Factors associated with the frequency of stool examination: effect on incidence of reported rectal bleeding

Rectal bleeding is an important presenting symptom of colorectal cancer. The presentation and investigation of patients with rectal bleeding may be delayed if people do not regularly inspect their stool or toilet paper.

To determine how frequently stool or toilet paper is inspected, factors associated with the frequency of inspection, and whether this affects the reported prevalence of rectal bleeding.

A questionnaire on the frequency of stool inspection and the occurrence of various gastrointestinal symptoms and diseases was developed, validated and sent to 2149 subjects chosen from four general practice lists in south-west London.

There was a 79% response rate. Four hundred and forty-two of 1611 subjects (27%) examined both their stool and toilet paper every time. One hundred and two (6%) never examined either. Those who always examined their stool and toilet paper were more likely to report rectal bleeding compared to those who never examined either (23% vs 4%). They were also more likely to be male, to open their bowels more than three times per day, to have watery stools, to experience urgency, and have a history of piles.

Many people examine their stools and toilet paper infrequently. The possibility that this may contribute to delayed diagnosis of colorectal cancer deserves further evaluation.