Final Examination Stress and Bowel Symptoms

University students may experience increased psychological stress during final examination periods due to academic workload, performance expectations, and time pressure. Stress may influence gastrointestinal function through alterations in the brain-gut axis, autonomic nervous system activity, gastrointestinal motility, and visceral sensitivity. Examination periods may also be accompanied by changes in daily lifestyle behaviors, such as sleep duration, physical activity, and fluid intake, which may further influence bowel function.

This prospective, observational, analytical study is designed to evaluate bowel symptoms among university students during the final examination period. Participants will complete a sociodemographic and clinical information form and will be assessed for constipation-related symptoms using Rome IV-based questions. Additional bowel-related characteristics, including pain during defecation, pain intensity and location, urgency to defecate, and stool type, will be recorded.

Participants will also complete a 7-day follow-up diary during the final examination period. The diary will include daily records of defecation-related symptoms and stool characteristics as well as daily fluid intake, step count, and sleep duration. Daily step count and sleep duration will be considered potential lifestyle-related factors associated with bowel symptoms rather than primary outcomes.

The primary objective of the study is to investigate bowel symptoms during a period of final examination stress in university students. Secondary objectives are to examine the relationships between bowel symptoms and selected lifestyle-related factors, particularly sleep duration, physical activity, and fluid intake. No therapeutic, pharmacological, exercise-based, or invasive intervention will be administered as part of the study.

• Observational Assessment During the Final Examination Period (Other): Participants will complete assessments of bowel symptoms and a 7-day diary during the final examination period. The diary will include daily records of bowel-related symptoms, stool characteristics, fluid intake, step count, and sleep duration. No treatment, medication, exercise program, or other therapeutic intervention will be administered.

Primary outcomes

• Constipation-Related Bowel Symptoms [Baseline]: Constipation-related bowel symptoms will be assessed using Rome IV-based questions. The assessment (Rome IV criterias) will include defecation frequency, painful or difficult defecation, large-diameter stools, stool withholding behaviors, sensation of a large fecal mass in the rectum, fecal incontinence, and duration of symptoms.

Secondary outcomes

• Defecation-Related Pain [Daily for 7 consecutive days during the final examination period]: Participants will record the presence or absence of pain during defecation each day. When pain is present, its location (abdominal or anal region) and intensity will also be recorded. Pain intensity will be rated on a numerical scale ranging from 0 to 10, with higher scores indicating greater pain intensity.
• Defecation Urgency [Daily for 7 consecutive days during the final examination period]: Participants will record the severity of urgency to defecate each day as mild, moderate, or severe.
• Stool Type [Daily for 7 consecutive days during the final examination period]: Participants will record their daily stool type according to the stool form chart provided in the study diary.
• Daily Step Count [Daily for 7 consecutive days during the final examination period]: Daily step count will be recorded using data obtained from participants' personal smartphones, smartwatches, or other step-counting devices. The mean daily step count across the 7-day monitoring period will also be calculated and evaluated as a lifestyle-related factor potentially associated with bowel symptoms.
• Sleep Duration [Daily for 7 consecutive days during the final examination period]: Participants will record the total duration of sleep for each day in hours. The mean daily sleep duration across the 7-day monitoring period will be calculated and evaluated as a potential factor associated with bowel symptoms.
• Daily Water Intake [Daily for 7 consecutive days during the final examination period]: Participants will record their total daily water intake in milliliters. The mean daily water intake across the 7-day monitoring period will be calculated and examined in relation to bowel symptoms.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Being 18 years of age or older
* Being an undergraduate university student
* Being enrolled in courses with final examinations during the study period
* Being able to complete the study assessments and the 7-day follow-up diary during the final examination period
* Being able to read and understand Turkish
* Voluntarily agreeing to participate in the study and providing informed consent

Exclusion Criteria:

* Having a diagnosed organic gastrointestinal disease that may substantially affect bowel function, such as inflammatory bowel disease, celiac disease, or gastrointestinal malignancy
* Having a history of major gastrointestinal or pelvic surgery that may affect bowel function
* Regular use of medications that directly affect bowel motility, such as laxatives or antidiarrheal medications
* Having an acute gastrointestinal infection, including acute diarrhea or vomiting, during the assessment period
* Failing to adequately complete the study assessments or the 7-day follow-up diary