Evaluating the role of the Bristol stool chart in diagnosing functional constipation in pediatric populations

Table 1 Rome IV criteria

Rome IV criteria for pediatric functional constipation
From infants to 4-year-old children
A child with FC must have 1 month of at least 2 of the following or 2 or fewer stooling a week and a history of
Excessive stool retention
Painful or hard stooling
Large-diameter stools
Large fecal mass in the rectum
In children trained in the toilet, additional points are added to the criteria
At least one episode per week of stool incontinence after being trained in toileting
History of large-diameter stools that may obstruct the toilet

Rome IV criteria; fifth edition; Rome foundation. FC: Functional constipation.

Table 2 Demographic data and family status, n (%)

Data	Functional constipation (n = 43)	Non-functional constipation (n = 232)	P valve
Age, month (mean ± SD)	30.1 ± 11.9	21.2 ± 12.2	< 0.001a
Male	19 (44.2)	102 (44.0)	1.000
Body weight, kg (mean ± SD)	12.8 ± 3.8	11.3 ± 3.2	0.009a
Single family	17 (39.6)	77 (33.2)	0.484
Main caregiver: Mother	30 (69.8)	153 (66.0)	0.507
Main caregiver educational level			0.248
Mandatory	14 (32.56)	95 (40.96)
Bechalor	26 (60.47)	108 (46.55)
> Bechalor	3 (6.98)	29 (12.50)
Family status			0.794
Together	38 (88.4)	207 (89.2)
Separated	5 (11.6)	25 (10.8)
Family income			0.186
Low income (< 30000 baht/month)	16 (37.2)	113 (48.7)
First-degree relative with a history of constipation	12 (27.9)	29 (12.5)	0.017a

^aP < 0.05.

Table 3 Results from the questionnaire on bowel habits in the Rome IV criteria, n (%)

Description	Total (n = 275)	Functional constipation (n = 43)	Non-functional constipation (n = 232)
Bristol stool chart	275 (100)
1-2 (hard)	25 (9.1)	21 (48.8)	4 (1.7)
3-5 (normal)	215 (78.2)	14 (32.6)	201 (86.6)
6-7 (loose/liquid)	35 (12.7)	8 (18.6)	27 (11.6)
Defecation frequency	275 (100)
< 3 × /week	7 (2.5)	5 (11.6)	2 (0.9)
3-6 × /week	75 (27.3)	24 (55.8)	51 (22)
Daily	118 (43)	10 (23.3)	108 (46.6)
2-3 × /day	71 (25.8)	4 (9.3)	67 (28.9)
> 3 × /day	4 (1.5)	0	4 (1.7)
Stool consistency	275 (100)
Hard	25 (9.1)	21 (48.8)	4 (1.7)
Normal	146 (53.1)	12 (27.9)	134 (57.8)
Soft	65 (23.6)	2 (4.7)	63 (27.2)
Mucous	4 (1.5)	0	4 (1.7)
Liquid	0	0	0
Alternating mucous and liquid	35 (12.7)	8 (18.6)	27 (11.6)
Painful defecation	266 (100)
Yes	45 (16.9)	32 (76.2)	13 (5.8)
No	221 (83)	10 (23.8)	211 (94.2)
Large diameter stool	275 (100)
Yes	35 (12.7)	30 (70)	5 (2.2)
No	240 (87.3)	13 (30.2)	227 (97.8)
Withholding behavior	263 (100)
Never	220 (83.7)	12 (32.4)	208 (92)
1-3 times/month	24 (9.1)	13 (35.1)	11 (4.9)
> 1 time/week	19 (7.2)	12 (32.4)	7 (3.1)
Fecal incontinence	91 (100)
Never	66 (72.5)	11 (50)	55 (79.7)
< 1 time/month	16 (17.6)	5 (22.7)	11 (16.0)
1-3 times/month	8 (8.8)	5 (22.7)	3 (4.4)
> 1 time/week	1 (1.1)	1 (4.6)	0
Stools obstruct the toilet	91 (100)
Yes	3 (3.3)	2 (9.1)	1 (6.5)
No	88 (96.7)	20 (90.9)	68 (98.6)

Table 4 Screening characteristics of the Bristol stool chart compared to Rome IV functional constipation

Parameter	Result	95%CI
Sensitivity (%)	48.8	33.3-64.5
Specificity (%)	98.3	95.6-99.5
Positive predictive value (%)	84	63.9-95.5
Negative predictive value (%)	91.2	87.0-94.4
Positive likelihood ratio	28.3	10.2-78.4
Negative likelihood ratio	0.5	0.4-0.7

CI: Confidence interval.