Self‐reported Diarrhea: What Does It Mean?

Objective: We aimed to determine perceptions of diarrhea in the general population. Methods: We obtained an age‐ and gender‐stratified random sample of Olmsted County, Minnesota, residents aged 20 to 64 yr. Subjects were mailed a valid self‐report questionnaire; 77% responded (n = 1644). Results: A total of 57 subjects reported their usual bowel pattern as diarrhea alone (3.5%), whereas an additional 148 reported alternating diarrhea and constipation (9.0%). Among subjects with self‐reported diarrhea, loose or watery stools and urgency were the commonest diarrheal symptoms, whereas in those with an alternating bowel habit a feeling of incomplete evacuation was the most common diarrheal symptom. Diarrheal symptoms inadequately discriminated self‐reported diarrhea from a self‐reported normal bowel habit in a logistic regression model adjusted for age, gender, and irritable bowel syndrome. Furthermore, only 39% of the subjects in the sample who had at least one of the four major symptoms compatible with diarrhea also reported their usual bowel habit as diarrhea. Conclusions: Because of the observed lack of agreement, we conclude that the term “diarrhea” should be interpreted very cautiously in epidemiological studies or clinical trials, as it is unlikely to accurately reflect symptoms of diarrhea.