Impact of emotional stress on bowel habits and defecation disorders In children and adolescents

Abstract

INTRODUCTION: Emotional stress is known to affect gastrointestinal functions, but the role of day today stresses on bowei habits and defecation disorders has not been studied. OBJECTIVES: To evaluate the effect of family and school related stressful life events on bowel habits and defecation disorders in 10 - 16 year olds. METHODS AND MATERIALS: Children were randomly selected from 5 schools in 4 districts. Details regarding their bowel habits and exposure to stressful events, during previous two months, were collected using a validated, self administered, questionnaire. Constipation and faecal incontinence were diagnosed using Rome III criteria. RESULTS: Out of 2770 questionnaires distributed 2699 (97.4%) were included in the analysis. Of them 416 (15.4%) had constipation and 55 (2%) had faecal incontinence. Prevalence of constipation and faecal incontinence was high in those exposed to stressful life events. After multivariate analysis, stressful life events associated with constipation were separation from the best friend, failure in an examination, severe illness in a family member, loss of job by a parent, frequent punishment by parents and living in the eastern province affected by the war. Faecal incontinence was significantly higher in those being bullied at school and hospitalized for other illness. Even in healthy children bowei frequency <3/week, large volume stools, painful defecation, straining and withholding posture were more common in those exposed to stressful life, events (p<0.05). CONCLUSIONS: Modulation of gut motility through brain gut axis probably alters colonic transit and ano-rectal functions, causing alterations in bowel habits and defecation disorders in children.