The Modified Bristol Stool Form Scale

AbstractStool consistency is evaluated mainly in reference to indirect indicators such as water content or the appearance of stool forms using Bristol Stool Form Scale (BSFS). Methods of measurement are limited. We thus aimed to develop a simple protocol for direct measurement of stool consistency using the TA.XTExpress Texture Analyser (Stable Micro Systems Ltd.). We developed a protocol which enables mechanical quantification of the gram-force against a cylindrical probe (ø 6 mm) pushed into the stool surface at 2.0 mm/s to 5 mm depth. The consistency of 252 stools collected from 40 healthy Belgians was evaluated by the direct method and by the indirect indicators (water content and BSFS) for comparison. The log-transformed stool consistency values measured by the texture analyzer had a negative linear correlation with the stool water contents (rrm = − 0.781) with homoscedastic variance, suggesting the appropriateness of the new protocol. They showed a similar correlation with the BSFS, but with a large variance in the consistency values of normal stool forms. This correlation was much smaller for BSFS scored by subjects (rrm = − 0.587) than by experts (rrm = − 0.789), collectively indicating BSFS as a rough indicator of stool consistency susceptible to subjective bias despite its effectiveness in clinical use. The optimized direct method using the texture analyzer enables the accurate quantification of stool consistency, which facilitates understanding of the intestinal environment and function and thus may enhance the value of the stool as a predictor of human health.

Download Full-text

The Effect of Exoskeletal-Assisted Walking on Spinal Cord Injury Bowel Function: Results from a Randomized Trial and Comparison to Other Physical Interventions

Journal of Clinical Medicine ◽

10.3390/jcm10050964 ◽

2021 ◽

Vol 10 (5) ◽

pp. 964

Author(s):

Peter H. Gorman ◽

Gail F. Forrest ◽

Pierre K. Asselin ◽

William Scott ◽

Stephen Kornfeld ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Bowel Function ◽

Bowel Dysfunction ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Cord Injury ◽

Patient Reported ◽

Stool Form ◽

Time Since Injury

Bowel function after spinal cord injury (SCI) is compromised because of a lack of voluntary control and reduction in bowel motility, often leading to incontinence and constipation not easily managed. Physical activity and upright posture may play a role in dealing with these issues. We performed a three-center, randomized, controlled, crossover clinical trial of exoskeletal-assisted walking (EAW) compared to usual activity (UA) in people with chronic SCI. As a secondary outcome measure, the effect of this intervention on bowel function was assessed using a 10-question bowel function survey, the Bristol Stool Form Scale (BSS) and the Spinal Cord Injury Quality of Life (SCI-QOL) Bowel Management Difficulties instrument. Fifty participants completed the study, with bowel data available for 49. The amount of time needed for the bowel program on average was reduced in 24% of the participants after EAW. A trend toward normalization of stool form was noted. There were no significant effects on patient-reported outcomes for bowel function for the SCI-QOL components, although the time since injury may have played a role. Subset analysis suggested that EAW produces a greater positive effect in men than women and may be more effective in motor-complete individuals with respect to stool consistency. EAW, along with other physical interventions previously investigated, may be able to play a previously underappreciated role in assisting with SCI-related bowel dysfunction.

Download Full-text

Irritable Bowel Syndrome with Constipation

10.2310/gastro.5444 ◽

2015 ◽

Author(s):

Loni Tang ◽

Brooks D. Cash

Keyword(s):

Irritable Bowel Syndrome ◽

Differential Diagnosis ◽

Abdominal Pain ◽

Digital Rectal Examination ◽

Recurrent Abdominal Pain ◽

Differential Diagnoses ◽

Rectal Examination ◽

Stool Form ◽

Alarm Features ◽

Irritable Bowel

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain or discomfort that has occurred at least 3 days per month in the 3 months prior to diagnosis. One of the subtypes of this disorder is IBS with constipation (IBS-C), where individuals experience hard or lumpy stools at least 25% of the time and loose or watery stools less than 25% of the time with defecation. This review addresses IBS-C, detailing the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis. A figure shows the Bristol stool form scale. Tables list IBS subtypes, components of digital rectal examination, differential diagnoses for IBS and IBS-C, alarm features, and the American College of Gastroenterology Recommendations. This review contains 1 highly rendered figure, 6 tables, and 71 references.

Download Full-text

MO515CONSTIPATION IN CHRONIC KIDNEY DISEASE: PREVALENCE AND RISK FACTORS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.0035 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Sourabh Sharma ◽

Neha Sharma ◽

Kailash Sharma

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Tertiary Care ◽

Functional Constipation ◽

Common Symptom ◽

Psychological Burden ◽

Ckd Stage ◽

Stool Form ◽

Rome Iv

Abstract Background and Aims Among various gastrointestinal disorders, constipation is one of the most common symptom in chronic kidney disease (CKD). However it is often neglected by nephrologists as self-limiting condition. Constipation impacts quality of life in multiple ways and increases socio-psychological burden. Constipation and associated risk factors have been poorly studied and most studies are retrospective. Method We enrolled CKD stage 3 to 5 patients on regular follow-up with nephrologist from June 2018 to June 2020, at a tertiary care centre in North India. Constipation was defined using Rome IV criteria (Functional constipation) which is composed of six constipation related symptoms, and diagnosis of constipation is established by presence of two or more symptoms for at least 3 months. Patients were also asked to maintain a 7 day prospective stool diary. It consisted of seven day written prospective chart of stool form and frequency. Patients were instructed to record when each bowel movement happened and to mark stool form type for each movement as described in words and pictures on Bristol Stool Form Scale (BSFS). Opioid induced constipation was defined as per Rome IV criteria. The diagnostic criteria is similar to functional constipation, but with requisite that new or worsening symptoms occurred when initiating, changing or increasing opioid therapy. Results Two hundred twenty five patients were studied out of which 59 (26.2%) patients were in CKD stage3, eighty one (36%) patients were in CKD stage4 and 85 (37.8%) patients were in stage5. Out of 85 CKD stage5 patients, 23 (27%) were on dialysis. Mean age of patients was 49.1 years. Out of 225 patients, 135 (60%) were male. Constipation symptoms and diagnosis reported in each stage has been depicted in Table 1. Clinical correlates of constipation has been depicted in Table 2. Conclusion Constipation measured using Rome IV criteria affects around two-third of CKD stage 3-5 patients. Diabetes, hypertension and opioid use has been found to be significantly associated with constipation.

Download Full-text

Laxative co-medication and changes in defecation patterns during opioid use

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155218801066 ◽

2018 ◽

Vol 25 (7) ◽

pp. 1613-1621

Author(s):

Frans de Bruin ◽

Karin Hek ◽

Jan van Lieshout ◽

Monique Verduijn ◽

Pim Langendijk ◽

...

Keyword(s):

Hospital Admissions ◽

Functional Gastrointestinal Disorders ◽

Community Pharmacists ◽

Opioid Use ◽

Chi Square ◽

Rome Iii ◽

Stool Form ◽

Waiting Strategy ◽

Watchful Waiting Strategy ◽

Opioid Users

Introduction Opioid-induced constipation is a clinically relevant side effect and a cause of potentially avoidable drug-related hospital admissions. Objectives To describe the presence of laxative co-medication, the reasons for not starting laxatives and to evaluate changes in stool patterns of opioid initiators. Methods In this observational study community pharmacists evaluated the availability of laxative co-medication in starting opioid users and registered reasons for non-use. Two opioid initiators per pharmacy were invited to complete questionnaires (‘Bristol stool form scale’ and ‘Rome III Diagnostic Questionnaire for the Adult Functional Gastrointestinal Disorders’) on their defecation prior to and during opioid use. Descriptive statistics and Chi square tests were used to analyse reasons for non-use of laxatives and changes in defecation patterns. Results Eighty-one pharmacists collected data from 460 opioid initiators. Of those, 344 (74.8%) used laxatives concomitantly. Main reason not to use laxatives was that either prescribers or patients did not consider them necessary. Sixty-seven (89.3%) of the 75 opioid starters with two questionnaires completed were not constipated at opioid start. Eleven of them (16%) developed constipation during opioid use (Chi square p=0.003). At follow-up within laxative users 10.6% were constipated compared to 20.7% in subjects without laxatives. Conclusion One in four opioid starters did not dispose of laxative co-medication, mainly because they were not considered necessary by either the prescriber or the patient. The prevalence of constipation doubled during opioid use. A watchful waiting strategy for the use of laxative co-medication might include a monitoring of defecation patterns with validated questionnaires.

Download Full-text

Effectiveness of probiotics for antipsychotic-induced functional bowel disorders: A single-center retrospective observational study

10.21203/rs.2.18286/v1 ◽

2019 ◽

Author(s):

Masaru Nakamura ◽

Takahiko Nagamine

Keyword(s):

Observational Study ◽

Bowel Movement ◽

Functional Constipation ◽

Antipsychotic Treatment ◽

Intestinal Function ◽

Single Center ◽

Functional Bowel Disorders ◽

Psychiatric Setting ◽

Stool Form ◽

Bowel Disorders

Abstract Background Probiotics have the potential to improve functional constipation, however, evidence is lacking regarding its recommendation related to gut microbiota. Constipation is highly prevalent and a serious side-effect in antipsychotic treatment. This study was to investigate the effects of probiotics supplementation on defecation in psychiatry.Methods Subjects consisted of 31 male and 37 female inpatients who were co-administrated either of two probiotics: BIO-THREE or BIOFERMIN tablets. The medications that affect bowel movement including gastrointestinal drugs and antipsychotics in addition to their levels of chlorpromazine equivalent (CPeq) doses were compared between the two groups. Intestinal function was evaluated at baseline and one and two months using Bristol stool form scale. Sequential change of the three indices: average, constipation and diarrhea levels were compared within the group and analyzed to see any significant correlation against the CPeq levels. Results There were no significant differences in the medical treatment between the groups. In both groups, the average and constipation levels increased, and the diarrhea levels decreased at two months from baseline; in particular, the constipation levels were significantly increased at two months from baseline in the BIO-THREE group (-9.6±1.0 vs -6.5±0.9, mean±se). In the BIO-THREE group, only the diarrhea levels were significantly negatively correlated with the CPeq levels at two months (r= -0.341), while no such correlations were found in the BIOFERMIN group.Conclusions Probiotics supplementation may improve stool consistency, especially severe constipation and ameliorate diarrhea depended on antipsychotic dosage in psychiatric setting.

Download Full-text