Introduction: Abdominal symptoms are frequently encountered in clinical practice. Mostly patients seek medical attention after attempting various dietary modifications and sometimes even after self-medicating. These patients express dissatisfaction when they receive similar advice in their subsequent hospital visits. Studies suggests that a significant proportion of patients coming to hospital with abdominal symptoms would have already consulted a doctor and would be hoping for alternative treatment or advices in the current visit. Method and Methods: This was an observational cross-sectional study conducted in Vydehi Institute of Medical Sciences and Research Centre, Bangalore over a period of 6 months and was designed to examine the relationship between abdominal symptoms and their potential risk factors. 100 patients who reported abdominal symptoms that were outlined in the structured questionnaire were included in the study. Results: The study population consisted of 100 participants with a mean age of 37.48 years (SD = 12.12), ranging from 19 to 70 years. The prevalence of various abdominal symptoms among the study participants. 61 participants reported symptoms belonging to this category. The most common symptoms were heartburn (42%), water brash (21%), halitosis (20%), and belching (26%). 51 participants reported symptoms belonging to this category. The most frequently reported symptoms were a sense of incomplete evacuation of stools (39%) and straining during defecation (32%). Less common symptoms included mass per rectum (8%), blood in stool (6%), and mucus in stool (3%). Conclusions: The findings emphasize the need to identify specific risk factors associated with particular symptoms while interviewing patients. This will enable healthcare providers to tailor the interventions to address the unique needs of patients. Also, the methodology employed in this study can be extended to study symptoms and risk factors related to different medical conditions. For example, similar studies could be conducted with respiratory or cardiovascular symptoms utilizing statistical tests to find significant associations and co-occurrences of symptoms and risk factors. This can help us in developing models that can improve the overall management of patients in clinical settings
Abdominal symptoms are frequently encountered in clinical practice. Mostly patients seek medical attention after attempting various dietary modifications and sometimes even after self-medicating.1 These patients express dissatisfaction when they receive similar advice in their subsequent hospital visits. Studies suggests that a significant proportion of patients coming to hospital with abdominal symptoms would have already consulted a doctor and would be hoping for alternative treatment or advices in the current visit.2
This study aims to investigate the relationship between specific abdominal symptoms and their potential risk factors. The goal is to identify possible risk factors that may be contributing to a specific symptom. Understanding these relationships will be useful in improving patient management and outcomes.
This was an observational cross-sectional study conducted in Vydehi Institute of Medical Sciences and Research Centre, Bangalore over a period of 6 months and was designed to examine the relationship between abdominal symptoms and their potential risk factors. 100 patients who reported abdominal symptoms that were outlined in the structured questionnaire were included in the study.
The interview collected information on the presence or absence (Yes/No) of various abdominal symptoms that were categorized into four main groups:
Additionally, data on potential risk factors, such as dietary habits, lifestyle factors, stressors and medication use were collected using standardized questionnaires. The questionnaire was administered in both online and hard copy formats.
Statistical methods:
The data were analyzed using JASP version 0.18.3. Data
was organized using binary coding (1 for present, 0 for absent) for both symptoms and risk factors. Non-parametric Chi-square test with Standardized residuals and Logistic regression were used for performing statistical analysis and to assess the association between risk factors and symptoms. The analysis of the co-occurrence of abdominal symptoms and co-occurrence of risk factors were conducted using the Chi-square test and standardized residuals. Logistic regression analysis was employed to assess the relationship between each symptom and potential risk factors. Statistical significance was assumed with a p-value of < 0.05. Standardized residual values greater or lesser than ±1.96 were considered as significant contributors to the Chi-square test.
Symptom Profile
The study population consisted of 100 participants with a mean age of 37.48 years (SD = 12.12), ranging from 19 to 70 years. The prevalence of various abdominal symptoms among the study participants is presented in Table 1.
Table 1: Prevalence of abdominal symptoms
GERD or Acid reflux symptoms |
61 |
Acid peptic disease symptoms |
67 |
Bowel symptoms |
75 |
Anorectal disease symptoms |
51 |
Heartburn |
42 |
Feeling uncomfortably full after eating |
47 |
Bloating |
54 |
Incomplete evacuation of stools |
39 |
Water brash |
21 |
Abdominal pain |
40 |
Cramps |
31 |
Straining during defecation |
32 |
Belching |
26 |
Early satiety |
34 |
Flatulence |
28 |
Mass per rectum |
8 |
Halitosis |
20 |
Nausea |
22 |
Hard/dry stool |
23 |
Blood in stool |
6 |
Vomiting |
9 |
Mucus in stool |
3 |
||||
Dark/black stool |
9 |
GERD or Acid reflux symptoms:
61 participants reported symptoms belonging to this category. The most common symptoms were heartburn (42%), water brash (21%), halitosis (20%), and belching (26%).
Acid peptic disease symptoms:
67 participants reported symptoms belonging to this category. The most frequently reported symptoms were abdominal pain (40%), feeling uncomfortably full after eating (47%), and early satiety (34%) followed by nausea (22%), vomiting (9%), and dark/black stool (9%).
Bowel symptoms:
75 participants reported symptoms belonging to this category. Bloating (54%) was the most common symptom, followed by cramps (31%), flatulence (28%), and hard/dry stool (23%).
Anorectal disease symptoms:
51 participants reported symptoms belonging to this category. The most frequently reported symptoms were a sense of incomplete evacuation of stools (39%) and straining during defecation (32%). Less common symptoms included mass per rectum (8%), blood in stool (6%), and mucus in stool (3%).
The analysis of the co-occurrence of abdominal symptoms revealed the following significant associations among various symptoms and the findings have been summarized in Table 2.
Table 2: Symptom co-occurrence with p value and Standardized residuals
Symptoms |
Co-occur with |
P value, Standardized residuals |
Acid reflux symptoms |
Acid peptic disease symptoms |
<0.001, 3.545 |
Acid reflux symptoms |
Abdominal pain |
0.006, 2.762 |
Acid reflux symptoms |
Early satiety |
0.007, 2.709 |
Acid reflux symptoms |
Feeling uncomfortably full after food |
0.003, 3.011 |
Acid reflux symptoms |
Vomiting |
0.012, 2.515 |
Acid reflux symptoms |
Black/dark stool |
0.012, 2.515 |
Acid reflux symptoms |
Bloating |
0.013, 2.493 |
Acid reflux symptoms |
Sense of incomplete evacuation of stools |
0.029, 2.190 |
Heartburn |
Waterbrash |
<0.001, 3.572 |
Heartburn |
Acid peptic disease symptoms |
0.012, 2.525 |
Heartburn |
Early satiety |
<0.001, 3.73 |
Heartburn |
Feeling uncomfortably full after food |
<0.001, 3.353 |
Heartburn |
Black / dark stool |
0.023, 2.280 |
Heartburn |
Mass per rectum |
0.049, 1.972 |
Water brash |
Belching |
0.048 (1.981) |
Water brash |
Acid peptic disease symptoms |
0.040, 2.052 |
Water brash |
Abdominal pain |
0.021, 2.305 |
Water brash |
Early satiety |
0.002, 3.037 |
Water brash |
Feeling uncomfortably full after food |
0.012, 2.524 |
Water brash |
Nausea |
0.001, 3.189 |
Water brash |
Vomiting |
0.008, 2.668 |
Water brash |
Anorectal disease |
0.009, 2.598 |
Water brash |
Sense of incomplete evacuation of stools |
0.015, 2.421 |
Halitosis |
Belching |
0.006 (2.736) |
Halitosis |
Abdomen pain |
0.041, 2.041 |
Halitosis |
Dark/Black stool |
0.005, 2.795 |
Halitosis |
Sense of incomplete evacuation of stools |
0.001, 3.178 |
Belching |
Acid peptic disease symptoms |
0.007, 2.705 |
Belching |
Abdomen pain |
0.032, 2.141 |
Belching |
Vomiting |
<0.001, 3.712 |
Belching |
Dark/black stools |
<0.001, 3.712 |
Belching |
Bowel symptoms |
0.018, 2.369 |
Belching |
Bloating |
<0.001, 3.641 |
Belching |
Hard/dry stool
|
0.001, 3.261 |
Belching |
Anorectal disease |
0.031, 2.162 |
Belching |
Straining during defecation |
0.022, 2.287 |
Belching |
Sense of incomplete evacuation of stools |
0.023, 2.272 |
Acid peptic disease symptoms |
Cramps |
0.016, 2.405 |
Acid peptic disease symptoms |
Bloating
|
0.040, 2.057 |
Acid peptic disease symptoms |
Hard/dry stool |
0.020, 2.320 |
Abdominal pain |
Early satiety |
0.006, 2.758 |
Abdominal pain |
Nausea |
0.010, 2.562 |
Abdominal pain |
Dark/black stool- |
0.002, 3.138 |
Abdominal pain |
Bowel symptoms- |
<0.001, 3.300 |
Abdominal pain |
Cramps |
<0.001, 5.120 |
Abdominal pain |
Hard/dry stool- |
0.020, 2.328 |
Early satiety |
Feeling uncomfortably full after food |
<0.001, 7.622 |
Early satiety |
Nausea |
0.021, 2.303 |
Early satiety |
Dark/black stool |
0.030, 2.169 |
Early satiety |
Hard/dry stool |
0.036, 2.097 |
Feeling full after food |
Dark/black stool |
0.008, 2.639 |
Feeling full after food |
Bloating |
0.024, 2.259 |
Feeling full after food |
Hard/dry stool |
0.046, 1.995 |
Feeling full after food |
Straining during defecation |
0.033, 2.130 |
Nausea |
Vomiting |
<0.001, 5.922 |
Nausea |
Hard/dry stool |
0.024, 2.260 |
Vomiting |
Hard/dry stool |
0.015, 2.433 |
Dark or black stool |
Cramps |
0.001, 3.181 |
Dark or black stool |
Bloating |
0.028, 2.201 |
Dark or black stool |
Hard/dry stool |
0.015, 2.433 |
Dark or black stool |
Anorectal disease |
0.017, 2.384 |
Dark or black stool |
Straining during defecation |
0.019, 2.337 |
Dark or black stool |
Sense of incomplete evacuation of stool |
0.001, 3.217 |
Dark or black stool |
Mass per rectum |
0.003, 2.937 |
Bowel symptoms |
Straining during defecation |
0.013, 2.475 |
Bloating |
Flatulence |
0.029, 2.181 |
Bloating |
Straining during defecation |
0.042, 2.030 |
Bloating |
Sense of incomplete evacuation |
0.001, 3.266 |
Flatulence |
Anorectal disease |
0.035, 2.103 |
Flatulence |
Mass per rectum |
0.023, 2.266 |
Flatulence |
Blood in stool |
0.030, 2.176 |
Hard/dry stool |
Anorectal disease |
<0.001, 3.456 |
Hard/dry stool |
Straining during defecation |
<0.001, 4.911 |
Hard/dry stool |
Sense of incomplete evacuation of stool |
0.05, 1.963 |
Straining during defecation |
Sense of incomplete evacuation of stool |
<0.001, 4.624
|
Straining during defecation |
Mass per rectum |
0.007, 2.718 |
Sense of incomplete evacuation of stools |
Mass per rectum |
0.003, 2.932 |
Mass per rectum |
Blood in stool |
<0.001, 3.911 |
Blood in stool |
Mucus in stool- |
0.043, 2.024 |
Risk profile
The risk profile of participants in this study was assessed to identify lifestyle factors, dietary dietary habits, stress and medication use. The findings are summarized below in Table 3.
Table 3: Prevalence of risk factors
Dietary habits |
Number of participants |
Lifestyle factors |
Number of participants |
Stress and Medication Use |
Number of participants |
Irregular mealtimes |
64 |
Sleeping immediately after food |
45 |
Stress at home or workplace |
62 |
Eating spicy foods |
57 |
Inadequate sleep |
44 |
Stress at home |
49 |
Eating late at night |
54 |
Being overweight |
40 |
Stress at workplace |
35 |
Habit of skipping meals |
50 |
Decreased water intake (less than 1.5 liters per day) |
37 |
Use of over-the-counter painkillers
|
21 |
Eating high-fat foods |
47 |
Physical inactivity |
34 |
Using Aspirin
|
5 |
Eating too quickly |
46 |
Sleeping without pillows |
14 |
||
Eating sweets |
44 |
Exercising after food |
11 |
||
Eating large meals |
43 |
||||
Eating a diet low in fruits and vegetables |
41 |
||||
Excessive coffee or tea consumption |
36 |
||||
Carbonated drinks/soft drinks |
30 |
||||
Eating leftover food |
30 |
||||
Eating pickled foods |
26 |
||||
Excessive intake of meat |
24 |
||||
Eating very hot foods |
23 |
||||
Consuming alcohol |
16 |
||||
Smoking |
8 |
||||
Consuming peppermints |
5 |
The most common dietary risk factors were irregular mealtimes (64%), consumption of spicy foods (57%), and eating late at night (54%). The most common lifestyle factors were sleeping immediately after food (45%), inadequate sleep (44%), and high levels of stress (62% reporting stress either at home or workplace).
The analysis of the co-occurrence of the risk factors showed some significant associations between dietary, lifestyle, and psychosocial factors and are summarized in Table 4 with their respective significance levels.
Table 4: Risk factor co-occurrence with p value and Standardized residuals
Risk factors |
Co-occur with |
P value, Standardized residuals |
Eating high-fat foods |
Spicy foods |
<0.001, 3.727 |
Very hot food |
0.003, 2.947 |
|
Eating sweets |
0.032, 2.147 |
|
Eating pickled foods |
0.008, 2.640 |
|
Eating large meals |
0.006, 2.748 |
|
Eating too quickly |
0.010, 2.565 |
|
Eating late at night |
0.008, 2.661 |
|
Excessive intake of meat |
<0.001, 5.029 |
|
Irregular meal times |
<0.001, 3.723 |
|
Habit of skipping meals |
<0.001, 3.406 |
|
Carbonated drinks |
0.032, 2.142 |
|
Consuming alcohol |
0.003, 2.995 |
|
Smoking |
0.002, 3.131 |
|
Decreased water intake |
0.002, 3.158 |
|
Being over weight |
0.003, 2.945 |
|
Eating spicy foods |
Eating very hot foods |
0.019, 2.347 |
Eating pickled foods |
0.004, 2.846 |
|
Eating large meals- |
0.002, 3.056 |
|
Eating left over food |
0.031, 2.160 |
|
Habit of skipping meals |
0.026, 2.222 |
|
Decreased water intake |
0.013, 2.473 |
|
Physical inactivity |
0.049. 1.970 |
|
Sleeping immediately after food |
0.010, 2.578 |
|
Eating very hot food |
Eating sweets |
0.005, 2.815 |
Eating pickled food |
0.007, 2.720 |
|
Eating large meals |
0.049, 1.973 |
|
Eating too quickly |
0.035, 2.107 |
|
Excessive intake of meat |
0.013, 2.493 |
|
Eating very hot and irregular mealtimes |
0.034, 2.119 |
|
Eating a diet that is low in fruits and vegetables |
Eating too quickly |
0.036, 2.097 |
Carbonated drinks |
0.019, -2.352 |
|
Smoking |
0.041, 2.039 |
|
Vegetables and decreased water intake |
0.042, 2.034 |
|
Eating sweets |
Eating pickled food |
<0.001, 3.472 |
Eating large meals |
0.039, 2.067 |
|
Eating too quickly |
0.006, 2.732 |
|
Irregular mealtimes |
0.042, 2.031 |
|
Eating pickled foods |
Eating large meals |
0.026, 2.220 |
Carbonated drinks |
0.010, 2.587 |
|
Consuming alcohol |
0.017, 2.388 |
|
Sleeping immediately after food |
0.049, 1.971 |
|
Eating large meals |
Eating excessive meat |
0.027, 2.213 |
Habit of skipping meals |
0.002, 3.030 |
|
Consuming peppermints |
0.008, 2.641 |
|
Being over weight |
0.017, 2.391 |
|
Inadequate sleep |
0.013, 2.474 |
|
Stress at workplace |
0.036, 2.096 |
|
Eating leftover food |
Habit of skipping meals |
0.009, 2.619 |
Consuming alcohol |
0.012, 2.500 |
|
Inadequate sleep |
0.011, 2.550 |
|
Eating late at night |
Excessive intake of meat |
<0.001, 3.307 |
Irregular meal times |
<0.001, 3.528 |
|
Habit of skipping meals |
0.005, 2.809 |
|
Consuming alcohol |
0.017, 2.386 |
|
Smoking |
0.006, 2.722 |
|
Sleeping immediately after food |
0.022, 2.299 |
|
Stress at workplace |
0.032, 2.145 |
|
Excessive intake of meat |
Irregular mealtimes |
0.024, 2.263 |
Consuming alcohol |
0.044, 2.018 |
|
Smoking |
<0.001, 3.521 |
|
Decreased water intake |
0.013, 2.483 |
|
Irregular mealtimes |
Habit of skipping meals |
<0.001, 5.417 |
Consuming alcohol |
0.033, 2.137 |
|
Decreased water intake |
0.022, 2.296 |
|
Sleeping immediately after food |
0.029, 2.178 |
|
Stress at home or workplace |
0.022, 2.283 |
|
Stress at workplace |
<0.001, 3.320 |
|
Habit of skipping meals |
Decreased water intake |
0.007, 2.693 |
Being over weight |
0.041, 2.041 |
|
Inadequate sleep |
0.016, 2.417 |
|
Stress at home or workplace |
0.004, 2.884 |
|
Stress at workplace |
0.002, 3.145 |
|
Excessive coffee or tea |
Peppermints |
0.035, 2.103 |
Decreased water intake |
0.014, 2.451 |
|
Physical inactivity |
0.003, 2,973 |
|
Sleeping immediately after food |
0.004, 2.848 |
|
Consuming peppermint |
Smoking |
0.007, 2.706 |
Decreased water intake |
0.041, 2.043 |
|
Exercising after food |
0.033, 2.126 |
|
Consuming alcohol |
Smoking |
<0.001, 6.757 |
Over the counter pain killers |
- 0.015, 2.438 |
|
Smoking |
Over the counter pain killers |
0.036, 2.100 |
Decreased water intake |
Inadequate sleep |
0.005, 2,804 |
Sleeping immediately after food |
0.002, 3.060 |
|
Stress at workplace |
0.028, 2.193 |
|
Inadequate sleep |
Sleeping without pillows |
0.026, 2.229 |
Stress at home or workplace |
0.050, 1.959 |
|
Stress at home |
0.028, 2.192 |
|
Physical inactivity |
Sleeping immediately after food |
<0.001, 3.692 |
Sleeping without pillows |
0.010, 2.580 |
|
Exercising after food |
Over the counter pain killers |
0.035, 2.111 |
Sleeping without pillows |
Over the counter pain killers |
0.030, 2.165 |
Relationship between symptoms and risk factors
The analysis of the relationship between abdominal symptoms and associated risk factors was conducted using logistic regression analysis. This also revealed significant associations between various symptoms and dietary, lifestyle, and medication-related risk factors and the findings are summarized in Table 5.
Table 5: Risk factors significantly associated with symptoms with p values
Symptoms |
Associated risk factors |
P values |
Acid reflux symptoms |
Eating spicy foods |
0.006 |
Eating large meals |
0.034 |
|
Eating late at night |
0.020 |
|
Sleeping without pillows |
0.035 |
|
Use of over-the-counter painkillers |
0.003 |
|
Using medications like Aspirin |
0.047 |
|
Heartburn |
Eating spicy foods |
0.027 |
Use of over-the-counter painkillers |
0.002 |
|
Water brash |
Stress at Home or Workplace |
0.028 |
Use of over-the-counter painkillers |
0.020 |
|
Halitosis |
- |
|
Belching |
Consuming peppermint |
0.032 |
Acid peptic disease symptoms |
Eating spicy foods |
0.031 |
Eating pickled foods |
0.017 |
|
Eating large meals |
0.007 |
|
Eating too quickly |
0.036 |
|
Sleeping without pillows |
0.002 |
|
Stress at workplace |
0.030 |
|
Use of over-the-counter painkillers |
0.003 |
|
Using medications like Aspirin |
0.047 |
|
Abdominal pain |
Eating large meals |
0.003 |
Decreased water intake |
0.007 |
|
Physical inactivity |
0.034 |
|
Sleeping without pillows |
0.013 |
|
Early satiety |
Eating a diet that is low in fruits and vegetables |
0.014 |
Carbonated drinks / Soft drinks |
0.009 |
|
Exercising after food |
0.022 |
|
Stress at Home or Workplace |
0.006 |
|
Stress at workplace |
0.013 |
|
Use of over-the-counter painkillers |
0.036 |
|
Feeling full after food |
Eating too quickly |
0.012 |
Stress at Home or Workplace |
0.021 |
|
Stress at home |
0.046 |
|
Stress at workplace |
0.011 |
|
Nausea |
Eating spicy foods |
0.028 |
Excessive coffee or tea |
0.043 |
|
Sleeping immediately after food |
0.027 |
|
Sleeping without pillows |
0.011 |
|
Use of over-the-counter painkillers |
0.006 |
|
Vomiting |
- |
|
Dark or black stool |
- |
|
Bowel symptoms |
Stress at workplace |
0.033 |
Cramps |
Eating large meals |
0.050 |
Use of over-the-counter painkillers |
0.042 |
|
Bloating |
Eating large meals |
0.029 |
Flatulence |
Use of over-the-counter painkillers |
0.020 |
Hard/dry stool |
Eating sweets |
0.262 |
Eating too quickly |
0.036 |
|
Stress at workplace |
0.006 |
|
Anorectal disease symptoms |
- |
|
Straining during defecation |
Eating spicy foods |
0.043 |
Sense of incomplete evacuation of stools |
- |
|
Mass per rectum |
- |
|
Blood in stool |
- |
|
Mass per rectum and blood in stool |
- |
|
Mucus in stool |
- |
|
Prevalence and Co-occurrence of Symptoms and Risk Factors
The prevalence of specific abdominal symptoms and potential risk factors found in the study aligned with the existing literature on abdominal symptoms and their impact on quality of life.
GERD or Acid Reflux Symptoms
In the study, 61 participants reported symptoms belonging to this group, with heartburn being the most common (42%). This is consistent with a study that reports heartburn and regurgitation as the most common manifestations of GERD. The presence of water brash (21%) and halitosis (20%) in our study shows that symptoms associated with GERD are diverse and can also include atypical symptoms such as chronic cough and dental erosions.3
Risk Factors
The study identified several risk factors associated with acid reflux symptoms, including eating spicy foods (p = 0.006), consuming large meals (p = 0.034), and sleeping without pillows (p = 0.035). These findings are consistent with a study that reported that dietary habits like consumption of spicy and fatty foods, and large meal sizes can significantly increase the risk of acid reflux.4 The study showed that use of over-the-counter painkillers (p = 0.003) and medications like aspirin (p = 0.047) were strong risk factors and therefore these medications should be used judiciously in patients with high risk of developing abdominal symptoms. Reflux symptoms associated with nonsteroidal anti-inflammatory drugs (NSAIDs) could be due to irritation of gastric mucosa leading to increased acid secretion.3, 5
Heartburn and Water Brash
Heartburn was associated with consumption of spicy foods (p = 0.027) and the use of over-the-counter painkillers (p = 0.002). This aligns with findings from a study which reported that dietary factors and certain medications can trigger heartburn episodes. Water brash symptoms were associated with stress at home or the workplace (p = 0.028), indicating that stress can exacerbate GERD symptoms through increased gastric acid production as previously reported in other studies.5,6
Acid Peptic Disease Symptoms
The study showed that abdominal pain (40%) and a feeling of fullness after eating (47%) were common complaints in this category. These findings are supported by another study that has documented similar complaints in patients with acid-related disorders.7
Risk Factors
The study found that acid peptic disease symptoms were linked to dietary habits like eating spicy foods (p = 0.031) and pickled foods (p = 0.017). Studies in the past have highlighted that diet high in salt and preservatives contribute to gastric mucosal damage and increase the risk of peptic ulcer disease.5,8,9
Other Contributing Factors
Eating large meals (p = 0.007), eating too quickly (p = 0.036), sleeping without pillows (p = 0.002), stress at workplace (p = 0.030), use of over-the-counter painkillers (p = 0.003), and medications like Aspirin (p = 0.047) were also significant risk factors reflecting findings from previous study.5 Decreased water intake (p = 0.007) and physical inactivity (p = 0.034) were other risk factors for acid peptic disease related symptoms and are substantiated by the evidence that hydration and regular physical activity are crucial for maintaining gastrointestinal health.10,11
Bowel Symptoms
Among bowel symptoms, bloating (54%) was the most common symptom, followed by cramps (31%) and flatulence (28%). The high incidence of these symptoms in our study could be suggesting a potential overlap of bowel symptoms in patients with functional gastrointestinal disorders which are also commonly characterized by symptoms like bloating and discomfort.12
Risk Factors
Bowel symptoms were associated with stress (at workplace, p = 0.033), eating large meals (p = 0.050 for cramps and p = 0.029 for bloating), and the use of over-the-counter painkillers (p = 0.042 for cramps and p = 0.020 for flatulence). These findings are supported by studies that indicate that large meals can lead to discomfort and NSAIDs can disrupt gut motility and by exacerbating bowel symptoms.5,12
Anorectal Disease Symptoms
A sense of incomplete evacuation (39%) and straining during defecation (32%) were the most common anorectal disease symptoms found in the study.
Risk Factors
The study found that straining during defecation was strongly associated with eating spicy foods (p = 0.043). This is consistent with the evidence that dietary irritants can lead to bowel dysmotility and straining.13
Overall, the prevalence of gastrointestinal symptoms and associated risk factors reported in this study reflects the trends observed in the existing literature. The statistical approach used in the study provided a framework for identifying patterns of symptoms, risk factors and their relationship with each other. Certain risk factors found to co-occur in the study could be suggesting that these risk factors act synergistically resulting in the development of particular abdominal symptoms. Understanding such co-occurrences of symptoms and risk factors can guide clinicians in anticipating future symptoms and complications as well as help in planning for the required investigations. This can assist in efficient use of healthcare resources.
Limitation
Recall bias is inherent to the design of the study as it relies on the details reported by the patients.
The findings emphasize the need to identify specific risk factors associated with particular symptoms while interviewing patients. This will enable healthcare providers to tailor the interventions to address the unique needs of patients.
Also, the methodology employed in this study can be extended to study symptoms and risk factors related to different medical conditions. For example, similar studies could be conducted with respiratory or cardiovascular symptoms utilizing statistical tests to significant associations and co-occurrences of symptoms and risk factors. This can help us in developing models that can improve the overall find management of patients in clinical settings.