Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors

AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal(GI) organic diseases.METHODS: Participants were 4738(603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms(borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios(ORs) were estimated.RESULTS: In multivariate analysis, constipation [adjusted odds ratio(AOR) = 1.57, CI: 1.33-1.85, P < 0.01] and hard stools(AOR = 1.56, CI: 1.33-1.84, P < 0.01) were associated with diabetes, and fecal urgency(AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation(AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good(mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with Hb A1 c ≥ 8.0%(AOR = 2.11, CI: 1.19-3.73), b o d y m a s s i n d e x( B M I) < 2 5( A O R = 2. 1 1, C I : 1.22-3.66), and insulin use(AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration(AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI < 25(AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI < 25(AOR = 2.60, CI: 1.52-4.43), serum creatinine level(AOR = 1.27, CI: 1.10-1.47), and insulin use(AOR = 1.92, CI: 1.09-3.38).CONCLUSION: Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.