Increased Bowel Frequency Research Articles

Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms

To investigate the effect of reducing dietary fiber on patients with idiopathic constipation. Sixty-three cases of idiopathic constipation presenting between May 2008 and May 2010 were enrolled into the study after colonoscopy excluded an organic cause of the constipation. Patients with previous colon surgery or a medical cause of their constipation were excluded. All patients were given an explanation on the role of fiber in the gastrointestinal tract. They were then asked to go on a no fiber diet for 2 wk. Thereafter, they were asked to reduce the amount of dietary fiber intake to a level that they found acceptable. Dietary fiber intake, symptoms of constipation, difficulty in evacuation of stools, anal bleeding, abdominal bloating or abdominal pain were recorded at 1 and 6 mo. The median age of the patients (16 male, 47 female) was 47 years (range, 20-80 years). At 6 mo, 41 patients remained on a no fiber diet, 16 on a reduced fiber diet, and 6 resumed their high fiber diet for religious or personal reasons. Patients who stopped or reduced dietary fiber had significant improvement in their symptoms while those who continued on a high fiber diet had no change. Of those who stopped fiber completely, the bowel frequency increased from one motion in 3.75 d (± 1.59 d) to one motion in 1.0 d (± 0.0 d) (P < 0.001); those with reduced fiber intake had increased bowel frequency from a mean of one motion per 4.19 d (± 2.09 d) to one motion per 1.9 d (± 1.21 d) on a reduced fiber diet (P < 0.001); those who remained on a high fiber diet continued to have a mean of one motion per 6.83 d (± 1.03 d) before and after consultation. For no fiber, reduced fiber and high fiber groups, respectively, symptoms of bloating were present in 0%, 31.3% and 100% (P < 0.001) and straining to pass stools occurred in 0%, 43.8% and 100% (P < 0.001). Idiopathic constipation and its associated symptoms can be effectively reduced by stopping or even lowering the intake of dietary fiber.

Relationship between endoscopic findings of the pouch and bowel frequency after restorative proctocolectomy in ulcerative colitis

Background and aim: Pouchitis is one of the late complications of restorative proctocolectomy in ulcerative colitis (UC) and is associated with increased bowel frequency. The present study aimed to clarify the endoscopic findings that are associated with bowel frequency. Patients and methods: The macroscopic and microscopic features in the ileum proximal to the pouch, the pouch, and the remnant short rectum in 100 endoscopies on 63 patients were studied retrospectively. Results: Four of 28 (14%) patients had inflammatory changes in the proximal ileum. Sixty-seven percent of patients showed an abnormal appearance of the pouch. Granularity, friability, presence of mucus, erythema, and erosions were significantly related to bowel frequency. ‘Endoscopic pouch activity index’ (EPAI), which is the number of positive findings of diffuse erythema, mucus, friability, ulcer, erosion, and granularity, was strongly associated with bowel frequency (P < 0.0001). Patients without macroscopic inflammation in the rectum had significantly lower bowel frequency than those with mild or moderately active inflammation (P = 0.0294 and 0.0183, respectively). Multivariate analysis revealed that ‘endoscopic pouch activity index’ and histological grade of pouch inflammation were significant factors (P = 0.0004 and P = 0.0429, respectively) influencing bowel frequency. Time–course study demonstrated that changes in EPAI and macroscopic grade of the rectum were significantly related to alteration in bowel frequency (P = 0.0120 and 0.0244, respectively). Conclusion: Erythema, mucus discharge and granularity were significantly related to bowel frequency. EPAI may be useful to evaluate endoscopic pouch inflammation.

The Relationship between the Val158Met Catechol-o-Methyltransferase (COMT) Polymorphism and Irritable Bowel Syndrome

BackgroundThe catechol-O-methyltransferase (COMT) enzyme has a key function in the degradation of catecholamines and a functional polymorphism is val158met. The val/val genotype results in a three to fourfold higher enzymatic activity compared with the met/met genotype, with the val/met genotype exhibiting intermediate activity. Since pain syndromes as well as anxiety and depression are associated to low and high COMT activity respectively and these conditions are all associated with irritable bowel syndrome (IBS) we wanted for the first time to explore the relationship between the polymorphism and IBS.Methodology/Principal Findings867 subjects (445 women) representative of the general population and 70 consecutively sampled patients with IBS (61 women) were genotyped for the val158met polymorphism and the IBS patients filled out the Hospital-Anxiety-and-Depression-Scale (HADS) questionnaire, and an IBS symptom diary.ResultsThere was a significantly higher occurrence of the val/val genotype in patients compared with controls (30% vs 20%; Chi2 (1) 3.98; p = 0.046) and a trend toward a lower occurrence of the val/met genotype in IBS patients compared with controls (39% vs 49%; Chi2 (1) 2.89; p = 0.089). Within the IBS patients the val/val carriers exhibited significantly increased bowel frequency (2.6 vs 1.8 stools per day; Chi2 (1) 5.3; p = 0.03) and a smaller proportion of stools with incomplete defecation (41% vs 68%; Chi2 (1) 4.3; p = 0.04) compared with the rest (val/met+met/met carriers). The val/val carriers also showed a trend for a smaller proportion of hard stools (0% vs 15%; Chi2 (1) 3.2; p = 0.08) and a higher frequency of postprandial defecation (26% vs 21%; Chi2 (1) 3.0; p = 0.08).Conclusions/SignificanceIn this study we found an association between the val/val genotype of the val158met COMT gene and IBS as well as to specific IBS related bowel pattern in IBS patients.

The effect of mosapride citrate on constipation in patients with diabetes

Objective Constipation is one of the most common gastrointestinal complications suspected to degrade the quality of life in diabetic patients. Mosapride citrate is a novel selective 5-HT4 receptor agonist, which enhances gastric emptying and motility in the upper gastrointestinal tract facilitating acetylcholine release from the enteric cholinergic neurons. Since the receptors of 5-HT4 have been recently found in the lower intestine including the rectum in humans, we tested if mosapride improves constipation in diabetic patients. Patients and methods Diabetic patients with constipation were treated with mosapride citrate (15 mg/day, n = 20) or domperidone (30 mg/day, n = 12) as controls for 8 weeks. Bowel frequency was monitored and gastrointestinal symptoms were evaluated by Gastrointestinal Symptoms Rating Scale (GSRS). Results Administration of mosapride resulted in increased bowel frequency after 4 and 8 weeks of administration, while no change was seen in the control group. Mosapride increased bowel frequency in even patients with diabetic polyneuropathy. Mosapride improved reflux and constipation evaluated by GSRS. As previously reported, glycemic control also improved by mosapride in these patients. Conclusions Administration of mosapride increased bowel frequency and ameliorated symptoms of reflux and constipation possibly stimulating the lower intestine. Given that mosapride has those beneficial aspects, it may be a useful prokinetic agent in treating diabetic patients with constipation.

Late Side Effects and Quality of Life After Radiotherapy for Rectal Cancer

There is little knowledge on long-term morbidity after radiotherapy (50 Gy) and total mesorectal excision for rectal cancer. Therefore, late effects on bowel, anorectal, and urinary function, and health-related quality of life (QoL), were studied in a national cohort (n = 535). All Norwegian patients who received pre- or postoperative (chemo-)radiotherapy for rectal cancer from 1993 to 2003 were identified. Patients treated with surgery alone served as controls. Patients were without recurrence or metastases. Bowel and urinary function was scored with the LENT SOMA scale and the St. Marks Score for fecal incontinence and QoL with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). Median time since surgery was 4.8 years. Radiation-treated (RT+) patients (n = 199) had increased bowel frequency compared with non-radiation-treated (RT-) patients (n = 336); 19% vs. 6% had more than eight daily bowel movements (p < 0.001). In patients without stoma, a higher proportion of RT+ (n = 69) compared with RT- patients (n = 240), were incontinent for liquid stools (49% vs. 15%, p < 0.001), needed a sanitary pad (52% vs. 13%, p < 0.001), and lacked the ability to defer defecation (44% vs. 16%, p < 0.001). Daily urinary incontinence occurred more frequently after radiotherapy (9% vs. 2%, p = 0.001). Radiation-treated patients had worse social function than RT- patients, and patients with fecal or urinary incontinence had impaired scores for global quality of life and social function (p < 0.001). Radiotherapy for rectal cancer is associated with considerable long-term effects on anorectal function, especially in terms of bowel frequency and fecal incontinence. RT+ patients have worse social function, and fecal incontinence has a negative impact on QoL.

A set of nomograms predicting acute gastrointestinal syndrome after prostate cancer conformal radiation

15555 Background: To predict acute toxicities (tox) of the gastrointestinal syndrome (SOMA LENT) in prostate cancer (PCa) patients (pts) undergoing 3D-CRT using a tool (nomogram) with clinical as well as dosimetric variables which has proved to be significant in the AIROPROS 01–02 trial. Methods: Acute rectal tox was scored in 1,132 pts using a 10 item self assessed questionnaire (QST) describing radio-induced GI symptoms profiles for bowel frequency, tenesmus, fecal continence, rectal pain and bleeding. The correlation between hormonal therapy (HT), drug prescription, diabetes or hypertension, pelvic node or seminal vesicles irradiation, mean rectal dose, DVH constraints and rectal tox was investigated by uni- and multivariate (MVA) logistic analyses. MVA results were used the R-project software to create nomograms predicting the symptoms of the acute GI syndrome. Results: 4/10 items of the QST are reported: moderate/severe bleeding, increased bowel frequency, moderate/severe bowel urgency and severe fecal incontinence. Bleeding is related to haemorrhoids (OR=1.9), HT (protective factor, OR=0.78) and mean rectal dose (continuous variable (cv), OR=1.024). Bowel frequency is related to seminal vesicles irradiation (OR=2.8) and V60 (cv, OR=1.024), while bowel urgency is correlated to seminal vesicles irradiation (OR=3.3) and mean rectal dose (cv, OR=1.027). Fecal incontinence depends on seminal vesicles irradiation (OR=4.6) and V70 (cv, OR=1.029). MVA results were used to create a set of nomograms. Conclusions: The combined effect of several independent, prognostically valuable variables for a specific disease can be expressed using nomograms. They can evaluate clinical and technical parameters of the single pt and offer clinicians a tailored probability of a specific outcome. To our best knowledge, this work presents the first set of nomograms available in the literature specific symptoms of the GI syndrome. The prediction capability of these tools will be validated on a independent set of patients. This work was partly supported by Fondazione I. Monzino, Milan No significant financial relationships to disclose.

Contribution of specialist nurses in managing patients with IBD

Inflammatory bowel disease (IBD) is a collective term for the medical conditions ulcerative colitis and Crohn's disease. Both are chronic relapsing remitting diseases with a major impact on a patient's quality of life. Symptoms of the diseases include increased bowel frequency, abdominal pain, rectal bleeding, urgency and incontinence, weight loss and reduced appetite. There is no known medical cure for either condition, and surgery often involves stoma formation and, therefore, has major implications for the patient in terms of management and body image.

Side effects of permanent I125 prostate seed implants in 667 patients treated in Leeds

Purpose To report the side effects and complications after I-125 seeds prostate implant after 8.5 years experience. Methods and materials Six hundred and sixty seven (667) patients were treated between March 1995 and December 2001. The median follow up is 31 months with a maximum of 98.2 months. Morbidity data were collected from a review of patient case-notes. Patients also provided prospective data on urinary symptoms using the International Prostate Symptom Score (IPSS) scoring chart before treatment and at regular follow up. Patients were also sent a questionnaire detailing symptoms and side effects following their brachytherapy. This enabled them to record urinary, bowel and sexual function side effects independently. Logistic regression analysis was carried out to identify the risk of catheterisation in relation to the pre-implant prostate volume and potential implant factors such as the number of seeds and needles and implant dose. Result The urinary symptom score rises in the first few months after implantation and returns to within one or two points of the pre-treatment score within one year. Nine patients reported incontinence prior to treatment and 15, 12 and 10 patients reported incontinence 6, 12 and 24 months after treatment, respectively. Catheterisation was reported in 97 (14.5%) patients. At six months 84.9% of patients reported no change in bowel function and 78.9% at 12 months. 6.4% of patients complained of some increased bowel frequency at 6 months and 5.7% at 12 months. 402 (77.2%) patients reported being fully potent before treatment and that this fell to 32.4% after treatment. Logistic regression showed that the most significant factors which correlate with the probability of catheterisation are the pre-treatment prostate volume and the number of seeds and needles implanted. Conclusion The side effects and complications after prostate brachytherapy as reported here and elsewhere confirm that the treatment is not only convenient but also has a low risk of serious long term side effects.

Sacral nerve stimulation induces pan‐colonic propagating pressure waves and increases defecation frequency in patients with slow‐transit constipation

Colonic propagating sequences are important for normal colonic transit and defecation. The frequency of these motor patterns is reduced in slow-transit constipation. Sacral nerve stimulation (SNS) is a useful treatment for fecal and urinary incontinence. A high proportion of these patients have also reported altered bowel function. The effects of SNS on colonic propagating sequences in constipation are unknown. Our aims were to evaluate the effect of SNS on colonic pressure patterns and evaluate its therapeutic potential in severe constipation. In eight patients with scintigraphically confirmed slow-transit constipation, a manometry catheter (16 recording sites at 7.5 cm intervals) was positioned colonoscopically and the tip fixed in the caecum. Temporary electrodes (Medtronic) were implanted in the S2 and S3 sacral nerve foramina under general anaesthesia. In the fasted state, 14 Hz stimulation was administered and four sets of parameters (pulse width 300 or 400 micros; S2 and S3) were tested in four 2-h epochs, in random order, over 2 days. Patients were then discharged home with the sacral wires in situ and a 3-week trial stimulation commenced during which patients completed a daily stool diary. When compared with basal activity, electrical stimulation to S3 significantly increased pan-colonic antegrade propagating sequence (PS) frequency (5.4 +/- 4.2 vs 11.3 +/- 6.6 PS/h; P=0.01). Stimulation at S2 significantly increased retrograde PSs (basal 2.6 +/- 1.8 vs SNS 5.6 +/- 4.8 PS/h; P=0.03). During the subsequent three-week trial (continuous stimulation), six of eight reported increased bowel frequency with a reduction in laxative usage. These data demonstrate that SNS induces pan-colonic propagating pressure waves and therefore shows promise as a potential therapy for severe refractory constipation.

B003 Electrical Stimulation of the S3 Sacral Root Increased the Frequency of Both Colonic High Amplitude Propagating Pressure Waves and Defaecation in Patients with Slow Transit Constipation

Objective Colonic high amplitude propagating sequences (HAPS) are important for colonic transit and defaecation. HAPS frequency is reduced in slow transit constipation (STC). Sacral nerve stimulation (SNS) can altered bowel function. The effects of SNS on colonic HAPS's in severe constipation are unknown. We aimed to determine, in patients with STC, whether SNS can: (1) induce colonic HAPS's, (2) improve symptoms.Method Eight patients with scintigraphically confirmed STC had a manometry catheter (16 recording sites at 7.5 cm intervals) positioned colonoscopically to the caecum. Temporary electrodes (Medtronic) were implanted in the S2 and S3 sacral nerve foramina. 14 Hz stimulation was administered and four sets of parameters (pulse width 300 or 400 μs; S2 and S3) were tested in 4 × 2 h epochs, in random order, over 2 days.Results When compared with basal, SNS to S3, significantly increased the frequency of pan‐colonic HAPSs (basal: 0.06 ± 0.09 HAPS/h vs. stimulation: 0.7 ± 0.6 PS/h, P = 0.04). During the subsequent 3 week trial (continuous stimulation), 6 of 8 reported increased bowel frequency and reduced laxative usage.Conclusion SNS induces HAPSs in the colon of patients with severe constipation, suggesting promise as a potential therapy for severe refractory constipation.Acknowledgement This study was supported by Medtronic Australia.

Calcium polycarbophil improves constipation in non-traumatic spinal cord disorders

Calcium polycarbophil shortened total colonic transit time (P < 0.05), increased bowel frequency and improved defecation difficulty in four patients with non-traumatic spinal cord disorders. Polycarbophil may be useful for the treatment of constipation.

Should high‐energy infant formula be given at full strength from its first day of usage?

To evaluate the feeding tolerance of a high-energy (1 kcal mL(-1)) infant formula (HEIF) for infants with faltering growth, weighing 2.5-8 kg, when administered at full strength from day 1 compared with stepwise introduction. Thirty infants (aged 2-43 weeks) from a supraregional children's hospital requiring a high-energy formula for faltering growth were randomly allocated to receive either a 1 kcal mL(-1) ready to feed infant formula at full strength from day 1 or the same formula in diluted form, graded to full strength over 3 days. Bowel actions, vomits and volume of feed taken were recorded daily for 2 weeks. Weight, length, head circumference and mid-upper arm circumference were recorded at recruitment and after 2 weeks. The number of bowel actions in the first 2 days was significantly higher for the full strength group than for the stepwise group (P = 0.02); younger infants (<12 weeks) had more bowel actions over the first 2 days on the HEIF at full strength (Spearman's correlation = -0.5; P = 0.04); and infants with a total higher energy intake (kJ kg(-1)) had more frequent bowel actions over the first 4 days (Spearman's correlation = 0.48; P = 0.01). There was no significant difference between groups for growth or vomiting. High-energy infant formula was generally well tolerated in infants under the age of 12 months with faltering growth when administered at full strength from day 1. However, younger infants (<12 weeks of age) may benefit from a graded introduction in order to avoid increased bowel frequency.

RELATIONSHIP BETWEEN ENDOSCOPIC FINDINGS OF THE POUCH AND BOWEL FREQUENCY AFTER RESTORATIVE PROCTOCOLECTOMY IN ULCERATIVE COLITIS

Background and aim: Pouchitis is one of the late complications of restorative proctocolectomy in ulcerative colitis (UC) and is associated with increased bowel frequency. The present study aimed to clarify the endoscopic findings that are associated with bowel frequency.Patients and methods: The macroscopic and microscopic features in the ileum proximal to the pouch, the pouch, and the remnant short rectum in 100 endoscopies on 63 patients were studied retrospectively.Results: Four of 28 (14%) patients had inflammatory changes in the proximal ileum. Sixty‐seven percent of patients showed an abnormal appearance of the pouch. Granularity, friability, presence of mucus, erythema, and erosions were significantly related to bowel frequency. ‘Endoscopic pouch activity index’ (EPAI), which is the number of positive findings of diffuse erythema, mucus, friability, ulcer, erosion, and granularity, was strongly associated with bowel frequency (P &lt; 0.0001). Patients without macroscopic inflammation in the rectum had significantly lower bowel frequency than those with mild or moderately active inflammation (P = 0.0294 and 0.0183, respectively). Multivariate analysis revealed that ‘endoscopic pouch activity index’ and histological grade of pouch inflammation were significant factors (P = 0.0004 and P = 0.0429, respectively) influencing bowel frequency. Time–course study demonstrated that changes in EPAI and macroscopic grade of the rectum were significantly related to alteration in bowel frequency (P = 0.0120 and 0.0244, respectively).Conclusion: Erythema, mucus discharge and granularity were significantly related to bowel frequency. EPAI may be useful to evaluate endoscopic pouch inflammation.

Long-Term Anorectal Dysfunction After Postoperative Radiotherapy for Rectal Cancer

Adjuvant radiotherapy in the treatment of rectal cancer has been shown to increase long-term morbidity causing severe anorectal dysfunction with physiologic changes whose interaction remains poorly understood. This study examines long-term anorectal morbidity from adjuvant postoperative radiotherapy. In a prospective study, patients with Dukes B or C rectal carcinoma were randomized to postoperative radiotherapy or no adjuvant treatment after anterior resection. The long-term effect of radiotherapy on anorectal function in a subset of surviving patients was assessed from a questionnaire on subjective symptoms and from physiology laboratory evaluation and flexible sigmoidoscopy. Twelve of 15 patients (80 percent) treated with radiotherapy had increased bowel frequency compared with 3 of the 13 patients (23 percent) who did not have radiation therapy (P = 0.003). The former group had loose or liquid stool more often (60 vs. 23 percent, P = 0.05), had fecal incontinence more often (60 vs. 8 percent, P = 0.004), and wore pad more often (47 vs. 0 percent, P = 0.004). They also experienced fecal urgency and were unable to differentiate stool from gas more often. Endoscopy revealed a pale and atrophied mucosa and telangiectasias in the irradiated patients. Anorectal physiology showed a reduced rectal capacity (146 vs. 215 ml, P = 0.03) and maximum squeeze pressure (59 vs. 93 cm H2O, P = 0.003) in the radiotherapy group. Impedance planimetry demonstrated a reduced rectal distensibility in these patients (P < 0.0001). Adjuvant postoperative radiotherapy after anterior resection causes severe long-term anorectal dysfunction, which is mainly the result of a weakened, less sensitive anal sphincter and an undistensible rectum with reduced capacity.

Case report: colonic manometry reveals abnormal propulsive behaviour after anterior resection of the rectum

Anterior resection of the rectum is a frequent surgical procedure. However, abnormal bowel habits following this procedure are frequently reported. The functional evaluation of these patients is usually limited to the anorectal area. By means of colonic manometry, we have evaluated a patient with frequent urge for defecation and increased bowel frequency following anterior resection of the rectum with straight coloanal anastomosis and almost normal anorectal function. Analysis of the tracing revealed a reduction of contractile segmental activity and much more high-amplitude propagated contractions than which occur in healthy subjects. These high-amplitude propagated contractions, representing the manometric equivalent of mass movements, were always in association with urge for defecation and, sometimes, with loose stools. High-amplitude simultaneous contractions were also observed. We feel that the surgical resection of a potential physiological brake may be responsible for these observations.

Manometric and clinical evaluation of patients after low anterior resection for rectal cancer

The aim of this study was to examine the anorectal physiological and clinical changes that occur after low anterior resection for rectal cancer. Since 1998, 30 patients underwent laboratory tests of anorectal function, preoperatively and 1 month and 6 months after low anterior resection. Postoperatively all patients presented with increased bowel frequency, 60% of the patients with mild soiling and 30% with urgency for defecation. Six months after surgery there was a significant improvement of these symptoms. The anal resting pressure was significantly decreased postoperatively, while maximum squeezing pressure remained unchanged. The rectoanal inhibitory reflex was absent in 80% of the patients and at 6 months after surgery it tended to recover. Rectal capacity and compliance were reduced in all patients. In the current study, the majority of patients demonstrated manometric anorectal changes and clinical anorectal function disorders during the first year after surgery. We observed that these disorders correlated with the low level of the anastomosis.

Bowel function after urinary diversion.

Removal of bowel segments for the purposes of urinary diversion may have a significant effect on bowel function. The remaining bowel may not be able to fulfill its normal role, resulting in not only malabsorption syndromes, but also dysfunctional defecation. Provided, however, care is taken in selecting patients and the bowel segments for such procedures and follow-up is vigilant, complications should be minimal. There appears to be a significant risk of developing symptoms of increased bowel frequency following urinary diversion and reconstruction. Patients need to be counselled regarding this prior to surgery, however, further data needs to be collected to accurately quantify the risk and the effect it has on quality of life.

Bowel Frequency in Critically III Children

BACKGROUND Bowel frequency in healthy children has been determined, but it is not well documented in critically ill children. The objectives of this prospective observational study were to determine if critical illness alters stool frequency in children and to identify risk factors that may increase or decrease stool frequency. METHODS Stool frequency was assessed in children admitted to the pediatric intensive care unit (PICU) over a five month period. The median daily number of bowel movements during admission to the PICU was compared to the patient's estimated number of bowel movements prior to illness. Stepwise linear regression was performed to determine which factors best predicted stool frequency in critically ill children. RESULTS Daily stool frequency was significantly reduced (P &amp;lt; 0.001) during PICU stay (median = 0.5; interquartile: 0, 0.8) compared to preadmission stool frequency estimates (median = 2; interquartile: 1, 2.5). Covariates associated with an increase in stool frequency included male gender and length of stay in the PICU. Conversely, the administration of opioids decreased stool frequency. CONCLUSIONS Bowel frequency was reduced by 75% in children admitted to the PICU. The use of opioids was associated with decreased bowel frequency. Male gender and increased PICU stay was associated with increased bowel frequency.

This month in Gastroenterology

This month in Gastroenterology

Increased stool frequency occurs when finely processed pea hull fiber is added to usual foods consumed by elderly residents in long-term care

Dietary fiber fortification of food offers a preventative strategy that is a less invasive alternative to laxatives and enemas in the management of constipation in elderly individuals. To determine if a moderate increase in fiber provided in foods would increase bowel movement frequency among elderly institutionalized residents, data were collected on the same elderly residents (n=114) before and during a 6-week intervention. The intervention consisted of adding finely processed pea hull fiber (1–3 g/serving) to 3 to 4 foods each day. Laxative and enema use was monitored. Mean number of bowel movements/month increased from 18.7±9.4 to 20.1±9.6 (n=114, P=.034), and in 17 residents with low baseline frequency, the increase was highly significant (8.8±1.0 to 12.6±3.8 bowel movements/month, P=.001). With treatment, prune-based laxative administration decreased ( P<.001). Thus, addition of a moderate amount of finely processed fiber to foods results in increased bowel frequency in institutionalized elderly individuals.