Can unrecognized fecal loading without infrequent bowel movements be a cause of symptoms in a subset of patients with fu
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SHORT REPORT
Can unrecognized fecal loading without infrequent bowel movements be a cause of symptoms in a subset of patients with functional bowel disorders? Jin-Yong Kang 1,2
&
James Hong-En Kang 3 & Graham Munneke 4 & Jamal Hayat 1 & Kok Ann Gwee 5
Received: 15 April 2020 / Accepted: 27 May 2020 # Indian Society of Gastroenterology 2020
Abstract Infrequent bowel movements are a common feature of constipation, but fecal loading as a cause of symptoms in patients with regular bowel movements has not previously been evaluated. The aim of this preliminary study was to assess prospectively if fecal loading may be a cause of bowel symptoms in patients with regular bowel movements. Consecutive patients attending a gastroenterology clinic for functional bowel symptoms (FBD) not including infrequent bowel movements and who did not fulfil the criteria for constipationpredominant irritable bowel syndrome or functional constipation underwent plain abdominal radiography. Those with fecal loading received dietary advice and laxative treatment. The reproducibility of determination of fecal loading using the Leech score was assessed ‘blindly’ by a consultant radiologist. Twenty-six of 74 patients with FBD but not infrequent bowel movements had fecal loading demonstrated on abdominal radiology. Their Leech scores were significantly higher than those of control patients matched for age, sex and hospital (median 6 vs. 4, IQR 5–7 vs. 3.5–5, p < 0.001). Three out of 20 patients (15%) who returned for review after dietary advice and laxatives were asymptomatic and 17/20 (85%) had improved. Fecal loading may therefore cause bowel symptoms in patients who move their bowels regularly and dietary and laxative treatment may then improve these symptoms. This approach may prove costeffective as an empirical interim measure especially where healthcare resources are limited and where sophisticated imaging is not readily available. Keywords Bowel habit . Bristol stool forms . Functional constipation . Functional gastrointestinal disorders . Gut transit . Irritable bowel syndrome . Laxative . Leech score . Rome criteria
Introduction Infrequent stools, together with hard stools, the need for straining, manual maneuvers and sensations of incomplete evacuation and blockage are the main symptoms of constipation and, when associated with abdominal symptoms such as pain and discomfort, may fulfil the criteria for constipationpredominant irritable bowel syndrome (IBS) [1–3]. Infrequent bowel movements are perceived as important for diagnosing
* Jin-Yong Kang [email protected] 1
Department of Gastroenterology and Hepatology, St George’s Hospital, London, UK
2
Department of Gastroenterology, Queen Mary Hospital, Roehampton Lane, London SW15 5PN, UK
constipation by the general public, by patients and especially by general practitioners and gastroenterologists [4–6]. Overemphasis on infrequent bowel movements may however lead to a failure to recognize symptoms of constipation. This may in turn result in withholding of therapy, which can pot
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