility. Clearer identification of predisposing factors for these GI changes will be helpful in pre-empting GI symptoms and the related considerable manpower loss in combat personnel. 1. Li X et al, Gastro May 2011 2. Farhadi, A et al, Life Sci 2006

Efficacy of Ramosetron in Male Patients With Irritable Bowel Syndrome With Diarrhea (Neurogastroenterol Motil 2011;23:1098-1104)

Serotonin (5-Hydroxytryptamine [5-HT]) plays an important role in gastrointestinal (GI) motility and sensation, and abnormal levels have been shown in patients with irritable bowel syndrome (IBS).1,2 Drugs acting on 5-HT receptors have the potential to reduce the smooth muscle spasm, abdominal pain, and changes in bowel habit in IBS. Recently, Lee et al3 assessed the efficacy and safety of ramosetron, a 5-HT3 receptor antagonist, compared with mebeverine in male patients with diarrhea-predominant IBS (IBS-D). This study was performed in a multicenter, randomized, open-label, parallel-group, non-inferiority comparative design. A total of 343 male patients with IBS-D were randomized to either ramosetron 5 µg once daily or mebeverine 135 mg 3 times daily for 4 weeks. The weekly responder rates for global IBS symptoms, abdominal pain/discomfort and abnormal bowel habits in the ramosteron and mebeverine groups significantly increased during the treatment period (P < 0.001). The severity scores of abdominal pain/discomfort and urgency, the stool form scores and the stool frequency recorded daily were reduced significantly in both treatment arms, compared with the baselines (P < 0.001). There were no significant differences in the weekly responder rates (37% vs 38% at 4-week) and in the adverse event profiles between the ramosetron and mebeverine groups. Neither severe constipation nor ischemic colitis was reported. The authors concluded that the ramosetron 5 µg once daily was as effective as mebeverine 3 times daily in male patients with IBS-D.

Colonic Transit Time and IBS Symptoms: What's the Link?

The relevance of colonic transit alterations for the overall symptom pattern in irritable bowel syndrome (IBS) is incompletely understood. The aim of this study was to assess the total and segmental colonic transit time (CTT) and their relationship to symptoms and subgroups in a large sample of IBS patients. Total and segmental CTT was assessed using radiopaque markers in 359 patients with IBS (279 females). These results were compared with existing normal values for healthy men and women without gastrointestinal (GI) symptoms. Stool frequency and consistency (Bristol Stool Form (BSF) scale), and the perceived severity of three GI symptoms (bloating, flatulence, and abdominal pain) were noted in a daily diary during the measurement week. Patients could be classified by the BSF scale characteristics into Rome III subtypes (n=338), or by use of the Rome II modular questionnaire into Rome II subtypes (n=143). CTT was normal in 287 patients (80%), whereas 53 (15%) had accelerated and 19 (5%) had delayed CTT. Transit abnormalities in relation to gender-specific reference values were more common in males (30.0%) than in females (17.2%; P < 0.05). IBS subgrouping according to Rome III (P < 0.0001) and Rome II criteria (P < 0.001) was associated with the presence of abnormal CTT. Stool form (r=-0.40; P < 0.0001) and stool frequency (r=-0.30; P<0.0001) were moderately and negatively correlated to total CTT. No correlations of clinical significance were found between transit data and the three GI symptoms. Total and segmental colonic transit alterations are of importance for the abnormal bowel habit seen in men and women with IBS, but of no or minor importance for other IBS symptoms.

Efficacy of ramosetron in the treatment of male patients with irritable bowel syndrome with diarrhea: a multicenter, randomized clinical trial, compared with mebeverine

The 5-HT(3) receptor antagonists are known to be effective for the treatment of diarrhea-predominant irritable bowel syndrome (IBS), but not widely used yet. The aim of this study was to compare the efficacy and safety of ramosetron, a 5-HT(3) receptor antagonist, and mebeverine in male patients with IBS with diarrhea (IBS-D). This study was performed in a multicenter, randomized, open-label design. Data of 343 male patients with IBS-D who were randomized to either a 4-week treatment of ramosetron 5μg once daily or a 4-week treatment of mebeverine 135 mg three times daily were analyzed by the intent-to-treat analysis. The primary efficacy parameter was the proportion of patients with adequate relief of IBS symptoms at the last week of treatment. The secondary endpoints were changes in each symptom score and the safety profiles. The responder rates for global IBS symptoms, abdominal pain/discomfort and abnormal bowel habits in the ramosetron and mebeverine groups significantly increased during the treatment period. The severity scores of abdominal pain/discomfort and urgency, the stool form score, and the stool frequency in both treatment arms were significantly reduced, compared with the baselines. There were no significant differences in the responder rates (37%vs 38% on ITT analysis) and adverse event profiles between the ramosetron and mebeverine groups. Neither severe constipation nor ischemic colitis was reported by ramosetron-treated patients. Ramosetron 5μg once daily is as effective as mebeverine three times daily in male patients with IBS-D.

Rupture of an ovarian artery aneurysm following normal vaginal delivery

A 30 year-old woman presented at the casualty department 12 days after having given birth to a healthy baby via normal vaginal delivery. She complained of increasing pain and a mass in her right flank. There were no complaints of nausea, vomiting, dysuria or abnormal bowel habits. &#x0D; On examination, the patient was acutely distressed, in severe pain and was anaemic with an Hb of 5 g/dl. Her blood pressure was 151/71 mmHg and her pulse rate 125/minute. Physical examination revealed a severely distended abdomen with features of peritonitis.&#x0D; An abdominal ultrasound revealed a large abdominal fluid collection and a CT scan was therefore requested. A contrast-enhanced CT scan demonstrated a large homogenous retroperitoneal fluid collection in the right flank, with a 25mm rounded, intensely enhancing focus located close to the inferior border of the collection. The collection displaced the bowel to the left and inferiorly, and the liver, superiorly.&#x0D; The differential diagnosis included a ruptured ovarian artery aneurysm. As soon as the patient was stable, she was taken for ovarian artery embolization that was successfully accomplished. The patient recovered well in the ward.

Colonic Transit Time and Its Influence on Abnormal Bowel Habits, IBS Symptoms and Psychological Symptoms

Colonic Transit Time and Its Influence on Abnormal Bowel Habits, IBS Symptoms and Psychological Symptoms

The Clinical Implications of Childhood Traumatic Events in Irritable Bowel Syndrome.

G A A b st ra ct s correlations were noted between abdominal pain and right colon transit time (r=-0.18; p<0.05) and bloating and left colon transit time (r=0.16; p<0.05). No associations were found between CTT and other GI symptoms, age, anxiety or depression. Conclusion: Total and segmental colonic transit alterations are of importance for the abnormal bowel habit seen in men and women with IBS, but of no or minor importance for other IBS symptoms. Colonic transit is not associated with psychological symptoms.

Study on postoperative fecal function and quality of life of patients with hirschsprung's disease

Objective To evaluate postoperative fecal function and quality of life of patients with hirschsprung's disease and to provide objective evidence for improving the quality of life after operations.Methods A follow-up research was made to 113 selected patients who were operated for Hirschsprung's disease. Their records were analyzed retrospectively and the qualities of life of patients were assessed according to the Heikkinen standard quantitative clinical scoring systems. Results 70. 80% of patients (80/113 ) have normal bowel habit after operations and 24.01% of them have abnormal bowel habit in different degree. Among 50 patients after school age, scoring of quality d life is good in 20 patients(40% ), fair in 23(46%) and week in 7( 14% ). A positive correlation was found between fecal function and quality of life. Conclusions The abnormal fecal function and complications after operations influence the quality of life of patients with Hirschsprung's disease to large extent and some positive measures should be taken to improve their quality of life. Key words: Hirschsprung's disease; Fecal functional; Quality of life

Guidelines for the Treatment of Irritable Bowel Syndrome

Traditional symptom-based therapies of irritable bowel syndrome (IBS) are directed at the relief of individual IBS symptoms, but they are often of limited efficacy in addressing the entire symptom complex. Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment. Increasing knowledge of the pathophysiology and molecular mechanisms of IBS has resulted in the development of several new therapeutic approaches. Thirteen consensus statements for the treatment of IBS were developed using the modified Delphi approach. Exclusion diets have modest efficacy in improving symptoms in some IBS patients. Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics and laxatives are effective in the improvement of some individual symptoms, e.g. dietary fiber and bulking agents for constipation, laxatives for constipation, antispasmodics for abdominal pain and discomfort, antidiarrheals for diarrhea. 5HT3 receptor antagonists and 5HT((4)) receptor agonists are effective in the relief of global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits. A short term course of nonabsorbable antibiotics may improve global IBS symptoms, particularly in patients with diarrhea- predominant IBS. Some probiotics appear to have the potential benefit in improving global IBS symptoms. Selective C-2 chloride channel activator is more effective than placebo at relieving global IBS symptoms in patients with constipation-predominant IBS. Both tricyclic antidepressants and selective serotonin reuptake inhibitors are equally effective in relieving global IBS symptoms, and have some benefits in treating abdominal pain. Certain types of psychologic therapy may be effective in improving global symptoms in some IBS patients. Further studies are strongly needed to develop better treatment strategies for Korean patients with IBS.

Syndrome de l’intestin irritable, syndrome du releveur, proctalgie fugace et douleurs pelvipérinéales chroniques

To define functional gastrointestinal pain, irritable bowel syndrome (IBS), levator ani syndrome, proctalgia fugax, the pathophysiology of these syndromes and the treatments that can be proposed. Review of articles published on the theme based on a Medline (PubMed) search and consensus conferences selected according to their scientific relevance. IBS is very common. Patients report abdominal pain and/or discomfort, bloating, and abnormal bowel habit (diarrhoea, constipation or both), in the absence of any structural or biochemical abnormalities. IBS has a complex, multifactorial pathophysiology, involving biological and psychosocial interactions resulting in dysregulation of the brain-gut axis associated with disorders of intestinal motility, hyperalgesia, immune disorders and disorders of the intestinal bacterial microflora and autonomic and hormonal dysfunction. Many treatments have been proposed, ranging from diet to pharmacology and psychotherapy. Patients with various types of chronic pelvic and perineal pain, especially those seen in urology departments, very often report associated IBS. This syndrome is also part of a global and integrated concept of pelviperineal dysfunction, avoiding a rigorous distinction between the posterior segment and the midline and anterior segments of the perineum.

A population-based epidemiologic study of bowel habits in Guangdong province

To determine the bowel habits and its perceptions in the general population of Guangdong province. Random clustered sampling involving permanent inhabitants aged 18 - 80 year was carried out under stratification of urban and suburban areas in Guangdong province. Questionnaire included the items on the characteristics of people being selected and their bowel habits. A total of 4103 residents (male 1878, female 2225) were investigated. Mean age among the responders was 42.81 ± 14.13 year. Among 4056 subjects (missing = 47), 2972 subjects (73.3%) reported daily defecation, and 3951 subjects (97.4%) reported stool frequency between 3 times per week and three times per day. Two hundred and seventy subjects (6.6%) reported abnormal bowel habits by themselves. The stool frequency (OR = 2.03, 95%CI: 1.54 - 2.67), forms of stool (OR = 2.75, 95%CI: 2.35 - 3.22) and straining (OR = 3.56, 95%CI: 2.49 - 5.11) were significantly associated with self-reported abnormal bowel habits. Among 3949 subjects (missing = 154), 644 (16.3%) were defined as having abnormal bowel habits according to Rome II criteria. There was poor agreement between self-reported abnormal bowel habits and that defined by Rome II criteria (Kappa = 0.312). It seemed to be appropriate that the normal stool frequency was defined as bowel movements between 3 times per week and three times per day in the general population. The prevalence of self-reported abnormal bowel habits was lower than that defined by Rome II criteria and the agreement between these two definitions was poor.

Prevalencia de incontinencia fecal y su relación con el hábito defecatorio en pacientes atendidos en medicina primaria

Fecal incontinence is a high prevalence disease in general population. The diagnosis of alterations in bowel habit could be of interest for the management of this clinical disorder. The aim of the study was to study the relationship between fecal incontinence prevalence and alteration of bowel habit in patients of a metropolitan area of Barcelona.A cross-sectional multicenter study was undertaken by interviewing the population attending 10 primary health centers. The presence of symptoms of fecal incontinence was analyzed and the bowel habit was assessed using the validated Spanish version of Bristol Stool Scale.A total of 518 subjects were studied with a mean age of 60.3 (SD: Standard deviation 17.7) years. The overall prevalence of fecal incontinence was 10.8% (2.7% incontinence to flatus, 3.7% liquid stool and 4.4% solid stool). There was a normal bowel habit in 75.6% in the group of patients without fecal incontinence and in 54.5% in patients with fecal incontinence (p=0.001).The prevalence of fecal incontinence in primary care is high. 45% of patients with fecal incontinence exhibited an abnormal bowel habit.

Irritable bowel syndrome: Epidemiology, diagnosis and treatment: An update for health‐care practitioners

Irritable bowel syndrome (IBS), a chronic gastrointestinal disorder, affects from 3-20% of the US population, depending on sociocultural and comorbid factors. IBS is characterized by a symptom complex of abdominal pain and abnormal bowel habits that present as diarrhea or constipation, and general physical weakness in the absence of abnormal morphological, histological or inflammatory markers. The main diagnostic Rome III criteria as established by international professional organizations are based on exclusion criteria and the occurrence and rate of symptoms. Because the pathophysiology and causes of IBS are poorly understood, treatment approaches are mainly focused on symptom management to maintain everyday functioning and improve quality of life for persons with IBS. The mainstay of intervention is pharmacological treatment with antispasmodics and antidiarrheals for diarrhea, prokinetics and high-fiber diets for constipation, and supportive therapy with low-dose antidepressants to normalize gastrointestinal motility. Other interventions include lifestyle and dietary changes, psychotherapy, herbal therapies and acupuncture. The purpose of this review is to critically assess benefits and risks of current treatment approaches as well as promising complementary and alternative therapies.

An Epidemiologic Study of Voiding and Bowel Habits in Korean Children: A Nationwide Multicenter Study

To evaluate the prevalence of abnormal voiding and bowel habits in healthy children, and to identify possible relationships between personal and familial factors and voiding and/or bowel habits. A randomly selected cross-sectional study was conducted in 19,240 children (5-13 years old) nationwide in the Republic of Korea. Parents were asked to complete questionnaires, which included items about nocturnal enuresis, daytime dysfunctional voiding symptoms (DVSs), and abnormal bowel habits (ABHs). Rates and associated factors were investigated. The overall rates of DVS, ABH, and of both were 46.4%, 31.3%, and 18.4%, respectively, and nocturnal enuresis was reported in 919 (5.6%). Daytime dysfunctional voiding symptoms were as follows: increased voiding frequency in 419 (2.5%), decreased voiding frequency in 720 (4.4%), urgency in 2740 (16.6%), daytime incontinence in 1854 (11.2%), urge incontinence in 2775 (16.8%), and holding maneuvers or postponed voiding in 3888 (23.5%). ABHs were as follows: constipation by frequency in 1103 (6.7%), constipation by the Bristol scale in 1941 (11.8%), fecal incontinence in 1293 (7.8%), and difficult or painful defecation in 2609 (15.8%). Delayed stool control, history of urinary tract infection, and a double-income family were positively associated with DVS or ABH or both. Furthermore, fathers with a low level of education and a low income were found to be associated with higher risk of ABH or DVS or both. Delayed stool control, a history of urinary tract infection, a low paternal level of education, a double-income family, and a lower family income had a negative effect on voiding or bowel habits in children.

W1247 IBS Patients Have Normal and Abnormal Bowel Habits: Relevance for Subtyping?

W1247 IBS Patients Have Normal and Abnormal Bowel Habits: Relevance for Subtyping?

Gender differences in self-reported constipation characteristics, symptoms, and bowel and dietary habits among patients attending a specialty clinic for constipation

This study assessed gender differences in the frequency of various characteristics of constipation, constipation-specific symptoms, and bowel and dietary habits, as well as the effects of independent but associated risk factors. A cross-sectional study of patients aged >or=18 years with a primary diagnosis of constipation (ie, constipation, slow-transit constipation, outlet dysfunction constipation) was conducted at a tertiary referral center; patients were excluded if they had a primary diagnosis of fecal incontinence. Patients completed both a clinical questionnaire to obtain information on demographic characteristics and medical history and an unvalidated self-report questionnaire relating to the characteristics and symptoms of constipation as well as various bowel and dietary habits. Likert scales were used to assess 4 characteristics of constipation (frequency of constipation, duration of constipation symptoms of >or=1 month, bowel movement frequency, stool consistency) and the frequency of occurrence of 6 constipation symptoms (abdominal pain, abdominal bloating, incomplete evacuation, unsuccessful attempts at evacuation, pain with evacuation, straining with evacuation). The bowel habits that were evaluated included time spent at each evacuation; frequency of needing to change position to evacuate; use of anal digitation to evacuate; and the use of laxatives, enemas, stool softeners, foods, drinks, or other aids. The dietary habits that were evaluated included use of dietary fiber, use of fiber supplements, and water intake. Of the 518 patients, the majority were female (79.0%), white (76.3%), and employed (62.0%), with a mean (SD) age of 52.4 (16.5) years (range, 18.6-91.5 years). After controlling for a number of related conditions, women were more likely than men to have infrequent bowel movements (adjusted odds ratio [AOR] = 2.97; 95% CI, 1.67-5.28), abnormal stool consistency (ie, hard or pelletlike stools) (AOR = 3.08; 95% CI, 1.80-5.28), and a longer duration of constipation symptoms (AOR = 2.00; 95% CI, 1.05-3.82). In addition, women were more likely to report an increased frequency of occurrence of abdominal pain (AOR = 2.22; 95% CI, 1.22-4.05), bloating (AOR = 2.65; 95% CI, 1.50-4.70), unsuccessful attempts at evacuation (AOR = 1.74; 95% CI, 1.01-3.00), and the use of anal digitation to evacuate stool (AOR = 3.37; 95% CI, 1.15-9.90). The women in this specialty-based clinic study experienced a number of constipation symptoms and abnormal bowel habits more frequently than did men. These findings warrant replication in both population- and specialty clinic-based samples. In addition, the physiologic mechanisms that underlie these gender differences warrant investigation.