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Bowel Habits and Behaviors Related to Defecation in 10- to 16-year-olds: Impact of Socioeconomic Characteristics and Emotional Stress

Devanarayana, Niranga Manjuri*; Rajindrajith, Shaman

Journal of Pediatric Gastroenterology & Nutrition: May 2011 - Volume 52 - Issue 5 - p 569–573
doi: 10.1097/MPG.0b013e3181fd082b
Original Articles: Gastroenterology

Objectives: Bowel habits vary depending on food consumption and genetic factors. The knowledge regarding this physiological phenomenon is limited. Thorough understanding of normal bowel habits is essential for correct diagnosis of defecation disorders. This study evaluated the normal bowel habits of Sri Lankan children.

Patients and Methods: Children ages 10 to 16 years were randomly selected from 5 schools in 4 districts. Those without defecation disorders were recruited. Details regarding their bowel habits during previous 2 months were collected using a validated, self-administered questionnaire.

Results: A total of 2273 children were enrolled (mean age 13.2 years, SD 1.7 years, boys 49.7%). Of them, 1748 (76.9%) opened bowels once daily, whereas 149 (6.6%) and 11 (0.5%) had <3/week and >3/day defecations, respectively. Stool consistency was normal in 1997 (87.9%), hard in 86 (3.8%), and changing consistency in 163 (7.1%). Straining was present in 639 (28.1%), painful defecation in 241 (10.6%), and bleeding in 49 (2.2%). One hundred six (4.7%) children reported stool withholding. Bulky stool was present in 158 (7.0%). Straining, bulky stools, and withholding posture were more common in boys, whereas painful defecation and bleeding were reported more often in girls (P<0.05). Defecation frequency was lower in those from a poor socioeconomic background and war-affected areas (P < 0.05). Bowel frequency < 3/week, bulky stools, painful defecation, straining, and withholding posture were more common in those exposed to stressful life events (P < 0.05).

Conclusions: The present study provides data on normal bowel habits of Sri Lankan schoolchildren and provides a firm platform to evaluate defecation disorders in them.

*Department of Physiology, Sri Lanka

Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.

Received 5 February, 2010

Accepted 16 September, 2010

Address correspondence and reprint requests to Dr Niranga M. Devanarayana, Senior Lecturer in Physiology, Department of Physiology, Faculty of Medicine, Thalagolla Road, Ragama (e-mail:

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN