The call to stool and its relationship to constipation

Abstract

Objective To determine the characteristics of the call to stool and to test hypotheses linking constipation to the suppression of the call to stool. Design Cross-sectional survey of apparently healthy adults. Setting Establishments with an occupational health service in or near Bristol, UK. Subjects The study included 400 adults aged from 16–70 years (47% female). Interventions Completion of a questionnaire concerning bowel habit, features of constipation and the call to stool, i.e. timing, location, strength, suppression and time to re-appearance, and morning routine. Main outcome measures Associations between responses to questions concerning the call to stool and bowel habit, including forward stepwise logistic regression analysis. Results In most subjects, the call was described as a hard-to-resist rectal sensation, but it could also be abdominal and could be vague or uncertain. The report of uncertain calls to stool was strongly associated with constipation by three out of four definitions. The call was resisted by most of the subjects, at least occasionally and, in 27%, a resisted call disappeared for at least a few hours. Prolonged disappearance of the call was a feature of subjects with a habit of defecating less often than once daily. The commonest times for a call to be felt were immediately on rising and after breakfast, but it came at no particular time in some subjects. Such subjects tended to have an irregular bowel habit and considered themselves to be constipated and lacked any routine in the early morning. Conclusions The call to stool varies in strength, timing and suppressibility. Constipation is associated with calls which are uncertain, unpredictable and slow to re-appear, and with an irregular morning routine.