Defecation frequency and stool form in a coastal eastern Indian population

Abstract

Background/aims: Data on normal stool form and frequency, which are important for defining constipation, are scanty; hence, we studied these in an eastern Indian population.

Methods: One thousand and two hundred apparently healthy asymptomatic subjects were evaluated for predominant stool form (Bristol chart with descriptor) and frequency. Data on demographic and life-style (diet and physical activity) were collected.

Results: Of 1,200 subjects (age 42 ± 14.5 years, 711, 59% male), most passed predominantly Bristol type IV stool (699 [58.2%]; other forms were: type I (23 [1.9%]), type II (38 [3.2%]), type III (99 [8.2%]), type V (73 [6%]), type VI (177 [14.7%]), type VII (7 [0.6%]) and an irregular combination (84 [7%]). Weekly stool frequency was 12.1 ± 4.7 (median 14, range 2-42). Less than 3 stools/week was noted in 32/1,200 (2.6%). Female subjects (n = 489) passed stools less frequently than males (n = 711) (11.1 ± 5.6/week vs. 12.8 ± 3.8/week, P < 0.001) and tended to pass harder forms (type I: 17, type II: 20, type III: 39 vs. 6, 18 and 60, respectively, P = 0.061). Vegetarians (n = 252) and physically active (n = 379) subjects tended to pass stool more frequently than occasional (n = 553) and regular non-vegetarian (n = 395) (11.8 ± 4.5 and 12.8 ± 4.7 vs. 11.3 ± 4.7; P < 0.05) and sedentary (n = 464) and intermediately active (n = 357) subjects (13.4 ± 4.0 and 12.3 ± 4.5 vs. 10.9 ± 5.1, P = 0.080) in different age groups, respectively. Older age was associated with less frequent stool, particularly among female population. Female gender and age > 35 years were significant on multivariate analysis.

Conclusions: Median stool frequency in the studied population was 14/week (range 2-42) and predominant form was Bristol type IV. Older age was associated with lesser stool frequency, particularly among female subjects.

Keywords: Constipation; Functional gastrointestinal disorder; Gastrointestinal transit; Irritable bowel syndrome.

Figure 1

Map of India showing the study area.

Figure 2

Dot plot showing weekly stool frequency of 1,200 apparently healthy subjects from eastern India. The horizontal line represents mean value.

Figure 3

Aggregate plots showing. (A) Weekly stool frequency in relation to age of the study population (blue dotted line indicates the age at which stool frequency started reducing), (B) Weekly stool frequency with increasing age in relation to gender (blue dotted line indicates the age at which stool frequency started reducing), (C) Weekly stool frequency with increasing age in relation to diet and (D) Weekly stool frequency with increasing age in relation to physical activity.