The perceived effect of various foods and beverages on stool consistency.

AIM: Some people believe that chocolate and other foods or beverages may cause constipation. This study was undertaken to quantify the effect of potentially constipating foods and beverages on apparently healthy and constipated populations of German individuals. METHODS: A questionnaire asking for the effect of certain foods and beverages on stool form (perceived consistency) was answered by 200 healthy controls, 122 patients with chronic constipation, and 766 patients with irritable bowel syndrome with constipation (IBS-C). RESULTS: Patients with constipation or IBS-C reported altered stool form after food and beverage consumption more often than controls (controls 42.5% vs constipation 52.0% vs IBS-C 57.0%, P < 0.001). Controls experienced hardening of stools less often and experienced softening more often than either constipation or IBS-C patients. When patients were asked which foods or beverages caused constipation (open ended question), chocolate was most frequently mentioned, followed by white bread and bananas. The results of systematic questioning yielded chocolate (48-64% of respondents), bananas (29-48%), and black tea (14-24%) as constipating, while prunes (41-52%), coffee (14-24%), wine (8-30%), beer (14-24%), and smoking (42-70% in those who smoked) were considered stool softeners. CONCLUSION: Several foodstuffs may exert an effect on stool consistency. Chocolate, bananas and black tea are perceived to cause constipation, while prunes are perceived to soften stools in many people. Coffee, wine and beer were perceived to soften stools in a minority of people. Cigarettes are perceived to soften stools by about half of the smokers.

Myths and misconceptions about chronic constipation.

There are many strongly held beliefs about constipation that are not evidence based. The purpose of this review is to address these beliefs concerning various aspects of constipation. There is no evidence to support the theory that diseases may arise via "autointoxication," whereby poisonous substances from stools within the colon are absorbed. Dolichocolon, defined as an elongated colon, should not be seen as a cause of constipation. The role of sex hormones altering gut function during the menstrual cycle appears to be minimal. During pregnancy they may play a role in slowing gut transit. Hypothyroidism can cause constipation, but among patients presenting with constipation, hypothyroidism is rare. A diet poor in fiber should not be assumed to be the cause of chronic constipation. Some patients may be helped by a fiber-rich diet but many patients with more severe constipation get worse symptoms when increasing dietary fiber intake. There is no evidence that constipation can successfully be treated by increasing fluid intake unless there is evidence of dehydration. In the elderly constipation may correlate with decreased physical activity, but many cofactors are likely to play a role. Intervention programs to increase physical activity as part of a broad rehabilitation program may help. It is unlikely that stimulant laxatives at recommended doses are harmful to the colon. A proportion of patients with chronic constipation is dependent of laxatives to achieve satisfactory bowel function, but this is not the result of prior laxative intake. Tolerance to stimulant laxatives is uncommon. There is no indication for the occurrence of "rebound constipation" after stopping laxative intake. While laxatives may be misused, there is no potential for addiction.

Quality of life and illness costs in irritable bowel syndrome.

Quality of life is reduced in patients with irritable bowel syndrome, and the costs for this disease are substantial to society. During a meeting in London, UK, the IBiS club reviewed the literature on these subjects. Drawbacks and advantages with existing instruments to assess quality of life and costs were discussed and the clinical and scientific relevance of the current knowledge was assessed. A summary from the meeting is presented in this paper.

Irritable bowel syndrome in Germany. A cost of illness study.

OBJECTIVES: When asked, between 10% and 15% of people in the Western world report symptoms compatible with irritable bowel syndrome, and around 5% seek medical advice for these complaints. This should incur considerable costs. The present study was designed to give a cost estimate for the treatment of patients with irritable bowel syndrome paid for by German statutory health insurance. METHODS: Fifty doctors working in private practice were randomly selected to each carry out personal interviews on four irritable bowel syndrome patients chosen from their own records (total 200 patients). Using a structured questionnaire, information regarding diagnostic procedures, drugs and other therapies, hospitalization and days off work were obtained from the case records. To calculate the total direct costs of the illness, all single cost elements such as physician services, medication and hospitalization were included. RESULTS: The number of office visits was nine per patient per year; nearly one-third of employed patients missed work for irritable bowel syndrome, and one out of 15 patients was hospitalized for this condition. Several technical procedures were ordered, mostly laboratory tests. Nearly all patients had at least one drug prescription for irritable bowel syndrome during the year of the survey, with a mean of 3.5 prescriptions per patient. The largest pharmacological groups were antispasmodics (29.2%) and prokinetics (8.9%). Total direct costs for one irritable bowel syndrome patient per year amounted to 1548 DEM (791.48 [OV0556]), comprising roughly 25% for physician visits and tests, 50% for drugs and 25% for hospitalization. Including indirect costs for sick leave, total costs were 1946 DEM (994.97 [OV0556]) per patient per year. CONCLUSIONS: The costs incurred by irritable bowel syndrome are considerable.