Defaecation disorders among information technology personnel: A cross-sectional study

INTRODUCTION

Lifestyle disorders are being increasingly reported all over the world. According to the WHO, 60% of factors related to individual health and quality of life correlate with lifestyle.¹ Variables that affect lifestyle include diet, exercise, sleep, sexual behaviour, substance abuse, study, recreation, medication abuse and misuse of technology. Many of these tenets of lifestyle affect bowel movements, especially among those working in the information technology (IT) industry, which has variable shifts of duty and high levels of stress of work.

Several Indian studies have highlighted the impact of lifestyle factors on defaecation disorders, mainly constipation.^2–5 In a questionnaire-based purposive sampling study on 1402 noncomplainant residents of Chennai city, we had reported normal stool form and pattern in an urban south Indian setting.⁶ However, it did not address the defaecatory problems in the select IT population, which we believe is likely to be distinct compared to the non-IT population. We, therefore, undertook a questionnaire-based study in a population working at the IT corridor of Chennai, to determine defaecation pattern and related problems in these individuals. Access to this population was feasible during health talks and talk shows organized by our institutions once a month on a fixed week day. The aim was to study the bowel movement pattern and factors associated with it in this cohort.

METHODS

This cross-sectional study was done between June and December 2018. The questionnaire was designed by three senior authors (MJ, MS and VJ) and included demographic information (age, sex, state of origin, duration of stay in Chennai and comorbid state), details pertaining to act of defaecation in the preceding 6 months that included type of toilet (Indian v. western closet), bowel frequency, characteristics of stools, history of urgency, faecal soiling, digitation, incomplete evacuation, bleeding, application of perianal pressure and straining, if any.

The questionnaire was circulated among 30 IT employees initially to pre-test for ease of comprehension and completion without help. After making few modifications based on the feedback, the final questionnaire was circulated among IT company employees during health talks or by email through their human resource departments. Participation was voluntary and unique identifiers such as name, email id or contact details were not mandatory. The survey questionnaire forms were screened for completion and responses were tabulated in Microsoft Excel (SKG, MJ). Of the 1000 questionnaires circulated, 956 (95.6%) were complete and included for analysis.

We included all IT employees between 18 and 60 years of age and excluded those who had stayed in Chennai for less than a year, were pregnant, unwilling to participate and those who did not complete the questionnaire. The study was approved by the Institutional Ethics Committee of Gleneagles Global Health City vide letter no. HR/2018/MS/014.

Based on the responses, the defaecatory pattern of the cohort was broadly classified as irritable bowel syndrome (IBS) and faecal evacuation disorder (FED) using the following criteria:

Irritable bowel syndrome. Abdominal pain relieved with passage of stool for most days in a week in the preceding 6 months (Rome IV criteria).⁷

Faecal evacuation disorder. Presence of at least two of the following symptoms: Bleeding/straining/sense of incomplete evacuation/use of pressure to facilitate defaecation/digitation.^8,9

The characteristics of the entire cohort were first compared by age, sex and then between the three bowel pattern groups (normal, IBS and dyssynergic defaecation [DD]) to determine any differences among them.

RESULTS

A total of 1000 questionnaires were circulated. Of these, 656 were circulated during health talks and 344 via email. The overall response rate was 95.6%. The response rate was much higher when questionnaires were circulated during health talks (650; 99%) compared to email (306; 89%).

DISCUSSION

Our study reports the prevalence of defaecation-related issues among IT employees, a population that is often under high work stress and has an erratic lifestyle. Over a quarter (27.6%) of the respondents had defaecation-related issues. Symptoms of FED and IBS were noted in 18.8% and 5.6% of respondents, respectively. FED was more common in women. Respondents >30 years of age more commonly complained of hard stools and FED. Comorbid states and lower stool frequency were noted in those with symptoms of IBS. Quality of life was affected universally in those with symptoms of IBS and FED.

We were surprised to note that about 58% of respondents used an Indian toilet, a physiologically tailored system for defaecation,¹⁰ despite urban living and economic betterment modifying their lifestyle including attire and dietary choices.

Our large non-complainant general population purposive sampling survey⁶ in the same city that included a third each of professionals, semi-professionals and non-office-goers reported daily bowel movement in 97%, Bristol stool form 1–4 in 88.4% and defaecation-associated abdominal pain in 8.5%. A significant sexual variation occurred in stool type with men passing hard and watery stools more often than women. There were no significant differences in stool pattern by occupation. Further, our previous study⁶ was not designed to probe the defaecatory behaviour in great detail, a limitation we have tried to address in the present study. However, to make the questionnaire easy to comprehend and answer for the study population, details of Bristol stool form were not recorded in the present study. The present study reports a higher prevalence of IBS-type symptoms in IT individuals and hardly any one reported loose stools.

The IT employees conformed to the almost universality of daily bowel movement in the general population of Chennai reported by us in the previous study⁶ and almost half opening their bowels more than twice in a day similar to reports from other parts of India.^3,11,12

The prevalence of constipation in the general population varies widely between various studies ranging from 2.4% in a rural northern Indian population¹² to 8.6% in urban Chandigarh,⁴ 11.6% from a northern Indian community¹³ and 24.8% in an elderly cohort from Bengaluru.¹⁴ Irrespective of this heterogeneity, our IT cohort had a much higher prevalence of hard stools (41%).

In a large pan-Indian multicentre study, comprising 4500 non-complaining individuals, 846 (18%) strained to pass stool and 1030 (23%) had incomplete stool evacuation.¹¹ These observations confirm that defaecation-related problems are common in the Indian population, and the prevalence seems higher among IT professionals. A small proportion (2.3%) of our respondents had faecal soiling and 14.8% reported urgency, which require further evaluation but were beyond the scope of our study.

More IT sector women had symptoms suggestive of FED. Factors such as slower transit, obstetric trauma, hard stool and over-reporting are possible reasons for this observation.^{3,4,8,15–18}

IBS was common in the age group of >30 years, with at least one comorbid condition in 42.8%. Defaecation-associated abdominal pain was less frequent, similar to other studies from India.^5,8,19–21 An overlap between dyssynergia and IBS has been previously reported, and we also had a small proportion (2.1%) with such an overlap.^22,23 We speculate that factors predisposing IT professionals to defaecation-related issues are sedentary lifestyle, work stress and inadequate fibre/fluid intake.