Stool frequency

Ask the patient about the absence or improvement in symptoms to determine whether laxative therapy is effective. Patients should have an increase in stool frequency to more than three well-formed stools per week. Patients should report the absence of prolonged defecation time or the absence of the need for excessive straining. 

Diarrhea is not a disease in itself but rather a symptom of some underlying problem. It is a condition marked by increased stool frequency (usually greater than 3 times daily), stool weight, liquidity, and decreased consistency of stools compared to a patient s usual pattern. Acute diarrhea is defined as diarrhea lasting for 14 days or less. Diarrhea lasting more than 30 days is called chronic diarrhea. Illness of 15 to 30 days is referred to as persistent diarrhea.1 2 3 4 5 6 7... 

Patients with diarrhea should be questioned about the onset of symptoms, recent travel, diet, source of water, and medication use. Other important considerations include duration and severity of the diarrhea along with an accounting of the presence of associated abdominal pain or vomiting, blood in the stool, stool consistency, stool appearance, stool frequency, and weight loss. Although most cases of diarrhea are self-limited, infants, children, elderly persons, and immunocompromised patients are at risk for increased morbidity. 

Antimotility agents should be expected to reduce stool frequency and control diarrhea. 

Monitor for increase in stool consistency and decrease in stool frequency. 

Alvisi et al. [21] 50% reduction in stool frequency by day 4 none 89% (16/18) of original isolates eradicated... 

Fiorentino et al. [22] 50% reduction in stool frequency between day 1 and 2 none 63% (7 Salmonella not eradicated despite clinical improvement)... 

Stornello and Slanitri [29] 50% reduction in stool frequency between day 3 and 4 in both treatment groups oral rifaximin therapy discontinued in 1 child due to vomiting 90%... 

Palermo et al. [30] 50% reduction in stool frequency by end of day 1 in both treatment groups self-limiting urticarial rash 100%... 

Standardized assessment tools have also been constructed for ulcerative colitis. Elements in these scales include (1) stool frequency (2) presence of blood in the stool (3) mucosal appearance (from endoscopy) and (4) physician s global assessment based on physical examination, endoscopy, and laboratory data. 

Figure 1 Effects of tegaserod in a constipation model in conscious dogs. Tegaserod normalizes stool frequency, stool quantity and softens stool consistency. Mean SEM (n — 8) p < 0.05 versus Vehicle ftp < 0.05 versus Morphine. From Weber et al., Gastroenterology (2003), 124 A1806 (Please see Color Plate Section in the back of this book).

Anti M, Pignataro G, Armuzzi A, Valenti A, Iascone E, Marmo R, Lamazza A, Pretaroli AR, Pace V, Leo F, Castelli A, Gasbar-rini G. Water supplementation enhances the effect of high fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Hepatogastroenterology 1998 45 727-732. 

The aims of antidiarrheal therapy are to prevent (1) dehydration and electrolyte depletion and (2) excessively high stool frequency. Different therapeutic approaches (in green) listed are variously suited for these purposes. 

Chronic, idiopathic constipation - Short-term trials have shown an acceleration of intestinal transit in healthy individuals and in those with chronic constipation. Improvement in stool frequency in patients with chronic constipation has been... 

There is a great deal of variability in bowel habits from person to person a normal stool frequency may vary from three stools per week up to three stools per day. Constipation is defined as the infrequent passage of stool. It may be secondary to sluggish colonic motility, in which soft stool is seen throughout the colon, or to difficulties with evacuation in which firm stool is seen primarily in the sigmoid and rectum. 

Laxatives are used to increase stool frequency and reduce stool viscosity. Even with long-term use, bulk laxatives and pure osmolar laxatives do not predispose patients to formation of a cathartic-type colon and should be the initial agents used for chronic constipation after a structural obstructing lesion has been excluded. Laxatives are also used before radiological, endoscopic, and abdominal surgical procedures such preparations quickly empty the colon of fecal material. Nonabsorbable hyperosmolar solutions or saline laxatives are used for this purpose. Classification and comparison of representative laxatives are provided in Table 40.1. 

Table 13.1 illustrates the decrease in stool frequency following phage therapy with an improvement observed in 50% of cases within 1-3 days 24.2% of cases showed a decrease in the frequency of stools within the first 24 hours of phage application. In 25.6% of cases there was no stool improvement observed or rehef of other disease symptoms, such as bleeding. Of 113 cases with blood in the stools, 28.3% showed relief of this symptom within the 24 hours of phage administration and a further 27.4% of patients showed an improvement within 2-3 days. Further... 

Table 13.1 Stool frequency and phage treatment (adapted from [34])...

Decrease in stool frequency following phage treatment ... 

For chronic abdominal pain, low doses of tricyclic antidepressants (eg, amitriptyline or desipramine, 10-50 mg/d) appear to be helpful (see Chapter 30). At these doses, these agents have no effect on mood but may alter central processing of visceral afferent information. The anticholinergic properties of these agents also may have effects on gastrointestinal motility and secretion, reducing stool frequency and liquidity. Finally, tricyclic antidepressants may alter receptors for enteric neurotransmitters such as serotonin, affecting visceral afferent sensation. 

Constipation is a complaint commonly seen in clinical practice. Because of the wide range of normal bowel habits, constipation is difficult to define precisely. Most persons have at least three bowel movements per week, and constipation has been commonly defined as a frequency of defecation of less than three times per week. However, stool frequency alone is not a sufficient criterion to use because many constipated patients describe a normal frequency of defecation but subjective complaints of excessive straining, hard stools, lower abdominal fullness, and a sense of incomplete evacuation. Thus, a combination of objective and subjective criteria must be used to define constipation. 

Tominaga, S., Hirayama, M., Adach, T., Tokunaga, T., and Lino, H., Effects of ingested fructooligosaccharides on stool frequency in healthy female volunteers a placebo controlled study, Biosci. Microflora, 18, 49-53, 1999. 

Date Handwriting specimen Body weight Stool frequency ... 

In a prospective, placebo-controUed study, tannin albuminate 500 mg plus ethacridine lactate 50 mg was given to 30 patients with Crohn s disease and chronic diarrhea for 5 days, followed by a 5-day break, and then a further 5 days treatment (2). Stool frequency was significantly reduced, albeit by only a small amount, with an improvement in the consistency of the stools. 

Alosetron (1 mg bd) was well tolerated and effective in alleviating abdominal pain, urgency, and stool frequency in a randomized, double-blind, placebo-controlled trial in 647 women with irritable bowel syndrome (26). Constipation occurred in 30% of patients taking alosetron and 3% of those taking placebo. Laboratory values, including liver function tests, were unchanged by alosetron. 

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