Simple diagnostic approach to childhood fecal retention using the Leech score and Bristol stool form scale in medical practice

Background and Aim: To assess fecal retention, plain abdominal radiography is frequently used to complement the clinical history and physical examination, and three scoring systems have been proposed by Barr, Blethyn, and Leech on a single abdominal radiography. The aim of the present study was to find simple and useful diagnostic tools for an approach to fecal retention by correlation of the three scoring systems with the clinical characteristics. Methods: This study included 76 children (5.6-15.4 years, male : female = 33:43) who presented with various gastrointestinal complaints and 20 healthy children from the years 2004-2008. Defecation characteristics, abdominal pain, anorexia and nausea, the Bristol stool form scale, and colonic transit time were studied. Plain abdominal radiographs were independently scored with the three scoring systems by a pediatrician and a radiologist. Results: The k-value of the Leech score (0.912) between two of the observers was higher than the others (Barr 0.870 and Blethyn 0.670), and the correlation coefficients of the Leech scoring system by a pediatrician in relation to the colonic transit time (r = 0.861, P < 0.001) and the Bristol stool form scale (r = -0.818, P < 0.001) were highest in the constipated children. Furthermore, there were statistically significant associations between the Leech scoring system and the defecation frequency per week (r = -0.569 and -0.625 in two observers) or abdominal pain (r = 0.574 and 0.567). Conclusions: The Leech score and the Bristol stool form scale may be simple and useful diagnostic tools for pediatricians to access childhood fecal loading in outpatient clinics along with a thorough clinical history.