Does the consistency of stools define a distinct patient cohort in young men presenting with severe lower urinary tract symptoms?

Introduction: Constipation has long been recognized to be associated with lower urinary tract symptoms (LUTS). However, there is little clinical data on bowel symptoms in young men who present with LUTS. This study analyses the association of stool consistency with severe LUTS in young men. Methods: This study is a secondary analysis of SciCOM 3 study examining young men presenting with LUTS. Stool consistency was recorded by the Bristol Stool Chart and classified into hard stools (Class 1, 2), normal stools (Class 3, 4), and loose stools (Class 5-7). LUTS, sexual dysfunction, bladder pain, non-bladder myofascial pain, perception of problems related to the bladder, and general well-being were captured by questionnaires along with basic clinical data. The poorest score on every question of each questionnaire was categorized as "severe". Results: Four hundred and forty-eight young men (18-40 years; median 30 years, interquartile range 25-35 years) were studied across 16 centers. Stool consistency was hard, normal, and loose in 105 (23.4%), 284 (63.4%), and 59 (13.2%), respectively. Constipation was not associated with severe LUTS. Loose stools showed an association with six of the 13 questions on the International Consultation on Incontinence Questionnaire for male LUTS. Erectile dysfunction, bladder and nonbladder pain, and general well-being were found to be associated with loose stools but not with constipation. On multinomial logistic regression analysis, recurrent urinary tract infection and low body mass index were associated with hard stools, while low maximum flow rate, severe erectile dysfunction, and severe myofascial pain were associated with loose stools. Conclusions: Loose stools are an important association in young men presenting with severe LUTS.