Relationship between Stool Form and Quality of Life in Patients with Chronic Constipation: An Internet Questionnaire Survey

Abstract

Introduction: Chronic constipation (CC) is a highly prevalent functional bowel disorder with low treatment satisfaction and impaired quality of life (QOL). However, physicians tend to emphasize only “stool frequency,” and relationship between “stool form” and QOL remains unclear. In this study, we aimed to investigate the actual situation of CC treatment in Japan and elucidate the relationship between stool form and QOL in patients with CC. Methods: We conducted an online questionnaire survey in September 2018 targeting Japanese adult patients already diagnosed with CC and taking prescribed drugs. Assessments included the type of drug treatment, treatment duration, frequency of drug use, frequency of bowel movements (BMs), Bristol Stool Form Scale (BSFS), and Japanese version of the Patient Assessment of Constipation QOL (PAC-QOL) scores. Relationship between BSFS and Japanese PAC-QOL scores was analyzed, and most important factor that influences QOL was investigated. Results: A total of 614 subjects were enrolled. Of these, 398 (64.8%) regularly used magnesium oxide and 162 (26.4%) used stimulant laxative, especially 81 (50.0%) used stimulant laxative “everyday.” Mean score of the PAC-QOL was 1.29 ± 0.74, and the lowest score (highest QOL) of 0.94 ± 0.61 was observed in BSFS type 4. Significant difference was seen between BSFS type 4 and all the other types except type 7. Multivariate analysis revealed that normal stool form (BSFS type 4) and BMs ≥3/week are strongly related to decreases of PAC-COL score. In BSFS types 6 and 7, 36% of individuals experienced self-discontinuation of prescribed drugs and 53% self-reduced drug intake because of excessive effects. Conclusions: Stool form and frequency of BMs are relevant to QOL, especially normal stool form (BSFS type 4) is important for improving the QOL in patients with constipation. Physicians should focus on “stool form” and reconsider the prescription especially in BSFS types 6–7 patients.

Prune intake ameliorates chronic constipation symptoms and causes little discomfort from diarrhea and loose stools: A randomized placebo-controlled trial

“…Ohkubo et al reported that the persistence of the percentage of BSFS score 4 correlated with the QOL as assessed by the PAC score. 24 In the present study, the percentage of score 4 increased significantly after 7 weeks of prune consumption compared to placebo. These facts suggest that the effect of prune intake on constipation should not be evaluated in a short period of time, but should be continued for at least nearly 2 months.…”

Internet Survey of Japanese Patients With Chronic Constipation: Focus on Correlations Between Sleep Quality, Symptom Severity, and Quality of Life

“…However, a recent publication reported that BSFS type 4 (normal stool form) is important for QOL improvement among patients suffering from constipation. 35 Thus, the clinical meaning of these results remains to be determined and should be further investigated. Nonetheless, we can infer that when patients with constipation are reporting sleep difficulties, it is key that clinicians manage their constipation symptoms, in order to improve sleep quality.…”

Real-World Comparison of Elobixibat and Lubiprostone Treatment in Patients with Chronic Constipation: A Propensity Score-Matched Analysis

“…Its value, though low, was approximately 4.3, which is closer to a sausage-shaped stool than the values in the L24 and L48 groups. Regarding stool form and QOL differences, patients with BSFS 4 had the best QOL [40]. In this study, the SCS of the E10 group may be more favorable for patient’s QOL because it was closer to BSFS 4 than the values in the L24 and L48 groups.…”