Bowel Habits In Patients Research Articles

Gastrointestinal comorbidities in patients with acne vulgaris: A population-based retrospective study

The gut-skin-brain axis has been long postulated in acne vulgaris. Few studies focused on bowel habits in patients with acne vulgaris have yielded controversial results. To examine the relationship between acne vulgaris and gastrointestinal comorbidities. We conducted a nationwide case-control study using data from the Taiwan National Health Insurance Research Database spanning the years 1997 to 2013. Acne vulgaris and the control group were stratified by age, and we examined the association of gastrointestinal comorbidities across different age, sex, and antibiotic use through conditional logistic regression analysis. A total of 185,491 patients with acne vulgaris were identified. The primary demographic for acne vulgaris comprised adolescents, followed by adult-onset groups, with a female predominance observed across all age subgroups. Patients with acne vulgaris exhibited a significantly elevated risk of developing gastrointestinal comorbidities, including peptic ulcers, irritable bowel syndrome, gastroenteritis, gastroesophageal reflux disease, and constipation. This increased risk was particularly notable in patients aged ≥12years, and those with moderate-to-severe acne. Miscoding and misclassification might have occurred. Patients with Acne vulgaris have higher risks of gastrointestinal comorbidities. For patients with moderate-to-severe acne, gastroenterology specialty consultation may be warranted.

The impact of a modified microbiota-accessible carbohydrate diet on gut microbiome and clinical symptoms in colorectal cancer patients following surgical resection.

A high-fiber diet is widely recognized for its positive effects on the gut microbiome. However, the specific impact of a high-fiber diet on the gut microbiome and bowel habits of patients with colon cancer remains poorly understood. In this study, we aimed to assess the effects of a modified microbiota-accessible carbohydrate (mMAC) diet on gut microbiota composition and clinical symptoms in colon cancer patients who underwent surgical resection. To achieve this, we enrolled 40 patients in two groups: those who received adjuvant chemotherapy and those who did not. Fecal samples were collected before and after dietary interventions for microbial and metabolite analyses. Each group was randomized in a 1: 1 ratio to follow either a 3-week conventional diet followed by a 3-week mMAC diet, or the reverse sequence. Although there were no significant differences in the microbial diversity data before and after the mMAC diet in both the non-chemotherapy and chemotherapy groups, distinct differences in gut microbial composition were revealed after the mMAC diet. Specifically, the abundance of Prevotella, which is associated with high-fiber diets, was further elevated with increased concentrations of acetate and propionate after the mMAC diet. Additionally, patients who experienced improved diarrhea and constipation after the mMAC diet exhibited an enrichment of beneficial bacteria and notable changes in metabolites. In conclusion, this study provides valuable insights into the potential benefits of the mMAC diet, specifically its impact on the gut microbiome and clinical symptoms in postoperative colorectal cancer (CRC) patients. These findings emphasize the potential role of a high-fiber diet in influencing the gut microbiome, and the clinical symptoms warrant further investigation.

Improvement of dyspeptic symptoms after Helicobacter pylori eradication therapy in Japanese patients.

Helicobacter pylori eradication therapy effectively improves the abdominal symptoms and bowel habits of patients. Patients in whom dyspepsia is under control by 6 to 12 months after successful H. pylori eradication are defined as having H. pylori-associated dyspepsia, and patients with dyspepsia that is refractory to successful eradication are defined as having functional dyspepsia. Here, we aimed to investigate the association between H. pylori eradication and improvement of dyspepsia in the short and long term after eradication therapy. Dyspeptic symptoms before treatment and at 2 and 12 months after eradication were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS) in 282 H. pylori-positive Japanese patients who underwent eradication therapy. Of the Japanese H. pylori-positive patients, 48.2% (136/282) had upper abdominal symptoms. Eradication improved dyspepsia in 34.5% (47/136) of the patients at 2 months post eradication, which continued to be under control up to 12 months. A significant decrease at 2 and 12 months after eradication, compared with before eradication, was observed in total GSRS (from 25.7 ± 10.4 [before eradication, n = 249] to 23.3 ± 7.2 [after 2 months, n = 249] and 24.8 ± 7.8 [after 12 months, n = 81]; P = 0.014 and 0.321, respectively), gastric pain score (from 4.1 ± 1.9 to 3.7 ± 1.3 and 3.7 ± 1.2; P = 0.025 and 0.047), and constipation score (from 5.9 ± 3.1 to 5.2 ± 2.3 and 5.9 ± 3.0; P < 0.021 and 0.862). H. pylori-positive dyspepsia patients should be recommended to undergo H. pylori eradication to alleviate dyspepsia-associated symptoms.

Sex differences in the central regulation of colorectal motility in response to noxious stimuli.

Distinct sex differences in the prevalence and symptoms of abnormal bowel habits in patients with irritable bowel syndrome (IBS) have been reported. We have elucidated the sex differences in the regulation of colorectal motility via the central nervous system. Noxious stimuli in the colorectum of anesthetized male rats enhance colorectal motility by activating monoaminergic neurons in descending pain inhibitory pathways from the brainstem to the lumbosacral spinal cord. These monoaminergic neurons release serotonin and dopamine into the lumbosacral spinal cord, resulting in the increment of colorectal motility. In female rats, in contrast, noxious stimuli in the colorectum have no effect on colorectal motility. We clarified that GABAergic inhibition in the lumbosacral spinal cord masks the enhancement of colorectal motility induced by monoamines in female animals. Considering that IBS patients often show visceral hypersensitivity and hyperalgesia, our studies suggest that differences in the descending neurons that respond to painful stimuli are involved in various sex differences in abnormal bowel habits.

Phase II Feasibility Study of the Efficacy, Tolerability, and Impact on the Gut Microbiome of a Low-Residue (Fiber) Diet in Adult Patients With Mitochondrial Disease.

Gastrointestinal (GI) dysmotility is a common and debilitating clinical manifestation in patients with mitochondrial DNA (mtDNA)-related disease with no curative and few effective symptomatic therapies. A low-residue diet (LRD) has been shown to be effective at reducing bowel urgency, pain, and distension in functional GI-related conditions. We assessed tolerability and effects of an LRD on bowel habits in patients with mtDNA-related disease. This was a 12-week single-arm pilot study in patients with genetically determined primary mtDNA-related disease, meeting the ROME III constipation criteria. The co-primary outcomes were tolerability of an LRD (<10 g fiber per day) assessed by food diaries and changes in stool frequency and consistency. The secondary outcomes included GI symptoms, disease burden, laxatives, physical activity levels, colonic transit time using radiopaque markers, gut microbiome (patients and controls), and metabolomics. The gut microbiome of the mtDNA-related disease patients was compared against controls for observational purpose only. Twenty-eight patients were enrolled, and 24 completed the LRD intervention. The LRD was well tolerated with a mean fold change of-34% in dietary fiber (5.3 ± 10.4 grams) per day (P= .03, confidence interval= 0.7-9.9) with no adverse events. The proportion of stool samples with normal stool consistency increased from 36% to 49% (P= .01); GI symptoms and laxative use were reduced. However, the LRD did not change stool frequency, stool output, and colonic transit time. The gut microbiome was significantly different between patients and controls but was not modulated by the dietary intervention. The LRD in patients with mtDNA-related mitochondrial disease and significant constipation is well tolerated and a promising treatment for alleviating GI symptoms. These positive findings should be confirmed in a randomized controlled trial.ClinicalTrials.gov Identifier: NCT03388528.

Evaluation of bowel habits in patients with acne vulgaris.

To evaluate the bowel habits of patients with acne vulgaris. In this case-control study, socio-demographical characteristics of the participants (age, gender, marital status, educational status, profession, economic status, smoking-alcohol habits, chronic diseases, previous operations, people they live with and diet) were questioned and the global acne grading scores of the patients were calculated. Bristol Stool Scale, Rome III IBS Criteria, International Physical Activity Questionnaire-Short Form, Hospital Anxiety Depression and KADF (dietary fibre information) scales were completed. The patient group consisted of 102 participants and the control group consisted of 104 participants. The mean age was 20.9±3.9years old in the case group and 21.8±5.0years old in the control group. Patient and control groups were similar in terms of age and gender. Smoking rates were significantly higher in the patient group (P=.035). The amount of coffee consumed/day was significantly higher in the patient group (P=.040). According to the global acne grading scores, 55.9% (n=57) had medium, 39.2% (n=40) had mild, 3.9% (n=4) had severe and 1% (n=1) had very severe acne. Anxiety scores were found to be significantly higher in the patient group (P=.005). When the case and control groups were compared for IBS presence, no significant difference was found (P=.317). Also, IBS was not related to acne severity (P=.162). Further large sample sized studies are needed on this subject, as there is strong evidence about brain-gut-skin axis existence.

A Distinct Faecal Microbiota and Metabolite Profile Linked to Bowel Habits in Patients with Irritable Bowel Syndrome.

Patients with irritable bowel syndrome (IBS) are suggested to have an altered intestinal microenvironment. We therefore aimed to determine the intestinal microenvironment profile, based on faecal microbiota and metabolites, and the potential link to symptoms in IBS patients. The faecal microbiota was evaluated by the GA-mapTM dysbiosis test, and tandem mass spectrometry (GC-MS/MS) was used for faecal metabolomic profiling in patients with IBS and healthy subjects. Symptom severity was assessed using the IBS Severity Scoring System and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. A principal component analysis based on faecal microbiota (n = 54) and metabolites (n = 155) showed a clear separation between IBS patients (n = 40) and healthy subjects (n = 18). Metabolites were the main driver of this separation. Additionally, the intestinal microenvironment profile differed between IBS patients with constipation (n = 15) and diarrhoea (n = 11), while no clustering was detected in subgroups of patients according to symptom severity or anxiety. Furthermore, ingenuity pathway analysis predicted amino acid metabolism and several cellular and molecular functions to be altered in IBS patients. Patients with IBS have a distinct faecal microbiota and metabolite profile linked to bowel habits. Intestinal microenvironment profiling, based on faecal microbiota and metabolites, may be considered as a future non-invasive diagnostic tool, alongside providing valuable insights into the pathophysiology of IBS.

Factors influencing changing bowel habits in patients undergoing sphincter-saving surgery for rectal cancer.

A research survey research was conducted to identify factors affecting changes in bowel habits of rectal cancer patients undergoing sphincter-saving surgery and to provide basic information useful in nursing interventions supporting treatment for rectal cancer patients. The subjects were rectal cancer patients who had undergone sphincter-saving surgery over 2 years ago. The final analysis included 107 patients who had made outpatient visits to the colorectal surgery from 12th to 31st May, 2014. Collected data were processed with SPSS Version 21.0. Changes in bowel habits in the subjects were observed: frequent bowel movement in 74 patients (69.2%) and faecal incontinence in 48 (44.9%). Most of the patients used self-care to improve their bowel function including dietary modification (78.5%), regular exercise (72.0%) and pelvic floor exercise (34.6%). Frequent defecation was associated with adjuvant chemoradiation therapy (P < 0.001) and faecal incontinence was associated with age of ≥65 years (P = 0.019) and a group who underwent adjuvant radiation therapy (P < 0.001). It is necessary to give sufficient information about possible postoperative changes in bowel habits to patients with the risk factors before surgery.

Anaemia as a risk stratification tool for symptomatic patients referred via the two-week wait pathway for colorectal cancer.

Introduction Anaemia is associated with cancer. In 2014 a new form was introduced in our department requesting a haemoglobin (Hb) result on every two-week wait referral for suspected colorectal cancer (CRC). The aim of this study was to review the impact of this intervention. In particular, the significance of any evidence of anaemia (without additional indices) was investigated. Methods A review was conducted of 1,500 consecutive suspected CRC referrals recorded prospectively over a 10-month period. Data on demographics, referral Hb, referral criteria and outcomes were analysed. Anaemia was defined according to World Health Organization criteria (Hb <120g/l for women, Hb <130g/l for men). Results Overall, 1,015 patients were eligible for inclusion in the study. Over a third (38.2%) were documented as anaemic on referral. These patients were three times more likely to be diagnosed with CRC than non-anaemic patients (odds ratio [OR]: 3.22, 95% confidence interval [CI]: 1.87-5.57). Using a more stringent threshold (Hb <100g/l for women and <110g/l for men), they were four times more likely to have CRC (OR: 4.27, 95% CI: 2.35-7.75). Almost a quarter (23.7%) were actually anaemic at the time of referral but not referred with anaemia. In this subgroup, there was a 2.8-fold increase in risk of CRC diagnosis compared with non-anaemic patients (adjusted OR: 2.77, 95% CI: 1.55-4.95). Conclusions Nearly a quarter of patients not referred with iron deficiency anaemia had evidence of anaemia and this was still associated with a higher rate of CRC detection. A full blood count alone might help to risk stratify symptoms such as change in bowel habit in patients on urgent pathways and identify those cases most likely to benefit from invasive investigation.

A New Acid-Resistant Seamless Capsule of Bifidobacterium Improves Chronic Constipation in Patients on Maintenance Hemodialysis

Objective: To assess the therapeutic efficacy of a new acid-resistant seamless capsule of Bifidobacterium supplements (Bs) for chronic constipation (Cc) in patients on maintenance hemodialysis (MHD). Design: This was a prospective interventional study. Setting: This study was performed in a tertiary care hospital. Subjects: Sixtheen patients on stable MHD (mean ± standard deviation age, 70.4 ± 10.1; mean ± SD duration of dialysis, 10.2 ± 7.4 years) were enrolled. Patients with physical frailty or cognitive decline were excluded. Intervention: Bs was added to the diet once daily for three months to assess whether it could achieve a beneficial effect on bowel habits in patients on MHD. Main outcome measure: We used the constipation scoring system (css) and Bristol stool form scale (Bss) for objective assessment of Cc. In this system, the constipation score (cs) ranges from 0 to 30, with 30 being the worst. Bs ranges from 1 to 7, 1 being interpreted as a hard stool and 7 being classified as a liquid one: diarrhea. Results were obtained by patient questionnaire, and scores were calculated monthly. Results: Compared with baseline, the mean cs improved significantly after the first month (from 10.7 ± 5.9 to 5.0 ± 4.0; p<0.001 by one-way analysis of variance with repeated measures). We also confirmed that the mean Bss changed significantly (from 3.4 ± 1.5 to 3.8 ± 1.0; p<0.02) after second month. Conclusion: The results of our study suggest that this new type of Bs may have merit for improving Cc in patients on stable MHD without any adverse effects and is well tolerated.

The Effect of Amlodipine Alone and in Combination with Atenolol on Bowel Habit in Patients with Hypertension: An Observation

The prevalence of hypertension increases with advancing age. The management of hypertension especially in the elderly has its own limitations. Verapamil is not recommended in the elderly on account of high incidences of troublesome constipation. Amlodipine has become very popular with the cardiologists and general physicians. Survey of literature has not yielded any citation where the troublesome effect of amlodipine on the gastrointestinal tract has been reported. In an experimental study on isolated rabbit intestine we have demonstrated that amlodipine dose-dependently inhibit the spontaneous activity of the intestinal tract. With this background the present observational study was planned. A total of 100 hypertensive patients were included in the present study. Fifty patients were on amlodipine alone and 50 patients on combination of amlodipine and atenolol. The main parameter analyzed was the frequency and consistency of stool before and after intake of drug. The relative risk (RR) of developing constipation was 4.00 with 95% CI 0.8930 to 17.917 in amlodipine alone group. From this study it can be concluded that the relative risk of developing constipation is 4 times more in patients who are taking amlodipine alone as compared to those patients who are on combination of amlodipine and atenolol.

Linaclotide, through activation of guanylate cyclase C, acts locally in the gastrointestinal tract to elicit enhanced intestinal secretion and transit

Linaclotide is a first-in-class, orally administered 14-amino acid peptide that is in development for the treatment of irritable bowel syndrome with constipation and chronic constipation. We have characterized the solution structure of linaclotide, the in vitro binding and agonist activity to guanylate cyclase C receptors, the stability of linaclotide under conditions mimicking the gastric environment, oral bioavailability, and the pharmacodynamic effects in rat models of gastrointestinal transit and intestinal secretion. Nuclear magnetic resonance spectroscopy analysis determined that the molecular structure of linaclotide is stabilized by three intramolecular disulfide bridges. Linaclotide exhibited high affinity and pH-independent binding ( K i: 1.23–1.64 nM) to guanylate cyclase C receptors on human colon carcinoma T84 cells and concomitantly, linaclotide binding resulted in a significant, concentration-dependent accumulation of intracellular cyclic guanosine-3′, 5′-monophosphate (cGMP) (EC 50:99 nM). Linaclotide was stable after 3 h incubation in simulated gastric fluid (pH 1) and similarly, was completely resistant to hydrolysis by pepsin. Pharmacokinetic analysis of linaclotide showed very low oral bioavailability (0.1%). Orally administered linaclotide elicited a significant, dose-dependent increase in gastrointestinal transit rates in rats at doses of ≥ 5 μg/kg. Exposure of surgically ligated small intestinal loops to linaclotide induced a significant increase in fluid secretion, accompanied by a significant increase in intraluminal cGMP levels. These results suggest that the guanylate cyclase C agonist linaclotide elicits potent pharmacological responses locally in the gastrointestinal tract, and that orally administered guanylate cyclase C agonists may be capable of improving bowel habits in patients suffering from irritable bowel syndrome with constipation and chronic constipation.

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.

T1273 Time to Onset of Linaclotide Effect On the Bowel Habits in Patients with Chronic Constipation: Results from a Phase 2B Study

T1273 Time to Onset of Linaclotide Effect On the Bowel Habits in Patients with Chronic Constipation: Results from a Phase 2B Study

Renzapride: a new drug for the treatment of constipation in the irritable bowel syndrome

Renzapride is a novel drug currently under clinical evaluation for the treatment of irritable bowel syndrome (IBS). Renzapride is a mixed 5-hydroxytryptamine type 4 (5-HT4) agonist and 5-HT3 receptor antagonist that has a stimulatory effect on gastrointestinal motility and transit, as established by in vivo and in vitro studies. Its therapeutic efficacy, tolerability and safety have been evaluated in diabetic gastroparesis in a single study, as well as in IBS in a few other studies. Phase II studies indicated potential beneficial effects on symptoms and bowel habits in patients with constipation-predominant IBS and mixed-type IBS. The outcome of Phase III studies is currently under evaluation.

T1405 Effects of a Novel Corticotrophin Releasing Factor Receptor-1 Antagonist, BMS-562086, On Gastrointestinal and Colonic Transit and Bowel Habits in Patients with Diarrhea-Predominant Irritable Bowel Syndrome (D-IBS)

T1405 Effects of a Novel Corticotrophin Releasing Factor Receptor-1 Antagonist, BMS-562086, On Gastrointestinal and Colonic Transit and Bowel Habits in Patients with Diarrhea-Predominant Irritable Bowel Syndrome (D-IBS)

A randomized, double-blind, placebo-controlled clinical trial of the effectiveness of the novel serotonin type 3 receptor antagonist ramosetron in both male and female Japanese patients with diarrhea-predominant irritable bowel syndrome

Objective. Irritable bowel syndrome is characterized by abdominal discomfort and/or pain associated with altered bowel habits. The neurotransmitter serotonin and serotonin type 3 receptors that are extensively distributed on enteric neurons in the human gastrointestinal tract play a role in increasing the sensation of pain and affecting bowel habits in patients with irritable bowel syndrome. The aim of this study was to evaluate the efficacy and safety of the serotonin type 3 receptor antagonist ramosetron hydrochloride in Japanese patients with diarrhea-predominant irritable bowel syndrome. Material and methods. In a double-blind, placebo-controlled, parallel group-comparative study with a 1-week run-in period, 539 patients with diarrhea-predominant irritable bowel syndrome meeting the Rome II diagnostic criteria received either 5 µg ramosetron hydrochloride (n=270) or placebo (n=269) once daily for 12 weeks. Results. Forty-seven percent of ramosetron hydrochloride-treated patients were monthly responders in the primary end-point, “Patient-reported global assessment of relief of irritable bowel syndrome symptoms”, compared with 27% for placebos (p<0.001). The most frequently reported adverse event in the ramosetron hydrochloride-treated group compared with the placebo group was hard stool. Conclusions. Ramosetron hydrochloride 5 µg once daily is effective and well tolerated in the treatment of abdominal pain, discomfort and bowel habits in patients with diarrhea-predominant irritable bowel syndrome.

Tegaserod for Constipation‐Predominant Irritable Bowel Syndrome

Tegaserod, a selective and partial agonist at the 5-hydroxytryptamine (5-HT [serotonin]) receptor subtype 4 (5-HT4), is the only United States Food and Drug Administration-approved drug for the treatment of constipation-predominant irritable bowel syndrome (IBS) in women. The drug's stimulation of 5-HT4 receptors on intestinal enterocytes increases peristaltic activity and fluid secretion into the gut lumen, facilitating stool passage. In addition, affinity of tegaserod for 5-HT4 receptors modulates visceral sensitivity, which helps alleviate abdominal pain associated with constipation-predominant IBS. The drug's pharmacokinetic and pharmacodynamic parameters do not differ significantly with age or sex. Tegaserod safely and effectively relieves overall gastrointestinal symptoms and abdominal discomfort and normalizes bowel habits in patients with constipation-predominant IBS. It is associated with few drug interactions. In clinical studies, tegaserod was well tolerated, and its adverse-effect profile was similar to that of placebo. Severe diarrhea, as well as abdominal pain, flatulence, headache, and nausea, were the most commonly reported events. Patients who experience severe diarrhea should discontinue the drug. With the data available, tegaserod remains an option for patients with constipation-predominant IBS.

Disturbed bowel habits in patients with non‐ulcer dyspepsia

BACKGROUND; Emerging medications for non-ulcer-dyspepsia, such as the serotonin-receptor modulators, also affect bowel habits by altering colonic transit. If drugs that alter colonic function were to prove useful in non-ulcer dyspepsia, knowledge of baseline bowel habit disturbances would be potentially critical. To estimate the rate of non-ulcer dyspepsia patients with clinically relevant constipation or diarrhoea potentially precluding use of motility agents. Consecutive patients with non-ulcer dyspepsia (n = 79), gastro-oesophageal reflux disease (n = 135) and organic upper gastrointestinal disease (upper gastrointestinal disease; n = 36) completed a validated symptom questionnaire evaluating predominant bowel habits in the last year. Prevalence of constipation was higher in non-ulcer dyspepsia (34%) than in gastro-oesophageal reflux disease (P = 0.01) and organic upper gastrointestinal disease (P = 0.01), prevalence of alternating diarrhoea/constipation (24%) and diarrhoea (22%) was similar, while prevalence of normal bowel habits was significantly less in non-ulcer dyspepsia (20%; P = 0.01 vs. gastro-oesophageal reflux disease and P < 0.01 vs. organic upper gastrointestinal disease). Constipation was particularly frequent in ulcer-like and dysmotility-like non-ulcer dyspepsia, while prevalence of diarrhoea was lowest in dysmotility-like non-ulcer dyspepsia. A normal bowel habit was equally uncommon in male (21%) and female non-ulcer dyspepsia patients (20%). Only one of five non-ulcer dyspepsia patients had normal bowel habits based on clinical symptoms; constipation is particularly prevalent. Patients with functional dyspepsia who are prescribed motility altering drugs should be evaluated by taking a thorough bowel habit history.

Clinical effects of preoperative radiation therapy on anorectal function after proctectomy and colonic J-pouch-anal anastomosis.

Preoperative radiotherapy is increasingly used for certain rectal cancers, although some evidence suggests that it may adversely affect anorectal function. Reconstruction with a colonic J-pouch-anal anastomosis after complete proctectomy is thought to improve function, but few published data on pouch function after radiation exists. The aim of our study was to compare long-term bowel habits in patients receiving preoperative radiation for rectal cancer followed by colonic J-pouch-anal anastomosis with those of patients having similar rectal cancer surgery without radiation. Patients (n = 125) having undergone colonic J-pouch-anal anastomosis for rectal cancer, of whom 28 had preoperative radiotherapy and 97 did not, responded to a detailed questionnaire about their bowel habits at least 12 months after surgery, with a mean (+/- standard deviation) interval of 64 (+/-42) months. Radiation was administered preoperatively as a short (25 Gy over 5 days, n = 22) or long (45 Gy over 4 weeks, n = 6) course. All patients had colonic J-pouch-anal anastomosis with manual anastomosis at or immediately above the dentate line. Except for tumor stage, no preoperative difference was observed between the two groups. The number of bowel movements per 24 hours in patients with and without radiation was 1.8 (+/-0.8) and 1.8 (+/-1.5), respectively (P> 0.05). In the irradiated group, diarrhea (39 vs.13 percent, P= 0.005) and nocturnal defecation (36 vs.15 percent, P= 0.03) were more frequent than in the nonirradiated group. No other significant difference existed between groups with regard to stool clustering, use of protective pads, ability to defer evacuation >15 minutes, ability to evacuate the bowel within 30 minutes, incontinence score, use of medications, or dietary restriction. Preoperative radiotherapy followed by proctectomy and colonic J-pouch-anal anastomosis significantly increased nocturnal defecation frequency and diarrhea compared with similar nonirradiated patients but had no influence on the other bowel-habit parameters studied.