Female bowel function: the real story.
OBJECTIVE
There has been minimal research done on normal female bowel habits. Because we do not know what is normal, this affects counseling of patients and research. The aim of this study was to conduct a survey of females with no bowel pathology to obtain a baseline of normal bowel function and examine any normal changes that occur during a woman's lifetime.


METHODS
Females accompanying patients to our hospital and clinic were invited to fill out an IRB-approved questionnaire after excluding those with current bowel pathology, depression, a stoma, or were wheelchair bound.


RESULTS
Four hundred twenty-five of 528 questionnaires of females who reported they had normal bowel habits were evaluated. The age range was from 18 to 80 years and comparison was according to age, race, and parity. Fifty-one percent had one bowel movement daily while 30 percent reported fewer. Overall, 15 percent reported constipation, which was higher in African-American females (26 percent) vs. Caucasian females (14 percent), P = 0.08. The average time for a bowel movement was 5-6 minutes, which was longer in African-American females (7.7 min) vs. Caucasian (5.0 min), P = 0.002. Younger females had changes in their bowel pattern reported as soft stool usually associated with their menstrual cycle; this was seen mostly in single females. Menopause did not affect bowels. Thirty-six percent of parous females reported occasional stool incontinence. Flatal incontinence was seen occasionally in over 50 percent of females, more frequently in those over 35 years old. Seventy-four percent of parous females reported incontinence to gas. One-third of females read on the toilet, with a majority doing so to relax or to be distracted and with African-American females reading more (54 percent) vs. Caucasian (32 percent), P = 0.004. Interestingly, Caucasian females read to conserve time (26 percent) vs. African-Americans (4 percent), P = 0.02. Fiber as a supplement was taken by only 8 percent. Foods affected bowel function in all age groups, while travel and exercise did not. Stress affected a change in 35 percent in the 18 to 50-year group.


CONCLUSIONS
There is a vast diversity in what is considered normal female bowel habits. One daily bowel movement is not the norm. Normal older females and those who have had children report more flatal incontinence. One-third experience some element of fecal incontinence. Foods most commonly caused a change in bowel pattern, followed by menstruation, stress, and childbirth. A vast majority do not take fiber as a supplement.
Zutshi
M
M
Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Hull
T L
TL
Bast
J
J
Hammel
J
J
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003248:Constipation / Q000453:epidemiology / Q000208:ethnology; D003672:Defecation / Q000502:physiology*; D004032:Diet; D005242:Fecal Incontinence / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D006801:Humans; D008598:Menstruation / Q000502:physiology; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011932:Reading; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires