Bowel Movement Patterns Research Articles

Association Between Bowel Movement Pattern and Cognitive Function: Prospective Cohort Study and a Metagenomic Analysis of the Gut Microbiome.

Little is known regarding the association between intestinal motility patterns and cognitive function in individuals who are baseline cognitively healthy. The gut microbiome may contribute to the association. We examined the association between bowel movement (BM) pattern and cognitive function and explored the role of the gut microbiome in explaining this association. In this prospective study, we leveraged 3 cohort studies, Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS). Participants reported BM frequency and subjective cognitive function. In a subset of NHSII participants, we assessed cognitive function using an objective neuropsychological battery. We profiled the gut microbiome in a subset of participants using whole-genome shotgun metagenomics. General linear models, Poisson regression, and logistic regression were used to quantify the association of BM frequency with different cognitive measurements. We followed 112,753 men and women (women: 87.6%) with a mean age of 67.2 years at baseline (NHS: 76 years, NHSII: 59 years, HPFS: 75 years) for a median follow-up of 4 years (NHSII and HPFS: 4 years, NHS: 2 years). Compared with those with BM once daily, participants with BM frequency every 3+ days had significantly worse objective cognitive function, equivalent to 3.0 (95% confidence interval [CI],1.2-4.7) years of chronological cognitive aging. We observed similar J-shape dose-response relationships of BM frequency with the odds of subjective cognitive decline and the likelihood of having more subsequent subjective cognitive complaints (both p nonlinearity < 0.001). BM frequencies of every 3+ days and ≥twice/day, compared with once daily, were associated with the odds ratios of subjective cognitive decline of 1.73 (95% CI 1.60-1.86) and 1.37 (95% CI 1.33-1.44), respectively. BM frequency and subjective cognitive decline were significantly associated with the overall gut microbiome configuration (both p < 0.005) and specific microbial species in the 515 participants with microbiome data. Butyrate-producing microbial species were depleted in those with less frequent BM and worse cognition, whereas a higher abundance of proinflammatory species was associated with BM frequency of ≥twice/day and worse cognition. Lower BM frequency was associated with worse cognitive function. The gut microbial dysbiosis may be a mechanistic link underlying the association.

Movin’ right along

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), constipation is defined as having fewer than three bowel movements a week; stools that are hard, dry, or lumpy; stools that are difficult or painful to pass; or a feeling that not all stool has passed. It's important to note, however, that people have different bowel movement patterns, and “normal” can vary enormously among patients.

Is Fecal Calprotectin an Applicable Biomarker of Gut Immune System Activation in Chronic Inflammatory Demyelinating Polyneuropathy? - A Pilot Study.

Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a complex autoimmune disease caused by dysregulated response to not fully recognized antigens. Some association between CIDP and inflammatory bowel disease (IBD) has been reported, but the exact pathophysiological links of these disorders are not well understood.Aim of the Study: To evaluate fecal calprotectin as a biomarker of gut inflammation in CIDP patients without IBD.Methods: Fifteen patients with CIDP and 15 healthy controls were included in the study. The CIDP diagnosis was based on the EFNS/PNS criteria. The occurrence of bowel symptoms was assessed based on a questionnaire. The quantitative evaluation of fecal calprotectin level was performed by the ELISA test.Results: The fecal calprotectin level (μg/g) expressed as median along with the lower and upper quartiles [25Q–75Q] was significantly higher in CIDP patients compared to the controls: 26.6 [17.5–109.0] vs 15.6 [7.1–24.1], p = 0.0066. Abnormal fecal calprotectin level (>50 μg/g) was found in 33% of all CIDP patients and in none of the control subjects. The patients with abnormal fecal calprotectin level did not differ from the rest of the study group regarding the neurological status. The most common bowel symptoms reported by CIDP patients included constipation (33%), feeling of incomplete evacuation (33%), bloating (27%), and alternating bowel movement pattern (27%).Conclusion: In one-third of CIDP patients the signs of gut immune system activation have been observed. This finding may be associated with CIDP pathogenesis and induction of autoimmune response as well as concomitant dysautonomia with gastrointestinal symptoms.

Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis

Introduction: Intra-abdominal adhesions are common features of endometriosis. Adhesions lead to several chronic symptoms including abdominal distension, pain, nausea, and abnormal bowel movement pattern. Adhesive disease may be life-altering in many patients. Aims and Objectives: To study types of pain and compare it with type and degree of adhesion. Materials and Methods: Thirty women diagnosed with endometriosis were studied. Pain intensity was assessed by visual analogue scale (VAS) and categorized as mild, moderate or severe accordingly. This was followed by laparoscopy/ laparotomy and staging of endometriosis which was done as per the American Society for Reproductive Medicine (ASRM) classification system. Corrective procedures were done simultaneously. Women were followed-up after 6 weeks to re-assess the pain intensity by using the same visual analogue scale (VAS). Results: Mean age of study cohort was 30 ±5.75 years. As per VAS, half of the patients had moderate pain (50%). Forniceal thickening was present in 73.33% and cyst was felt in 66.66% women.76.66% had unilateral cysts. Unilateral tubal adhesions were present in 76.66% women and bilateral adhesions were present in 23.33% women. Among the types of adhesions, flimsy adhesions were most common, being present in 76.66% women and deep adhesions were present in 20% women. Majority had 1/3rd-2/3rd tubal adhesions (46.7%). All the ovarian adhesions were flimsy. Obliteration was present in 30% women. Forniceal thickening was reported in majority of the women with moderate pain (93.3%) (p=0.001). Cyst was felt on per-vaginum examination in 80% women with severe pain. The correlation of degree of ovarian adhesions (p=0.003) and type and degree of tubal adhesions (p=0.004) with degree of pain by VAS in endometriosis was significant. Conclusion: We found significant association between severity of pain and type of adhesions and between degree of tubal and ovarian adhesions and severity of pain. Operative pro

Investigation of the reproducibility and validity of a questionnaire on usual bowel movement patterns and stool characteristics compared to an evacuation diary

Objective Stool reflect our dietary and nutritional status as well as the characteristics of gut microbiota; thus, stool can be a convenient, noninvasive index for the evaluation of physical health and nutritional intake. However, there are few studies on appropriate tools for comprehensive and easy-to-perform objective assessments of stool. Therefore, there is a need for an effective questionnaire to accurately ascertain daily bowel movement patterns ("usual evacuation") and stool characteristics. Herein, we have created an assessment tool to determine stool characteristics (volume, color, form, etc.). To investigate the validity of this tool, we compared the results with evacuation diary data wherein the participants were asked to record the number of evacuations and stool characteristics.Methods This study included 35 adult men and women, aged 22-78 years (45.2±17.1years). A questionnaire was administered to the subjects on usual stool characteristics for the most recent month, including the average number of evacuations, stool volume per evacuation, stool color and form, stool float, and abdominal bloating. To confirm the reproducibility of each item of this questionnaire, the survey was performed twice. Thereafter, an evacuation diary was used, wherein the subjects recorded the daily number of evacuations and stool characteristics for one week. Using the evacuation diary as the valid criterion for the number of evacuations and stool characteristics, we compared responses between the diary and the usual stool questionnaire. Additionally, the questionnaire had two types of responses for the number of evacuations, namely, multiple choice for categories indicating the number of evacuations and open answers using numerical values.Results Assessment of the reproducibility of the questionnaire on usual stool by Spearman rank correlation coefficients showed a significant correlation (ρ=0.431-0.911) for all items. The weighted κ coefficient also showed high coincidence (weighted κ=0.348-0.841). Validity was assessed by comparing the number of evacuations per one-week period between the evacuation diary and the usual stool questionnaire. A higher correlation (ρ=0.855) was observed in the open responses for the number of evacuations per one-week period. Assessment of the correlations between median values for responses to stool characteristics in the one-week evacuation diary and the usual stool questionnaire showed significant correlation (ρ=0.429-0.800) for all items except for "stool float".Conclusion We confirmed the high reproducibility and validity of the questionnaire created in this study for the assessment of usual bowel movement patterns and stool characteristics.

A novel digital approach to describe real world outcomes among patients with constipation

Understanding day-to-day variations in symptoms and medication management can be important in describing patient centered outcomes for people with constipation. Patient Generated Health Data (PGHD) from digital devices is a potential solution, but its utility as a tool for describing experiences of people with frequent constipation is unknown. We conducted a virtual, 16-week prospective study of individuals with frequent constipation from an online wellness platform that connects mobile consumer digital devices including wearable monitors capable of passively collecting steps, sleep, and heart rate data. Participants wore a Fitbit monitoring device for the study duration and were administered daily and monthly surveys assessing constipation symptom severity and medication usage. A set of 38 predetermined day-level behavioral activity metrics were computed from minute-level data streams for steps, sleep and heart rate. Mixed effects regression models were used to compare activity metrics between constipation status (irregular or constipated vs. regular day), medication use (medication day vs. non-medication day) and the interaction of medication day with irregular or constipation days, as well as to model likelihood to treat with constipation medications based on daily self-reported symptom severity. Correction for multiple comparisons was performed with the Benjamini–Hochberg procedure for false discovery rate. This study analyzed 1540 enrolled participants with completed daily surveys (mean age 36.6 sd 10.0, 72.8% female, 88.8% Caucasian). Of those, 1293 completed all monthly surveys and 756 had sufficient Fitbit data density for analysis of activity metrics. At a daily-level, 22 of the 38 activity metrics were significantly associated with bowel movement or medication treatment patterns for constipation. Participants were measured to have fewer steps on irregular days compared to regular days (−200 steps, 95% CI [−280, −120]), longer periods of inactivity on constipated days (9.1 min, 95% CI [5.2, 12.9]), reduced total sleep time on irregular and constipated days (−2.4 min, 95% CI [−4.3, −0.4] and −4.0 min, 95% CI [−6.5, −1.4], respectively). Participants reported greater severity of symptoms for bloating, hard stool, difficulty passing, and painful bowel movements on irregular, constipation and medication days compared to regular days with no medication. Interaction analysis of medication days with irregular or constipation days observed small increases in severity compared to non-medication days. Participants were 4.3% (95% CI 3.2, 5.3) more likely to treat with medication on constipated days versus regular. No significant increase in likelihood was observed for irregular days. Daily likelihood to treat increased for each 1-point change in symptom severity of bloating (2.4%, 95% CI [2.0, 2.7]), inability to pass (2.2%, 95% CI [1.4, 3.0]) and incomplete bowel movements (1.3%, 95% CI [0.9, 1.7]). This is the first large scale virtual prospective study describing the association between passively collected PGHD and constipation symptoms and severity at a day-to-day granularity level. Constipation status, irregular or constipated, was associated with a number of activity metrics in steps and sleep, and likelihood to treat with medication increased with increasing severity for a number of constipation symptoms. Given the small magnitude of effect, further research is needed to understand the clinical relevance of these results. PGHD may be useful as a tool for describing real world patient centered experiences for people with constipation.

The Usefulness of the “Bowel Movement Pattern Classification Flowchart” in Clinical Settings

The Usefulness of the “Bowel Movement Pattern Classification Flowchart” in Clinical Settings

Evaluation of the Classification Accuracy of Bowel Movement Patterns Using a Flowchart : A Study Using Simulated Bowel Movement Records

Evaluation of the Classification Accuracy of Bowel Movement Patterns Using a Flowchart : A Study Using Simulated Bowel Movement Records

Fecal Calprotectin as a Marker of the Gut Immune System Activation Is Elevated in Parkinson's Disease.

IntroductionAlpha-synucleinopathy constituting a characteristic feature of Parkinson’s disease (PD) occurs at all levels of the brain-gut axis including the enteric nervous system (ENS). Lesions in the ENS may be connected with gut inflammation, increased intestinal permeability and dysmotility contributing to the pathogenesis of PD and its gastrointestinal manifestations.AimsTo evaluate fecal calprotectin and zonulin as biomarkers of gut inflammation and intestinal barrier dysfunction in PD patients.MethodsQuantitative evaluation of fecal biomarkers was performed by ELISA tests in 35 PD patients and 20 healthy controls. Additionally, patients filled out a short questionnaire concerning gastrointestinal symptoms.ResultsMedian fecal calprotectin level (μg/g) was significantly higher in PD patients compared to the controls: 54.5 (29.0–137.9) vs. 9.7 (5.2–23.3), p < 0.0001. Applying age-related reference ranges, the increased fecal calprotectin level was found in 43% of PD patients and in none of the control subjects (p < 0.001). No correlation between fecal calprotectin level and PD duration was observed. No statistically significant difference between the groups regarding zonulin level was found. The most frequent bowel symptoms reported by PD patients included constipation (69% of subjects), feeling of incomplete evacuation (51%), bloating (51%), abdominal pain (20%), and alternating bowel movement pattern (17%).ConclusionThe evaluation of fecal calprotectin level may be a useful tool to detect the signs of gut immune system activation present in a remarkable number of PD patients, also in the early stage of the disease. Calprotectin may constitute a critical link between amyloid formation and neuroinflammatory cascades serving as a prospective diagnostic and therapeutic target.

The Effects of Mixed Nut Consumption on Satiety, Anxiety, Postprandial Glucose, Insulin Response, and Bowel Movement Patterns in Healthy Adults (P06-008-19)

ObjectivesNuts are a rich source of nutrients, fiber, antioxidants and phytochemicals which may reduce the risk for chronic diseases. Many studies have examined the effects of individual types of nuts only. There is limited research investigating if the beneficial effects extend to the consumption of a nut mixture, which is how people more often choose to consume nuts. Therefore, the purpose of this study was to examine the effects of daily mixed nut consumption on satiety, postprandial glucose, insulin response, anxiety and bowel movement patterns in healthy young adults. MethodsSubjects (N = 20) were randomized into two groups either consuming 42 g (250 Kcal) of mixed nuts (n = 10, 9 females, 1 male, age 24.5 ± 1.2 y, BMI 24.8 ± 1.5 kg/m2) containing cashews, almonds, pecans, peanuts, walnuts, pistachios, brazil and macadamia nuts or 46 g of iso-Kcaloric lightly salted potato chips (n = 10, 8 females, 2 males, age 24.2 ± 1.0 y, BMI 23.3 ± 1.0 kg/m2) every day for three weeks. Measurements for blood pressure (BP) using an automatic BP monitor, waist to hip ratio, satiety using a visual analogue scale, anxiety using the State-Trait Anxiety Inventory Scale and bowel movement patterns using a 7-day bowel movement diary were taken at baseline and wk 3. Plasma glucose and insulin levels were measured at baseline, 45mins postprandial and at wk 3 and analyzed using an ultrasensitive insulin enzyme-linked immunosorbent assay. ResultsBoth types of snack consumption increased satiety while only mixed nut consumption improved postprandial glucose and insulin levels (P < 0.05). Body weight, BMI (body mass index), body fat, systolic and diastolic BP, waist and hip circumferences, waist to hip ratio, and anxiety were not significantly different among groups. Both the potato chip and mixed nut groups significantly reduced straining during bowel movements however only the mixed nut group significantly increased stool amount (P < 0.05). ConclusionsThe consumption of mixed nuts stabilized postprandial glucose and insulin responses and improved bowel movement patterns more than the potato chip group suggesting that the regular consumption of mixed nuts may reduce the risk for developing diabetes as well as improve gut health. Funding SourcesAmerican Heart Association (16GRNT31360007).

Implementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects.

Goals:The goal of this study was to evaluate the influence of defecation postural modification devices (DPMDs) on normal bowel patterns.Background:The introduction of DPMDs has brought increased awareness to bowel habits in western populations.Materials and Methods:A prospective crossover study of volunteers was performed that included real-time collection of data regarding bowel movements (BMs) for 4 weeks (first 2 wk without DPMD and subsequent 2 wk with DPMD). Primary outcomes of interest included BM duration, straining, and bowel emptiness with and without DPMD use.Results:In total, 52 participants (mean age, 29 y and 40.1% female) were recruited for this study. At baseline 15 subjects (28.8%) reported incomplete emptying, 23 subjects (44.2%) had increased straining, and 29 subjects (55.8%) noticed blood on their toilet paper in the past year. A total of 1119 BMs were recorded (735 without DPMD and 384 with DPMD). Utilizing the DPMD resulted in increased bowel emptiness (odds ratio, 3.64; 95% confidence interval (CI), 2.78-4.77) and reduced straining patterns (odds ratio, 0.23; 95% CI, 0.18-0.30). Moreover, without the DPMD, participants had an increase in BM duration (fold increase, 1.25; 95% CI, 1.17-1.33).Conclusions:DPMDs positively influenced BM duration, straining patterns, and complete evacuation of bowels in this study.

Small bowel lymphoma presenting as inguinal hernia: case report and literature review

BackgroundInguinal hernia is one of the most common benign pathologies that primarily affects men. Primary gastrointestinal non-Hodgkin’s lymphoma (PGI NHL) is the most common type of extranodal lymphoma. This study reports a rare case in which these two conditions co-exist.Case presentationAn 85-year-old male complained of bowel movement pattern change, abdominal distension and loss of weight, without vomiting but with nausea. A computed tomographic scan of the abdomen showed a small bowel obstruction caused by a migration of a small bowel loop in the right inguinal canal, with a clinically non-reducible inguinal hernia. The patient underwent surgery. The histopathological report showed small bowel large B cell non-Hodgkin’s lymphoma.ConclusionWhen the diagnosis of the contents of an inguinal hernia is not well-established, surgery should be performed as soon as possible to ensure the cure of the disease and the correct diagnosis of the contents.

Bowel Movement Patterns and Constipation Prevalence in School Children of South Jordan

Background: Pediatric constipation is a common problem worldwide. Diet is one of the major determinants of bowel movement patterns, including the presence of constipation. Little is known about bowel movement pattern in Jordanian children. Parents might not recognize constipation in school children, which could lead to delayed treatment and increase rate of complication. This study aimed to investigate bowel motion pattern and constipation prevalence in Jordanian children using self-reporting. Methods: Six schools in Alkarak governorate were selected randomly. Students of grades 6 - 8 were asked to fill the Arabic version of Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII) questionnaire. Children were diagnosed with constipation if two or more criteria on the QPGS-RIII were met. Fisher’s exact test was used to analyze categorical data, while Student’s t -test was used for continuous data. Results: Of 429 questionnaires administered, 413 (96.3%) were completed (males: 50.8%; mean age: 12.7 years old (range: 11 - 16 years old)). A statistically significant sex difference in the presence of hard, bulky bowel movements and fecal incontinence was observed (P = 0.000, 0.041 and 0.002, respectively). In our cohort, 110 (26.6%) children met Rome III criteria for constipation, which was not statistically significant by sex (59 (28.1%) versus 51 (25.1%), male versus female participants, respectively; P = 0.491). Conclusion: Most Jordanian school children reported a daily soft bowel movement without pain or retention. Constipation affects approximately 25% of Jordanian school children between 11 and 16 years old. Int J Clin Pediatr. 2018;7(4):47-50 doi: https://doi.org/10.14740/ijcp318

Effect of herbal extract granules combined with otilonium bromide on irritable bowel syndrome with diarrhoea: a study protocol for a randomised controlled trial

IntroductionIrritable bowel syndrome (IBS), known as a functional and organic gastrointestinal disorder, is a collection of symptoms that occur together and generally include pain or discomfort in the abdomen and...

Implementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects

Introduction: Straining is the aspect of defecation over which individuals have the largest control from an anatomic standpoint. The introduction of defecation postural modification devices (DPMDs) has brought increased awareness of defecation posture to Western populations (Figure 1). There have not been previous studies within the United States addressing this topic. Therefore, we conducted a study to assess the impact of DPMDs in this population.Figure: Improved bowel posture using the defecation postural modification device. Image Copyright: Squatty Potty LLC, (St. George, UT).Methods: A prospective study was conducted where resident physicians were voluntarily recruited to record bowel movements for 4 weeks (2 weeks without DPMD and 2 weeks with DPMD). Exclusion criteria included previous DMPD use, pregnancy, wheelchair bound, presence of ileostomy/colostomy, or history of small bowel resection >12 centimeters. SQUATTY POTTY, LLC (St. George, UT) provided the DMPDs but did not provide financial support nor were they otherwise involved in the trial. Primary outcomes of interest included average bowel movement duration, straining pattern scores, and bowel emptiness scores with and without DPMD usage, which were compared using paired t-test. Results: 52 participants (mean age 29 years and 40.1% female) were recruited for this study. At baseline 15 subjects (28.8%) reported incomplete emptying, 23 subjects (44.2%) had increased straining with defecation, and 29 subjects (55.8%) noticed blood on their toilet paper in the past year (Table 1). A total of 1119 bowel movements were recorded (735 without DPMD and 384 with DPMD), with numerical differences between cohorts due to subjects having limited access to DPMD during work hours. Our findings show reduced duration (4.24 vs. 5.60 min, P<0.001), reduced straining patterns (2.46 vs. 3.10, P<0.001), and increased bowel emptiness (2.19 vs. 1.80, P<0.001) for DMPD versus non-DMPD bowel movements (Table 2). Post-study survey indicated that 35 patients (67.3%) plan to continue to use their DPMD. Of note, incomplete emptying prior to DPMD intervention was a clinical predictor for long-term use of the device (multivariate OR 12.94, P=0.03).Table: Table. Patient CharacteristicsTable: Table. Results of paired t-test for primary outcomes with and without the defecation postural modification devicesConclusion: DMPDs positively influenced bowel movement duration, straining patterns, and complete evacuation of bowels in this study. Moreover, approximately two-thirds of participants plan to continue to utilize their DMPD after study completion. Future studies should focus on use of the device in pertinent clinical processes such as constipation or hemorrhoids.

Lower gastrointestinal tract: What are normal bowel movement patterns?

Lower gastrointestinal tract: What are normal bowel movement patterns?

Abdominal adhesions: A practical review of an often overlooked entity.

Formation of intra-abdominal adhesions is a common consequence of abdomino-pelvic surgery, radiation therapy, and inflammatory processes. In a small but clinically significant proportion of patients, adhesive disease may develop, wherein adhesions lead to a variety of chronic symptoms such as abdominal distension, pain, nausea, and abnormal bowel movement pattern which can be daily, intermittent, or episodic. Due to the chronic and troublesome nature of these symptoms, adhesive disease may be life-altering in many patients, particularly when not recognized and appropriately addressed, as is the case not infrequently. In addition, there is a paucity of literature regarding the evaluation and management of patients with suspected abdominal adhesive disease. Therefore, in this concise review, we provide a clinically practical synopsis of the etiopathogenesis, symptoms, differential diagnosis, evaluation, and treatment of abdominal adhesive disease.

Examination of the Observation Period Necessary for a Bowel Movement Pattern Classification

Examination of the Observation Period Necessary for a Bowel Movement Pattern Classification

Diverticular Disease Runs in Families

Diverticular disease is among the most common gastrointestinal disorders and results in substantial disability and enormous cost each year in the U.S. Its etiology is usually considered to be environmental, often attributed to diets that are low in fiber and, more recently, to bowel movement patterns. Now, investigators evaluate the possible etiologic contribution of heritability to diverticular disease. Using nationwide registries of patients and …

Robot Assisted Laparoscopic Low Anterior Resection for Transmural Colorectal Endometriosis

This video demonstrates a robot assisted laparoscopic low anterior resection with primary reanastamosis. The patient is a 36 year old with severe dysmennorhea, dyspareunia, fluctuating bowel movement-pattern with constipation and diarrhea, and rectal bleeding. A colonoscopy performed pre-operatively demonstrates a mucosal lesion within the rectum, with biopsy confirming endometriosis. Surgical evaluation demonstrates Stage 4 endometriosis with obliterated cul-de-sac and a 3 cm transmural endometriotic nodule.