Test Anxiety on Bowel Health and Constipation in Students

Undergraduate students aged 18 years and older who are studying in the Department of Physiotherapy and Rehabilitation at Lokman Hekim University and who are in their final examination period. Participants will complete self-report questionnaires assessing test anxiety, bowel habits, stool form, constipation status, and constipation severity during a single face-to-face assessment session.

Participants completed assessment forms and diaries. No intervention was administered.

Constipation status will be assessed using the Rome IV criteria. This outcome will be reported as a binary classification: presence or absence of constipation. Participants will be classified as having constipation or not having constipation according to constipation-related symptoms, including reduced stool frequency, straining, hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, and need for manual maneuvers. The Rome IV criteria will not be reported as a scale score.

Constipation severity will be assessed using the Constipation Severity Instrument. The scale includes 16 items and evaluates constipation-related symptoms across three subdomains: obstructive defecation, colonic inertia, and pain. The total score ranges from 0 to 73, with higher scores indicating more severe constipation symptoms.

Stool form will be assessed using the Bristol Stool Scale. The Bristol Stool Scale is a 7-point stool form classification scale ranging from Type 1 to Type 7. Type 1 indicates separate hard lumps, and Type 7 indicates watery stool with no solid pieces. Higher scores do not indicate a better or worse outcome; lower scores generally indicate harder stool forms, while higher scores indicate looser stool forms. Participants will be asked to select the stool type that best represents their most common stool form during the last week.

Test anxiety level will be assessed using the Test Anxiety Inventory. The scale consists of 20 self-report items evaluating cognitive, emotional, and physiological symptoms of anxiety experienced before and during examinations. Total scores range from 20 to 80, with higher scores indicating higher test anxiety.

Bowel habits and bowel-related symptoms will be assessed using a researcher-developed evaluation form. The form includes questions about stool frequency, postponement of defecation, perceived bowel health, preferred toilet type, and symptoms such as abdominal pain, bloating, gas, diarrhea, nausea, vomiting, indigestion, and constipation during the last week.