Defecation symptoms in primary health care patients with irritable bowel syndrome

Scand J Gastroenterol. 2023 Aug 23:1-9. doi: 10.1080/00365521.2023.2248538.Online ahead of print.


Jenny Sjödahl 1Anna Ingemansson 1 2Tetyana Bureychak 2Anna-Karin Norlin 3Michael P Jones 4Åshild Faresjö 5Susanna Walter 1 6


Author information

1Department of Gastroenterology, University Hospital Linköping, County Council of Östergötland, Linköping, Sweden.

2Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden.

3Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden.

4School of Psychological Sciences, Macquarie University, North Ryde, NSW, Australia.

5Department of Health, Medicine and Caring Sciences (HMV), Division of Society and Health/Public Health, Linköping University, Linköping, Sweden.

6Department of Health, Medicine and Caring Sciences (HMV), Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden.


Background: The objectives of the present study were to (a) measure the prevalence of defecation symptoms in IBS, (b) investigate the relationship between stool consistency and defecation symptoms in IBS, and (c) investigate the association of defecation symptoms with health-related quality of life (HRQL) and self-reported stress in patients with IBS cared for in a primary health care setting.Methods: Ten primary health care centres joined the study. 282 patients with IBS as well as 372 non-IBS controls filled in gastrointestinal symptom diaries prospectively for two weeks as well as the Perceived Stress Scale-14 (PSS14) and the EuroQol barometer to measure perceived stress and HRQL, respectively.Results: Incomplete evacuation was present in 51% vs. 21% of the stools among the IBS patients and the non-IBS controls, respectively. The need to strain during defecation was existing in 41% vs. 33% of the stools for the IBS patients and the non-IBS controls, respectively. Urgency was experienced in 37% of the stools in the IBS patients compared with 18% of the stools in the non-IBS controls. Patients with IBS experienced in a significant higher degree of overlapping symptoms per stool (p < 0.001 to p = 0.007). The occurrence of all defecation symptoms in the same patient was related to decreased HRQL, and increased stress (p = 0.001 to p< 0.001).Conclusions: An overlap between IBS and symptoms from the anorectal region related to defecation was found in a primary health care population. Defecation symptoms are very common in primary care IBS-patients, it co-occurs with increased self-perceived stress, and decreased HRQL.

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