Bowel patterns, gastrointestinal symptoms and emotional well-being in adolescents: a cohort study

Background and Aims: Bowel patterns are varied in the general population. Gastrointestinal symptoms are common reasons for clinical visits. We aimed to examine the usual bowel pattern and the prevalence and significance of gastrointestinal symptoms in a population-based cohort of Australian adolescents.

Methods: Seventeen-year-old adolescents (n=1279) in the Western Australian Pregnancy Cohort (Raine) Study participated in a cross-sectional assessment, involving health questionnaires. Questions included medical history, diet, bowel patterns and gastrointestinal symptoms. Data were analysed to identify patterns of bowel motions, gastrointestinal symptoms, and factors associated with these in adolescents. Multivariate logistic regression analysis was used to determine predictors of poorer self-rated health status.

Results: The dominant pattern of bowel motions was passage of stool that was "not too hard and not too soft" (Bristol stool type 3 and 4) in 90%, and occurring between 3 and 7 times per week in 74%. The most prevalent gastrointestinal symptoms included abdominal bloating (72%), abdominal pain (36%), nausea (25%) and constipation (20%). A "Western" dietary pattern was associated with abdominal bloating, constipation and nausea (p<0.05). Apart from diarrhoea, gastrointestinal symptoms were more prevalent in females than males (p<0.05 for all). Female sex (OR 1.87, 95%CI 1.16-3.02, p=0.01), nausea (OR 3.18, 95% CI 2.03-4.98, p<0.001) and depression (OR 6.68, 95% CI 3.65-12.22, p=0.03) were independently associated with poorer self-rated health status, after adjusting for other gastrointestinal symptoms.

Conclusions: In adolescents, bowel patterns and gastrointestinal symptoms are diverse and show sex-differences. Nausea, depression and female sex are significant factors for poorer self-rated health.