PATIENT PRESENTATION MARKER

Low stool frequency

What this marker measures

Whether the patient reported typically passing a bowel motion less than 7 times per week.

Health categories/Interpretations informed by this marker

Gut function
‍● Slower colonic transit: patients with low stool frequency may have slower colonic transit.^1–3

‍Clinical features
‍● Lower GI symptoms: low stool frequency is a commonly-reported lower gastrointestinal symptom that can affect quality of life.
^‍

Interpreting the result

PRESENT

Questionnaire responses indicate typically passing a bowel motion less than 7 times per week (less than 3 times, or 3–6 times), without the use of laxatives, suppositories or enemas.

NOT PRESENT

Questionnaire responses indicate typically passing daily bowel motions.

Patient management insights

DIETARY STRATEGIES

Add kiwifruit: 2 green or 3 gold kiwifruit per day may increase stool frequency and soften stools in constipation and IBS-C.^4–6
GRADE C

Add ground flaxseed: ground flaxseed may increase defaecation frequency in functional constipation.^7,8
GRADE D

Add psyllium husk: psyllium husk may increase stool frequency, soften stool form, reduce straining severity, and increase complete spontaneous bowel movements in functional constipation.^9,10
GRADE D

SUPPLEMENTATION

Take L. reuteri (DSM 17938 strain): Lactobacillus reuteri DSM 17938 may improve stool frequency in individuals with functional constipation who are not reliant on laxatives.¹³
GRADE C
‍
Take peppermint oil: enteric-coated peppermint oil may improve abdominal pain, sensation of incomplete emptying, pain with evacuation, faecal urgency and help normalise stool frequency in IBS.^14–16
GRADE C
‍
Take PHGG: partially hydrolysed guar gum may improve bloating, stool frequency, stool form, straining, incomplete emptying sensation, abdominal pain and reliance on laxatives in patients with constipation, including those with slow transit.^18–20
GRADE D

Take oral sodium butyrate: oral sodium butyrate may improve low stool frequency in IBS.²¹
GRADE D

Tips for patients discussion

"Your questionnaire responses show that you usually open your bowels less than once a day. This can be a sign that things are moving a little slowly. Simple options like eating two kiwifruit a day or adding a fibre supplement can help, and we'll choose the one that best suits your situation."

Source references for all clinical associations, interpretation definitions, and patient management insights on this card.

1. Lewis, S. J. & Heaton, K. W. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32, 920–924 (1997).
2. Jaruvongvanich, V., Patcharatrakul, T. & Gonlachanvit, S. Prediction of delayed colonic transit using Bristol stool form and stool frequency in Eastern constipated patients: a difference from the West. J Neurogastroenterol Motil 23, 561–568 (2017).
3. Bohlin, J. et al. Longer colonic transit time is associated with laxative and drug use, lifestyle factors, and symptoms of constipation. Acta Radiol Open 7, 2058460118807232 (2018).
4. Gearry, R. et al. Consumption of 2 green kiwifruits daily improves constipation and abdominal comfort—results of an international multicenter randomized controlled trial. Am J Gastroenterol 118, 1058–1068 (2023).
5. Eady, S. L. et al. The effect of ‘Zesy002’ kiwifruit (Actinidia chinensis var. chinensis) on gut health function: a randomised cross-over clinical trial. J Nutr Sci 8, e18 (2019).
6. Chey, S. W., Chey, W. D., Jackson, K. & Eswaran, S. Exploratory comparative effectiveness trial of green kiwifruit, psyllium, or prunes in US patients with chronic constipation. Am J Gastroenterol 116, 1304–1312 (2021).
7. Sun, J. et al. Effects of flaxseed supplementation on functional constipation and quality of life in a Chinese population: a randomized trial. Asia Pac J Clin Nutr 29, 61–67 (2020).
8. Ma, J. et al. Influence of flax seeds on the gut microbiota of elderly patients with constipation. J Multidiscip Healthc 15, 2407–2418 (2022).
9. van der Schoot, A. et al. The effect of fiber supplementation on chronic constipation in adults: an updated systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 116, 953–969 (2022).
10. Erdogan, A. et al. Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation. Aliment Pharmacol Ther 44, 35–44 (2016).
11. Holtmann, G., Talley, N. J., Nandurkar, S. & Gibson, P. R. Randomized, placebo-controlled, double-blind 8-week trial on the efficacy of a proprietary kiwifruit extract on constipation-predominant irritable bowel syndrome. JGH Open 9, e70250 (2025).
12. Udani, J. K. & Bloom, D. W. Effects of Kivia powder on gut health in patients with occasional constipation: a randomized, double-blind, placebo-controlled study. Nutr J 12, 78 (2013).
13. Ojetti, V. et al. The effect of Lactobacillus reuteri supplementation in adults with chronic functional constipation: a randomized, double-blind, placebo-controlled trial. J Gastrointestin Liver Dis 23, 387–391 (2014).
14. Cappello, G. et al. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis 39, 530–536 (2007).
15. Liu, J.-H. et al. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 32, 765–768 (1997).
16. Cash, B. D., Epstein, M. S. & Shah, S. M. A novel delivery system of peppermint oil is an effective therapy for irritable bowel syndrome symptoms. Dig Dis Sci 61, 560–571 (2016).
17. Eskesen, D. et al. Effect of the probiotic strain Bifidobacterium animalis subsp. lactis, BB-12®, on defecation frequency in healthy subjects with low defecation frequency and abdominal discomfort: a randomised, double-blind, placebo-controlled, parallel-group trial. Br J Nutr 114, 1638–1646 (2015).